Open or percutaneous revascularization for chronic splanchnic syndrome

Abstract

ER appears to be preferential in the treatment of elderly patients and in patients with comorbidity, severe cachexia, or hostile abdomen. Long-term results after OR are excellent. OR can still be proposed as the preferred option for relatively young and fit patients.

Long-Term Results of Endovascular Treatment of Atherosclerotic Stenoses or Occlusions of the Coeliac and Superior Mesenteric Artery in Patients With Mesenteric Ischaemia

“…The present patency rates are in line with the metaanalysis by van Petersen et al, 18 which demonstrated that PMAS had lower morbidity, but a decreased primary patency compared with OSR after 1e2 years of follow-up. After this meta-analysis, several institutes published experiences and results after PMAS, both in an acute or chronic setting, 8e17 and largely confirmed these observations.…”

“…The present authors always try to achieve two vessel patency in accordance with a previously published meta-analysis by van Petersen et al in 2010. 18 This report states that long-term relief of symptoms can be achieved best by repair of more than one mesenteric artery, based on almost all reviewed studies. So the authors' policy is: "one is good, but two is better".…”

“…Van Petersen et al 18 compared the literature concerning the clinical and anatomical outcome after OSR and PMAS in case of CMI. They concluded that the short-term results were comparable, but there was a lack of robust data on mid-and long-term outcome after PMAS.…”

Chronic Mesenteric Ischemia: A Rare Cause of Chronic Abdominal Pain

“…studied the outcomes of endovascular and open surgical revascularization in eight recently published trials and found similar results for technical success. However, after mean followups of 20 and 35 months, recurrence treatments were almost 3 times more frequent in the endovascular compared to open revascularization group (30 vs. 13%, p < 0.001)(5). These results were confirmed in a recent meta-analysis(13).…”

“…Therefore, the diagnosis of chronic mesenteric ischemia requires compatible clinical symptoms, such as splanchnic syndrome; diarrhea and malabsorption; vomiting from gastric ischemia; and significant stenosis (> 70% narrowing of the contrast lumen) of the celiac artery, superior mesenteric artery, or inferior mesenteric artery. To better screen for patients who would benefit from revascularization, the CO2 pressure gradient can be measured between the stomach lumen and arterial blood using gastric exercise tonometry (3,4); however, this technique is invasive and not widely available (5).…”