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Cited by 18Abdominal vascular conditions and treatmentsVascular anomalies and interventionsRenal and Vascular Pathologies

Midterm Clinical Outcomes of Retrograde Open Mesenteric Stenting for Mesenteric Ischemia

Cirillo-Penn, Nolan C., DeMartino, Randall R., Rasmussen, Todd E., Shuja, Fahad, Colglazier, Jill J., Kalra, Manju, Oderich, Gustavo S., Mendes, Bernardo C.·2023·Annals of Vascular Surgery
DOI 10.1016/j.avsg.2022.09.062
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Abstract

Background Retrograde open mesenteric stenting (ROMS) has become a mainstay in treatment of mesenteric ischemia; however, follow-up in contemporary studies is limited. Methods A single-center retrospective review of patients undergoing ROMS from 2007 to 2020 was conducted. Demographics, presentation, and procedural details were reviewed. End points were morbidity and mortality, technical success, primary patency, reinterventions, and freedom from clinical recurrence. Results ROMS was performed in 34 patients, 19 female (56%). Mean age was 71 ± 10 years. Eighteen patients (53%) presented with acute mesenteric ischemia (AMI), 11 (32%) with acute-on-chronic, and 5 (15%) with chronic mesenteric ischemia. Etiology was chronic atherosclerosis with/without in-situ thrombosis in 28 patients (82%), superior mesenteric artery dissection in 3, and 1 each with embolic, vasculitic, and nonocclusive ischemia. Four patients (12%) had prior mesenteric procedures (3 Celiac/1 superior mesenteric artery stent) and 1 had unsuccessful transbrachial stenting attempt. Technical success, defined as successful stenting through a retrograde approach was attained in 31 patients (91%), with the 3 remaining patients treated with transbrachial stenting in 2 and iliomesenteric bypass in 1. Covered stents were used in 21 patients (64%) with or without stent extension with bare-metal stents. Eight patients (23%) required thromboembolectomy and 9 (26%) underwent patch angioplasty. Thirty-day mortality rate was 35%, all in patients with AMI (10) or acute-on-chronic (2). Eighteen patients (53%) underwent bowel resection, all presenting acutely. Early reinterventions within the first 30 days were required in 5 patients (15%), including 2 redo ROMS with thrombectomy and endarterectomy, 2 percutaneous stent extensions, and 1 aortic septum fenestration with coiling of a jejunal branch pseudoaneurysm. With a median follow-up of 3.7 (interquartile range: 0.8-5.0) years, in patients surviving discharge, 5 required reintervention yielding freedom from reintervention rates of 87% at 1 year and 71% at 3 years. All postdischarge reinterventions were endovascular with no conversion to bypass. The overall 1-year and 3-year primary patency rates were 70% and 61% (primary-assisted patency at 1 and 3 years was 87% and secondary patency at 1 and 3 years was 97%). The freedom from symptom recurrence was 95% at 1 and 3 years. Conclusions ROMS carries high rates of technical success in patients with mesenteric ischemia, despite a high chronic atherosclerotic burden. Although mid-term patency rates are acceptable, AMI is still associated with high early morbidity and mortality, with high rates of associated bowel resection. ROMS is a valuable tool in the armamentarium of vascular surgeons.

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Authors
Cirillo-Penn, N. C., DeMartino, R. R., Rasmussen, T. E., Shuja, F., Colglazier, J. J., Kalra, M., Oderich, G. S., & Mendes, B. C.
Affiliations
  • Mayo Clinic (US)
  • The University of Texas Health Science Center at Houston (US)
Corresponding author
Mendes, Bernardo C.
ORCID
Venue
Annals of Vascular Surgery
Publisher
Elsevier BV
Published
2023-02
Volume
89
Pages
20-27
ISSN
0890-5096 (ISSN-L)
DOI
10.1016/j.avsg.2022.09.062
OpenAlex
W4307726412
Cited by
17
References
18
Citations by year
2026: 3 · 2025: 3 · 2024: 7 · 2023: 4
FWCI
3.36
Type
journal article
Language
en
Open access
closed
Licence
Locations
  • Annals of Vascular Surgery (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Surgery › Abdominal vascular conditions and treatments
  • Health Sciences › Medicine › Surgery › Vascular anomalies and interventions
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Renal and Vascular Pathologies
Keywords
mesenteric ischemia, acute mesenteric ischemia, chronic mesenteric ischemia, covered stent, bare-metal stents, stent patency, reintervention, mortality, thromboembolectomy, patch angioplasty, superior mesenteric artery dissection
MeSH terms
Aftercare, Aged, Aged, 80 and over, Female, Humans, Ischemia, Middle Aged, Patient Discharge, Stents, Treatment Outcome, Atherosclerosis, Mesenteric Ischemia

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