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CLINICAL RESEARCH: INTERVENTIONAL CARDIOLOGY

Endovascular Therapy for Chronic Mesenteric Ischemia

Jose A. Silva, MD, FACC^_*,_*, Christopher J. White, MD, FACC^_*, Tyrone J. Collins, MD, FACC^_*, J. Stephen Jenkins, MD, FACC^_*, Malcolm E. Andry, MD, John P. Reilly, MD, FACC^_* and Stephen R. Ramee, MD, FACC^_*

^_* Department of Cardiology, Section of Gastroenterology, Ochsner Clinic Foundation, New Orleans, Louisiana
Department of Medicine, Section of Gastroenterology, Ochsner Clinic Foundation, New Orleans, Louisiana

Manuscript received July 20, 2005; revised manuscript received September 21, 2005, accepted October 3, 2005.

^_* Reprint requests and correspondence: Dr. Jose A. Silva, Department of Cardiology, Ochsner Clinic Foundation, Slidell Clinic, 2750 Gause Boulevard, Slidell, Louisiana 70461 (Email: jsilva{at}ochsner.org).

OBJECTIVES: We sought to describe the outcomes of a consecutive series of patients with chronic mesenteric ischemia (CMI) who were treated with percutaneous stent revascularization.

BACKGROUND: Historically, the treatment for CMI has been surgical revascularization. However, surgery carries a significant procedural complication rate and mortality.

METHODS: Fifty-nine consecutive patients with CMI underwent stent placement in 79 stenotic (>70%) mesenteric arteries. All patients had clinical follow-up and 90% had anatomical follow-up with angiography (computed tomography or conventional) or ultrasound at 6 months after the procedure.

RESULTS: Procedural success was obtained in 96% (76 of 79 arteries) and symptom relief occurred in 88% (50 patients). At a mean follow-up of 38 ± 15 months (range, 6 to 112 months), 79% of the patients remained alive, and 17% (n = 10) experienced a recurrence of symptoms. Angiography or ultrasound obtained at 14 ± 5 months after the procedure demonstrated a restenosis rate of 29% (n = 20). All patients with recurrent symptoms had angiographic in-stent restenosis and were successfully revascularized percutaneously.

CONCLUSIONS: Percutaneous stent placement for the treatment of CMI can be performed with a high procedural success and a low complication rate. The long-term freedom from symptoms and vascular patency are comparable with surgical results. The inherent lower procedural morbidity and mortality makes the endovascular approach the preferred revascularization technique for these patients.

Abbreviations and Acronyms   CMI = chronic mesenteric ischemia   CTA = angiographic computed tomography   SMA = superior mesenteric artery   TVR = target vessel revascularization

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