PP9. Endovascular Management of Chronic Mesenteric Ischemia

Article Outline

• Objectives
• Methods
• Results
• Conclusions
• Copyright

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Objectives 

Chronic Mesenteric Ischemia often presents in patients who are malnourished and nutritionally compromised, often exacerbated by a delay in diagnosis. These condition may predispose these patients to increased surgical risks in open surgery. We present our results of Endovascular management with percutaneous techniques in a large series of patients.

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Methods 

A retrospective review of all patients diagnosed with chronic mesenteric ischemia was performed. All procedures were performed in a single group practice setting. Diagnoses was made by physical examination, patient history and ultrasound examination. Patients were treated between October 2003 through November 2008. Patients with acute mesenteric ischemia were excluded Follow up was performed both in office and with ultrasound. Analysis consisted of patient demographics, failure of treatment, need for re-intervention as well as morbidity and mortality.

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Results 

Between October 2003 and November 2008 133 mesenteric arteriograms were performed for patients in whom chronic mesenteric ischemia was suspected. Twenty one patients had normal arteriograms, 112 patients and 128 vessels were treated with either angioplasty alone or with stenting. Patient age ranged from 31 to 90 years old. Average age was 70. Seventy-five percent of the patients were women. No deaths occurred within the first 30 days. Six patients died within the first year, 2 from acute mesenteric ischemia, 3 from unrelated causes and 1 from unknown cause. Seventeen patients were lost to followup. Three patients after initial endovascular treatment were eventually converted to an open procedure. None of the patients required bowel resection.

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Conclusions 

Patients with chronic mesenteric ischemia can be managed effectively with endovascular techniques. Many patients do require reintervention to maintain patencey, however this can be accomplished with minimal morbidity. Follow-up consisting of regular office visits and surveillance ultrasound is an important adjunct in the management of these complex patients.