Abstract

OBJECTIVE
To evaluate our experience with the endovascular treatment of total occlusions of the mesenteric and celiac arteries.
METHODS
We performed a retrospective review of endovascular stenting of 27 nonembolic total occlusions of the superior mesenteric artery (SMA) and celiac artery (CA) between July 2004 and July 2011 (26 patients, 16 females; mean age, 62 ± 13 years). A variety of demographic, lesion-related and procedure-related variables were evaluated for potential impact of technical success and patency. The follow-up protocol included clinical assessment, and color and spectral Doppler evaluation of the stented vessel(s).
RESULTS
The clinical presentation was chronic mesenteric ischemia in 12 patients, acute mesenteric vascular syndromes in 10 patients, foregut ischemia/ischemic pancreatitis in three patients, and prior to endovascular repair of aortic aneurysm in one patient. The treated vessel was SMA in 22 procedures, CA in three, and both SMA and CA in one. Technical success was achieved in 23 of the 27 attempted recanalizations (85%). Three patients who failed the attempt underwent open bypass, and another one underwent retrograde recanalization and stenting of the SMA. Procedure success was only significantly related to patient age <70 years or procedure performance after the year 2006. Notably, the presence of a stump, ostial plaque, extensive vascular calcification, recanalization route (intraluminal vs subintimal), occlusion length, and vessel diameter had no significant impact on procedure success. Traditional duplex criteria proved unreliable in predicting restenosis. Life table analysis of freedom from symptom recurrence showed a primary and assisted rates of 58% and 80% at 1 year, and 33% and 60% at 2 years, respectively. Clinical recurrences developed in six patients (four presented with abdominal angina and weight loss, two presented with abdominal catastrophe). There were six access-related complications and no procedural deaths. Four delayed deaths occurred during follow-up (two cardiac causes, two due to abdominal sepsis).
CONCLUSIONS
Endovascular recanalization of mesenteric artery occlusion is both feasible and successful, provided careful planning is used.

Links

Publisher Full Text

Authors

Sharafuddin MJ, Nicholson RM, Kresowik TF, Amin PB, Hoballah JJ, Sharp WJ

Institution

Department of Surgery, The University of Iowa Roy and Lucille Carver College of Medicine, Iowa City, IA 52242, USA. mel-sharafuddin@uiowa.edu

Source

Journal of vascular surgery : official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter 55:6 2012 Jun pg 1674-81

MeSH

Aged
Arterial Occlusive Diseases
Celiac Artery
Chi-Square Distribution
Constriction, Pathologic
Endovascular Procedures
Feasibility Studies
Female
Humans
Iowa
Ischemia
Life Tables
Male
Mesenteric Arteries
Mesenteric Vascular Occlusion
Middle Aged
Proportional Hazards Models
Recurrence
Retrospective Studies
Risk Assessment
Risk Factors
Stents
Survival Analysis
Time Factors
Tomography, X-Ray Computed
Treatment Outcome
Ultrasonography, Doppler
Vascular Diseases
Vascular Patency

Pub Type(s)

Journal Article

Language

eng

PubMed ID

22516890