Management of Chronic Mesenteric Ischemia. The Role of Endovascular Therapy

Abstract

Chronic mesenteric ischemia is an uncommon disorder manifested most commonly as abdominal pain. Surgical revascularization has traditionally been the treatment of choice. Endovascular management of this entity was originally attempted as an alternative for high-risk patients. Improvements in stent technology, refinement in technique, and increased efficiency of antiplatelet regimens have, over time, increased the popularity of this minimally invasive approach. We present a review of the available series on endovascular treatment of chronic mesenteric ischemia, with emphasis on short- and long-term outcome and morbidity and mortality results. Principles of operative technique and controversial issues and topics of interest are also discussed.

Aorto-Hepatic By-Pass Grafting as Treatment Option After Acute Thrombosis of a Celiac Trunk Stenting. Report of a Case

“…It remains a less invasive technique and have slightly inferior technical and clinical success rates compared to surgery [11].…”

Percutaneous Angioplasty and Stenting for Mesenteric Ischaemia

“…Another important issue is the longer-term arterial patency rate in patients treated by endovascular means compared to those managed surgically. In a recent review of 328 patients undergoing endovascular treatment for chronic mesenteric ischaemia, the overall technical success rate was 91% and immediate symptomatic relief was achieved in 82% of patients (Kougias et al, 2007 (Kougias et al, 2009;Atkins et al, 2007;Kasiragjan et al, 2001). Indeed, an analysis of all published literature comparing surgical and endovascular treatment options for CMI performed between 2000 and 2009 concluded that 5-year primary patency rates were 3.8 times greater in the surgical group (P<0.001), while freedom from symptoms at 5 years was 4.4 times greater in patients managed surgically compared to those treated with endovascular techniques (p<0.001) (Gupta et al, 2010).…”

“…There is general agreement that stenting is indicated for residual stenosis following primary angioplasty (defined as residual stenosis of 30% or more, or pressure gradient higher than 15mmHg), for ostial or eccentric lesions, or as a salvage procedure for acute dissection after angioplasty (Kougias et al, 2007). Balloon-expandable stents are preferred because of their accuracy and ability to generate considerable radial force.…”

“…More distal or long lesions may be better suited to self-expandable stents given their flexibility (Loffroy et al, 2009). Kougias et al (2007) reported that technical success was significantly higher with stenting compared with angioplasty alone (95% vs 83%, p=0.007), although the rate of restenosis was also higher in the stented subgroup, a finding that may have been biased by the inclusion of earlier studies where more primitive stents were used and peri-procedural anticoagulant and antiplatelet treatment regimens were not standardized. A recent case series demonstrated that long-term patency rate was higher in patients managed with primary stenting compared to angioplasty alone (Daliri et al, 2010).…”

Endovascular versus open revascularization for chronic mesenteric ischemia: a comparative study

“…The operative mortality is moderate (0% to 13%) but post-operative complications can reach 12% to 45% [1]. A recent review reported lower peri-procedural mortality (3%) and complication rate (9%) with percutaneous transluminal angioplasty (PTA) with stenting of mesenteric arteries for CMI [2]. When compared with OR, PTA had however lower efficacy in terms of technical success rate, pain control, and longterm primary patency.…”