Background: Chronic mesenteric ischaemia (CMI) is associated with a high morbidity and mortality. Most likely causes of CMI are atherosclerosis, external compression (Dunbar Syndrome) and vasculitis. We report on our experience with endovascular stent therapy.
Patients and methods: Between Sept. 1998 and Dec. 2005 we treated 21 consecutive patients (52% male; mean age 64+/-15 years, range 18-81 years) due to symptomatic CMI. A total of 34 interventions with 41 treated lesions were performed. Aetiology of vessel obstruction was atherosclerosis in 14 patients (67%), Dunbar syndrome in 3 patients (14%), chronic type B aortic dissection in 2 patients (9%), Takayasu's arteritis in 1 patient (4.5%), external compression following abdominal surgery in 1 patient (4.5%). Target lesions were celiac trunk (n=16), superior mesenteric artery (n=24), and inferior mesenteric artery (n=1). Twenty-two percent (n=9) of the lesions were total occlusions. The patients underwent serial follow-up duplex examinations before discharge and every 6 months thereafter or in case of symptom recurrence.
Results: Thirty-one of the 34 (91%) interventions were technically successful (37/41 lesions; 90%). Two of these 4 lesions were treated successfully using another approach in a second intervention. Brachial access was used in 16/34 cases (47%). One or more stents were placed in 29/34 interventions (85%) and 35/41 lesions. In 3 cases, in-stent restenosis was treated with balloon angioplasty alone, and in two cases, 3 occlusions could not be reopened. During 6 interventions, drug eluting stents were placed. All patients treated successfully were free of symptoms immediately after the intervention with recurrence of symptoms in case of restenosis. After a mean follow-up of 31+/-26 (range 0-87) months restenosis was detected in 6 patients (29%). Two major complications occurred which were treated without permanent sequelae.
Conclusion: Stenoses of mesenteric arteries resulting in symptomatic CMI can be treated successfully with stent-angioplasty; for anatomical reasons, the brachial approach should be considered. Recanalisation of total obstructions is feasible if a stump of the occluded artery is detectable. Restenosis is frequent and can easily be treated with balloon angioplasty or stent-in-stent placement.