Endovasular Treatment of Stenotic and Occluded Visceral Arteries For Chronic Mesenteric Ischemia

Objectives:: Endovascular treatment of chronic mesenteric ischemia (CMI) for completely occluded mesenteric vessels is not well defined. We reviewed our experience with PTA and stenting (PTAS) for CMI of stenotic and occluded vessels.
Methods: We examined the records of patients who underwent PTAS of the celiac (CA), superior mesenteric (SMA), and/or inferior mesenteric (IMA) arteries for CMI between 1/2001 and 12/2005. Demographics, lesion characteristics, procedure details, patency and mortality rates were recorded and analyzed using Kaplan-Meier with Cox proportional hazards.
Results: 87 vessels (57 SMA, 23 CA, and 7 IMA) were treated in 65 patients. Eighteen patients (28%) had completely occluded vessels, and 47 (72%) patients had >60% stenosis. Mesenteric angina was the most common symptom (97%). The cumulative 1-year patency results were: primary 65% (CI 50,80), primary assisted 97% (CI 92,100), secondary 99% (CI 96,100), and survival 89% (CI 80,98). All deaths occurred within the first 90 days. There was no difference between occluded and stenotic vessel in any outcome measure, irrespective of stent size or number. Patients requiring bowel resection were less likely to survive (OR 26; CI 3.5,192; p<.001). One-year primary patency was worse among patients with COPD (OR: 3.2; CI 1.4 7.7; p=.009) or those with femoral access (OR 3.0; CI 1.1,7.9; p= .015).
Conclusions: The results of endovascular treatment of occluded mesenteric arteries are indistinguishable from those treated for stenotic vessels. Patients requiring bowel resection are less likely to survive, and those with COPD or who had femoral access have less durable revascularizations.