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Endovascular recanalization of total occlusions of the mesenteric and celiac arteries.

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

    Source

    Journal of vascular surgery 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