Endovascular therapy of chronic mesenteric ischemia: improving midterm results justify continued use of bare metal stents
Woosup M. Park, MD, Collin Haben, BS, James F. Bena, MS, F. Ezequiel Parodi, MD, Sean P. Lyden, MD.
Cleveland Clinic and Foundation, Cleveland, OH, USA.
OBJECTIVES: To evaluate the contemporary results of interventions in the celiac axis (CA) and superior mesenteric artery (SMA) for chronic mesenteric ischemia and factors associated with patency.
METHODS: Retrospective review of patients with chronic mesenteric ischemia treated with angioplasty and stenting from 2001-2014. Demographic, history, risk factor, preoperative testing, and technical variables were collected and subject to univariate analysis, with end points of patency loss, symptom return, and death. The time period was divided into 2001-2008 (EARLY) and 2009-2014 (LATE) to compare early and contemporary results.
RESULTS: From 2001 to 2014, 162 patients (46 men, 116 women, age 70.4±11.2 years) with chronic mesenteric ischemia underwent interventions on the CA (62 vessels) and the SMA (143 vessels). 41 patients had both CA and SMA intervention. Only 8 patients (4.9%), late in the experience, had covered balloon expandable stents, the remainder had bare metal stents. Overall, primary patency for CA at 1 year 85.5% (95% CI 73.8-97.3) and 3 year 66.7% (95% CI 49.0-83.3) and SMA at 1 year 79.3% (95% CI 70.7-87.9) and 3 year 68.2 (95% CI 57.0-79.5) were not statistically different (Table). Only age over 70 years was associated with improved results in the SMA (P=0.043). Chronic total occlusion in the SMA conferred worse patency compared to stenosis (P=0.02). In the SMA, comparing EARLY(2001-2009, 70 patients) versus LATE (2009-2014, 73 patients), primary patency was better in the LATE experience (P=0.035). The LATE cohort trended to an older mean age (Early 68.5 versus 72.1 years, P=0.073).
CONCLUSIONS: Intervention for chronic mesenteric ischemia has acceptable mid-term results, and with experience, the results appear to be improving. Patients over 70 years of age have better results with stenting than younger patients, and this may reflect more aggressive disease in the younger patients. Chronic total occlusion conferred worse patency rates. Over 95% of patients had bare metal stents, and these results justify their continued use.
| 1 year | 3 year | |
| CA-Primary | 85.5 (73.8,97.3) | 66.7 (49.0, 84.3) |
| CA-Primary Assisted | 100 (100, 100) | 96.0 (88.3, 100) |
| CA-Secondary | 100 (100, 100) | 100 (100, 100) |
| SMA-Primary | 79.3 (70.7, 87.9) | 68.2 (57.0, 79.5) |
| SMA-Primary Assisted | 97.6 (94.4, 100) | 94.7 (88.2, 100) |
| SMA-Secondary | 98.9 (96.6, 100) | 95.9 (89.7, 100) |
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