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Home > Vascular Annual Meeting > PP8. Percutaneous Angioplasty and Stenting as...

PP8. Percutaneous Angioplasty and Stenting as First-Choice Treatment in Patients with Chronic Mesenteric Ischemia

Bram Fioole1, Joost Meijer1, Sebastiaan van Koeverden1, Frans L. Moll2, Michiel van de Rest1, Josua C. van den Berg3, Jean-Paul P.M. de Vries1
1Antonius Hospital Nieuwegein, Nieuwegein, Netherlands; 2University Medical Center Utrecht, Utrecht, Netherlands; 3Ospedale Regionale di Lugano, Lugano, Switzerland

OBJECTIVES: Open revascularization in patients with chronic mesenteric ischemia (CMI) is considered the gold standard. Percutaneous angioplasty and stenting (PTAS) is often reserved for patients not suitable for open revascularization. In our institute, endovascular revascularization is the first-choice treatment. We evaluated mortality, morbidity and patency in a series of 54 consecutive patients with CMI.

METHODS: A retrospective review was performed of all consecutive patients treated for CMI from August 1994 to April 2008. Only symptomatic (>6 months) patients treated for atherosclerotic CMI were included. Patency was evaluated using CT-angiography. Kaplan-Meier curves were used to calculate patient survival rates and patency rates of the treated mesenteric arteries.

RESULTS: Sixty-five mesenteric arteries (32 celiac, 26 superior mesenteric and 7 inferior mesenteric arteries) were treated in 54 patients (27 men). In two patients a major complication was observed (following dissection of the superior mesenteric artery (n=1) and brachial artery (access site, n=1), respectively, they underwent endarterectomy and patch plasty of the dissected arteries). In 4 vessels the lesion could not be crossed endovascularly and they were deemed immediate intention-to-treat failures. No 30-day mortality was observed. Median follow-up was 25 months. During follow-up 2 patients died of intestinal ischemia and 13 of non-CMI related causes. Overall 1- and 2-year survival rates were 89% and 79%. Symptomatic relief or weight gain was achieved in 81% of patients. Primary 1- and 2-year patency rates were 85% and 67%, respectively; primary assisted patency rates were 90% and 87%, respectively. During follow-up 4 patients underwent open revascularization due to failure of PTAS (1 to 47 months after the initial PTAS).

CONCLUSIONS: The initial technical success rate of PTAS as first-choice treatment of CMI is >90%. The 2-years primary patency rates are reasonable, and in-stent stenoses can often be treated successfully with renewed endovascular techniques. Only few patients needed open revascularization during follow-up.

AUTHOR DISCLOSURES: B. Fioole, None; J. Meijer, None; S. van Koeverden, None; F.L. Moll, None; M. van de Rest, None; J.C. van den Berg, None; J.P.M. de Vries, None.