Journal of Vascular and Endovascular Therapy

Editorial

Mesenteric arterial stenosis may be a common finding in elderly patients with arteriosclerotic disease. Found that the prevalence of serious (70% diameter stenosis) arterial mesenteric stenosis in subjects older than 65 years aged was 17.5%. Chronic symptoms associated with mesenteric arterial obstructive disease, termed chronic mesenteric ischemia (CMI), are an unusual clinical problem manifested by recurrent, debilitating abdominal pain, usually occurring after meals. In general, patients with CMI commonly have stenosis or occlusions of a minimum of two or more mesenteric arteries, and this condition may cause emaciation and death if left untreated. Historically, the treatment of this condition has been surgical revascularization, with a perioperative complication rate ranging between 33% and 47% and a 30-day mortality rate of 8% to 12%. Atherosclerotic mesenteric stenosis usually are focal and most often are located at the Ostium or the very proximal portion of these vessels, which makes them technically suitable for percutaneous trans luminal intervention. Small case series have shown that, in selected patients, endovascular therapy may be a safe and effective treatment for this condition.

the use of stents has been shown to be superior to balloon angioplasty alone. It is reasonable to infer that an equivalent could also be true for the treatment of arterial mesenteric stenosis; however, there are limited data within the literature addressing the role of percutaneous stent revascularization for the treatment of CMI. Therefore, the aim of this report is to explain the outcomes of a consecutive series of patients with CMI treated with percutaneous stent revascularization.

Retrograde common femoral arterial access was used in 77% (n 47), and brachial artery access was employed in 23% (n 14) of the procedures. Aspirin was begun at least one day before the procedure, with the use of clopidogrel left at the operator’s discretion. Unfractionated heparin was administered to maintain an activated clotting time of 250 s. Outcomes. All patients were followed for a minimum of six months. They were asked to return to the clinic at one month and six-month intervals after the procedure. A noninvasive imaging study (angiographic computerized tomography or a duplex ultrasound) to assess the patency of the stent(s) was performed between six months and one year after the procedure, or sooner if symptoms returned.

Quantitative measurement of the percent diameter stenosis of the target lesion was obtained from the invasive and noninvasive (i.e., computed tomography) angiograms , and estimated from duplex ultrasound velocities .

Primary stent placement was defined because the intention to deploy a stent during a target mesenteric vessel before the procedure, no matter the angiographic result after balloon pre dilation. Angiographic success was defined as a final diameter stenosis of 30%, and procedural success was defined as an angiographic success without an in hospital major complication. Major complications included death, myocardial infarct, stroke, need for emergent surgical revascularization or in-hospital repeat target vessel revascularization (TVR), athero embolization, need for transfusion, need for dialysis, or any vascular access complication that prolonged the hospital stay. Chronic renal insufficiency was defined as a Creatinine 1.5 mg/dl. Recurrence of (ischemic) symptoms was defined because the reappearance of symptoms with similar pattern and characteristics to people who occurred before stent placement. The use of percutaneous revascularization in the mesenteric circulation has been reported in small series with relatively short follow-up. These studies have shown that balloon angioplasty yields a high procedural success, with low morbidity and mortality rates, suggesting that endovascular therapy is an important alternative treatment to surgical revascularization in selected patients.