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Cited by 60Abdominal vascular conditions and treatmentsPeripheral Artery Disease ManagementRenal and Vascular Pathologies

Long-term outcomes of endoluminal therapy for chronic atherosclerotic occlusive mesenteric disease

Lee, Richard W., Bakken, Andrew M., Palchik, Eugene, Saad, Wael E., Davies, Mark G.·2008·Annals of Vascular Surgery
DOI 10.1016/j.avsg.2007.09.019
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Abstract

Percutaneous interventions for symptomatic chronic mesenteric arterial atherosclerosis are rapidly gaining popularity. This study evaluates the long-term anatomic and functional outcomes of endovascular therapy for chronic atherosclerotic occlusive mesenteric arterial disease at a tertiary referral academic medical center. A retrospective analysis of records from patients who underwent endovascular mesenteric arterial interventions between 1984 and 2006 for chronic mesenteric ischemia was performed. Cases of acute ischemia or cases with associated bowel resection were excluded. Results were standardized to current Society for Vascular Surgery (SVS) criteria. Kaplan-Meier survival analyses were performed to assess time-dependent outcomes. Factor analyses were performed using either a multivariate model for fixed variables or a Cox proportional hazard model for time-dependent variables. Data are presented as mean +/- SEM. Thirty-one patients (84% female, average age 70, range 43-90, years) with 41 visceral vessel interventions were identified. Indications for intervention included weight loss >10 kg (61%) and/or postprandial pain (94%). The median SVS comorbidity score was 15 (range 10-24). All had three-vessel athero-occlusive mesenteric disease with a median of two vessels occluded on angiography. The median number of vessels revascularized was two. In all cases stenosis, and not occlusion, was treated. The 90-day mortality was 20% and the major morbidity was 6%. While primary and assisted patency rates for the interventions at 7 years were 69 +/- 8% and 72 +/- 9%, respectively (mean +/- SE, n > or = 10), cumulative freedom from recurrent symptoms was only 56 +/- 10%. Twenty percent of the vessels developed restenosis at a median interval of 0.29 years (range 0.3-2.8), with a freedom from restenosis of 79 +/- 8% at 5 years. Fifty percent of these, all with recurrent symptoms, were reintervened successfully with balloon angioplasty and resolution of their symptoms. There was no significant difference between the celiac and superior mesenteric artery outcomes. The correlation of recurrent symptoms and restenosis was significant (p < 0.001). Endoluminal therapy for chronic mesenteric ischemia carries a low morbidity and mortality in a high-risk population. While anatomic patency remains high, long-term therapeutic benefit is not achieved. In its present iteration, endovascular therapy for mesenteric ischemia should be limited to those patients without an open surgical option.

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  • Smaller CMI PTA/S series have reported mortality sometimes similar to and sometimes lower than surgery.

    “There has been an increasing number of small reports of the use of angioplasty with or without stenting (PTA/S) for treatment of CMI with mortality rates similar to surgery in some reports and lower than surgery in others.12–17”

    From Mesenteric revascularization: management and outcomes in the United States, 1988-2006 (2009) · cites this paper as [16]

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Authors
Lee, R. W., Bakken, A. M., Palchik, E., Saad, W. E., & Davies, M. G.
Affiliations
University of Rochester Medicine (US)
Corresponding author
Davies, Mark G.
ORCID
Davies, Mark G.
Venue
Annals of Vascular Surgery
Publisher
Elsevier BV
Published
2008-07
Volume
22
Issue
4
Pages
541-546
ISSN
0890-5096 (ISSN-L)
DOI
10.1016/j.avsg.2007.09.019
OpenAlex
W2084627681
Cited by
60
References
29
Citations by year
2026: 1 · 2025: 1 · 2024: 1 · 2023: 1 · 2021: 3 · 2020: 3 · 2018: 2 · 2016: 2 · 2015: 4 · 2014: 3 · 2013: 3 · 2012: 7
FWCI
10.19
Type
journal article
Language
en
Open access
closed
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Annals of Vascular Surgery (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Surgery › Abdominal vascular conditions and treatments
  • Health Sciences › Medicine › Surgery › Peripheral Artery Disease Management
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Renal and Vascular Pathologies
Keywords
chronic mesenteric ischemia, endovascular treatment, endoluminal stenting, balloon angioplasty, restenosis, long-term patency, reintervention, celiac artery, superior mesenteric artery, postprandial pain, weight loss, mortality, recurrent symptoms, high-risk patients
MeSH terms
Adult, Aged, Aged, 80 and over, Angioplasty, Balloon, Chronic Disease, Female, Humans, Male, Mesenteric Arteries, Mesenteric Vascular Occlusion, Middle Aged, Recurrence, Stents, Atherosclerosis

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