Retrograde Open Mesenteric Stenting for Acute Mesenteric Ischemia: A Viable Alternative for Emergent Revascularization

Objectives:
Acute mesenteric ischemia carries a high mortality rate if not recognized. Significant co-morbidities and an exhausted physiologic reserve attend surgical exploration and revascularization. Retrograde open mesenteric stenting avoids major vascular reconstruction offering revascularization while minimizing morbidity.
Methods:
Two patients with acute on chronic mesenteric ischemia underwent retrograde open mesenteric stenting during exploratory laparotomy. Preoperative, operative, and postoperative considerations are discussed. Complete periprocedural and follow-up information is available. Follow-up with either duplex ultrasound (DUS) or computed tomography (CT) was performed.
Results:
Two Caucasian female patients aged 75 and 83.2 years presented with acute abdominal pain. In addition, one had peritoneal signs and the other had gastrointestinal bleeding requiring transfusion. Both had many risk factors for atherosclerotic disease and on preoperative imaging all three mesenteric vessels were diseased. Vein mapping was able to be performed in one prior to operation. Operative technique included isolating the superior mesenteric artery for cannulation and retrograde endovascular angioplasty and deployment of 2 stents in one and 1 stent in the other. The patient presenting with peritonitis required small bowel resection and anastomosis for ischemic perforation, and the other patient did not require any resection. Post-operatively both had minor complications: the patient with perforated bowel developed a wound infection and the other required a blood transfusion for a gastric ulcer. Hospital length of stay was 13 and 18 days. Follow-up is currently 1.2 and 10 months. Neither of the patients had recurrence of symptoms, weight loss, or other manifestations of acute or chronic mesenteric ischemia since the procedure. Primary patency is maintained in both confirmed with CT angiography and DUS.
Conclusion:
Retrograde open mesenteric stenting for acute mesenteric ischemia is a viable alternative to bypass. The fundamental need to explore the patient to evaluate bowel ischemia is maintained while avoiding the morbidity of an arterial bypass procedure.