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Cited by 151Abdominal vascular conditions and treatmentsPeripheral Artery Disease ManagementRenal and Vascular Pathologies

Mesenteric stenting for chronic mesenteric ischemia

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Brown, David J., Schermerhorn, Marc L., Powell, Richard J., Fillinger, Mark F., Rzucidlo, Eva M., Walsh, Daniel B., Wyers, Mark C., Zwolak, Robert M. +1 more·2005·Journal of Vascular Surgery
DOI 10.1016/j.jvs.2005.03.054
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Abstract

Background Mesenteric stenting has not been widely adopted for the treatment of chronic mesenteric ischemia (CMI). The recent availability of embolic protection and low-profile devices with the theoretical ability to decrease perioperative bowel necrosis, led us to begin using mesenteric stenting for patients with CMI. We review our initial experience to examine short-term outcomes.Methods We performed a retrospective analysis of all patients who were treated by vascular surgeons with mesenteric stenting for CMI. Patients with acute mesenteric ischemia were excluded. We evaluated perioperative morbidity and mortality, restenosis, recurrent symptoms, and reintervention. Kaplan-Meier methods were used to assess events during follow-up. We also compared these outcomes with a historical control group of patients treated with open surgical revascularization.Results Fourteen patients underwent mesenteric stenting over the past 3 years. Mean age was 73, and 64% were women. There was no perioperative or 30-day mortality or major morbidity. Early restenosis and recurrent symptoms occurred in 10% and 9% of patients at 6 months. At a mean follow-up of 13 months, 53% of patients underwent reintervention. However, 93% were symptom-free at their last follow-up. Compared with open surgery, stent patients had lower perioperative major morbidity (30% vs 0%, P < .01) and shorter hospital and intensive care unit length of stay (median 10 days vs 2 days, and 3 days vs 0 days, respectively, P < .01 for both). However, stent patients were seven times as likely to develop restenosis (P < .01), four times more likely to develop recurrent symptoms (P < .01), and 15 times more likely to undergo reintervention (P < .01). There was one death 13 months after stenting due to mesenteric infarction in a patient lost to follow-up. One patient was successfully converted to open surgery after a second restenosis. He had regained 20 pounds and was determined to be a better operative candidate than at his initial presentation. There was no perioperative or 30-day mortality or major morbidity with reintervention after mesenteric stenting.Conclusion Mesenteric stenting for CMI can be performed with low perioperative risk. However, stenting is associated with early restenosis and recurrent symptoms requiring secondary procedures. Patients with severe nutritional depletion or high surgical risk may benefit from mesenteric stenting for CMI, but close follow-up is required. Later open surgery can be performed for restenosis if nutritional status and surgical risk are improved, or repeat angioplasty and stenting can be effectively performed if operative risk remains high.

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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 [12]

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Authors
Brown, D. J., Schermerhorn, M. L., Powell, R. J., Fillinger, M. F., Rzucidlo, E. M., Walsh, D. B., Wyers, M. C., Zwolak, R. M., & Cronenwett, J. L.
Affiliations
  • Dartmouth–Hitchcock Medical Center (US)
  • Beth Israel Deaconess Medical Center (US)
Corresponding author
Schermerhorn, Marc L.
ORCID
Venue
Journal of Vascular Surgery
Publisher
Elsevier BV
Published
2005-08
Volume
42
Issue
2
Pages
268-274
ISSN
0741-5214 (ISSN-L)
DOI
10.1016/j.jvs.2005.03.054
OpenAlex
W2083408472
Cited by
151
References
17
Citations by year
2025: 1 · 2024: 1 · 2023: 6 · 2022: 2 · 2021: 2 · 2020: 7 · 2019: 2 · 2018: 2 · 2017: 4 · 2016: 8 · 2015: 5 · 2014: 6 · 2013: 9 · 2012: 12
FWCI
10.03
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal 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, mesenteric artery stenting, restenosis, reintervention, perioperative morbidity, open surgical revascularization, embolic protection, mesenteric infarction, length of hospital stay, nutrient depletion, surgical risk stratification, endovascular revascularization
MeSH terms
Aged, Angioplasty, Balloon, Celiac Artery, Chronic Disease, Endarterectomy, Female, Humans, Ischemia, Male, Mesentery, Nutritional Status, Recurrence, Retrospective Studies, Stents, Treatment Outcome, Mesenteric Artery, Inferior, Mesenteric Artery, Superior, Blood Vessel Prosthesis Implantation

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