Endovascular Stenting for Atherosclerotic Chronic Mesenteric Ischemia: Technical and Midterm Outcomes

To evaluate technical outcomes, early symptom relief, midterm patency, and periprocedural safety after attempted endovascular superior mesenteric artery (SMA) revascularization for atherosclerotic chronic mesenteric ischemia (CMI).

This retrospective single-center study included adults who underwent attempted endovascular SMA revascularization between September 2020 and September 2025. After exclusion of vasculitis-associated mesenteric disease, 27 patients with atherosclerotic CMI formed the intention-to-treat cohort. Technical success was defined as residual stenosis <30% with antegrade flow. Pain burden was assessed using a 10-point VAS at baseline and 4 weeks. Stent patency was assessed by duplex ultrasound, with computed tomography angiography when indicated, and estimated using Kaplan-Meier analysis.

Technical success was achieved in 25 of 27 patients (92.6%), including 10 of 10 stenoses and 15 of 17 occlusions. Paired VAS data were available in 23 patients. Median VAS score decreased from 8 (IQR, 8-9.5) at baseline to 1 (IQR, 0-2) at 4 weeks (P < 0.001), with a Hodges-Lehmann median reduction of 7.5 points (95% CI, 6.5-8.0). Median follow-up was 16 months (IQR, 12-20). Kaplan-Meier estimated primary patency was 90.7% at 12 months. Assisted primary and secondary patency were 92.0% and 100%, respectively. No major mesenteric arterial complications, bowel resection, CMI-related death, or stent occlusion-related death occurred.

In patients with atherosclerotic CMI, attempted endovascular SMA revascularization achieved high technical success, substantial early symptom relief, and favorable midterm patency. VAS assessment may provide a quantitative patient-centered measure that complements imaging-based follow-up.