COLLEAGUE COMMENTARY

Since the inception of superior mesenteric artery (SMA) angioplasty in 1980, several studies have presented the results of percutaneous transluminal angioplasty (PTA)/stenting in the treatment of chronic mesenteric ischemia with a periprocedural mortality rate of 0%-13%, and a complication rate of 0%-25%. However, most series have included only a small number of patients and have lacked objective assessment of treatment durability.

A few years ago, we reported the results of angioplasty/stenting of the SMA/celiac trunk in our institution (J. Endovasc. Ther. 2003; 10:1046-53). Twenty-two patients with 24 symptomatic SMA or celiac artery stenotic lesions were treated with PTA/stenting over a 4-year period. Clinical follow-up and duplex exams were used to evaluate long-term patency. The initial technical and clinical success rates were 96% and 95%, respectively, with no perioperative mortality or major morbidity. However, during a mean follow-up of 26 months, a range of 1-54 months, the primary late clinical success rate was 61%, and the freedom from restenosis (>70%) was 30%. The freedom from restenosis at 1, 2, and 3 years were 65%, 47%, and 39%, respectively. At that time, when we reviewed 185 patients (241 SMA/celiac lesions) treated with PTA/stenting, the mean technical success rate was 91%, with a mortality rate of 4.3%, and a complication rate of 16.4%. The early pain relief rate was 84%, with long-term pain relief of 71%, and a patency rate of 63% at a mean follow-up of 26 months.

As noted from our previous work, a previous meta-analysis by us, and the present article, the early results of PTA/stenting of the SMA/celiac are impressive and cannot be denied; however, the late restenosis rate is rather high and must be taken seriously, particularly for good surgical risk patients. These facts must be discussed with the patients, particularly in good surgical risk patients who present with chronic mesenteric ischemia, when selecting therapy for this disease entity