Natural History of Asymptomatic Superior Mesenteric Arterial Stenosis Depends on Coeliac and Inferior Mesenteric Artery Status
Open accessAbstract
Objective The benefit of preventive treatment for superior mesenteric artery (SMA) stenosis remains uncertain. The latest European Society for Vascular Surgery (ESVS) guidelines remain unclear given the lack of data in the literature. The aim of this study was to evaluate asymptomatic SMA stenosis prognosis according to the presence of associated coeliac artery (CA) and/or inferior mesenteric artery (IMA) stenosis. Methods This was a single academic centre retrospective study. The entire computed tomography (CT) database of a single tertiary hospital was reviewed from 2009 to 2016. Two groups were defined: patients with isolated > 70% SMA stenosis (group A) and patients with both SMA and CA and/or IMA > 70% stenosis (group B). Patient medical histories were reviewed to determine the occurrence of mesenteric disease (MD) defined as development of acute mesenteric ischaemia (AMI) or chronic mesenteric ischaemia (CMI). Results Seventy-seven patients were included. Median follow up was 39 months. There were 24 patients in group A and 53 patients in group B. In group B, eight (10.4%) patients developed MD with a median onset of 50 months. AMI occurred in five patients with a median of 33 months and CMI in three patients with a median of 88 months. Patients of group B developed more MD (0% vs. 15.1%; p = .052). The five year survival rate was 45% without significant difference between groups. Conclusion Patients with SMA stenosis associated with CA and/or IMA seem to have a higher risk of developing mesenteric ischaemia than patients with isolated SMA stenosis. Considering the low life expectancy of these patients, cardiovascular risk factor assessment and optimisation of medical treatment is essential. Preventive endovascular revascularisation could be discussed for patients with non-isolated > 70% SMA stenosis, taking into account life expectancy.
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Of 53 patients with SMA stenosis plus CA and/or IMA stenosis, five had AMI and three had CMI during follow up.
“Of the 53 patients with SMA stenosis plus CA and or IMA stenosis, five had AMI (most often triggered by another disease) and three had CMI during follow up. 11”
The mortality rate of that cohort was 52% after a median of 23 months.
“The mortality rate of the entire cohort was 52% after a median of 23 months.”
In a retrospective study of 77 patients, none of 24 patients with isolated SMA stenosis developed acute mesenteric ischaemia or CMI.
“In a retrospective study of 77 patients with a median follow up of 39 months, none of 24 patients with isolated SMA stenosis developed acute mesenteric ischaemia (AMI) or CMI. 11”
The majority died from cancer and cardiovascular disease, and 5.2% from AMI.
“The majority died from cancer and cardiovascular disease, and 5.2% from AMI.”
The long term risk of becoming symptomatic in patients with asymptomatic MAOD is low, even in patients with multivessel disease.
“Prophylactic revascularisation in patients with asymptomatic MAOD is controversial, and rarely performed, because the long term risk of becoming symptomatic is low, even in patients with multivessel disease whose prognosis is determined by events in other vascular territories, other comorbidities, and age.”
In patients with single vessel disease, the probability of progression to CMI and AMI is very low.
“In patients with single vessel disease, the probability of progression to CMI and AMI is very low.”
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- Authors
- Bordet, M., Tresson, P., Huvelle, U., Long, A., Passot, G., Bergoin, C., Lermusiaux, P., Millon, A., & Della Schiava, N.
- Affiliations
- Hospices Civils de Lyon (FR)
- Lyon 1 Université (FR)
- Corresponding author
- Bordet, Marine
- Venue
- European Journal of Vascular and Endovascular Surgery
- Publisher
- Elsevier BV
- Published
- 2021-05
- Volume
- 61
- Issue
- 5
- Pages
- 810-818
- ISSN
- 1078-5884 (ISSN-L)
- OpenAlex
- W3151835068
- Cited by
- 23
- References
- 28
- Citations by year
- 2026: 2 · 2025: 6 · 2024: 8 · 2023: 4 · 2022: 2 · 2021: 1
- FWCI
- 3.52
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- European Journal of Vascular and Endovascular 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
- superior mesenteric artery stenosis, mesenteric ischemia, acute mesenteric ischemia, chronic mesenteric ischemia, prognosis, endovascular revascularization, life expectancy, cardiovascular risk factors
- MeSH terms
- Computed Tomography Angiography, Heart Disease Risk Factors, Adult, Aged, Celiac Artery, Constriction, Pathologic, Follow-Up Studies, Humans, Male, Mesenteric Vascular Occlusion, Middle Aged, Prognosis, Retrospective Studies, Survival Rate, Practice Guidelines as Topic, Mesenteric Artery, Inferior, Mesenteric Artery, Superior, Risk Assessment, Endovascular Procedures, Asymptomatic Diseases, Mesenteric Ischemia
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