Stenting of Superior Mesenteric Artery Chronic Total Occlusions in Patients with Chronic Mesenteric Ischemia: Technical and Clinical Outcomes

Grilli CJ, Fedele CR, Tahir OM, Velez JD, Wrigley C, McGarry M, Ali MA, Agriantonis D, Kimbiris G, Garcia MJ, Leung DA

Christiana Care Health System, Newark DE/US

• Bowel manifestation of PAD• Atherosclerosis

– hardening of arteries– plaque buildup blockage

• Blockage of arteries supplying bowel – pain after eating– fear of food– weight loss– death

Chronic Mesenteric IschemiaChronic Mesenteric Ischemia

Chronic Mesenteric IschemiaChronic Mesenteric Ischemia

• Bowel arteries– celiac artery– superior mesenteric artery– inferior mesenteric artery

• Grading arterial blockages:– progressive atherosclerotic plaque– stenosis: 60-99% blockage

• amenable to endovascular stenting

– occlusion: 100% blockage• usually managed surgically

1. Sreenarasimhaiah J: Chronic Mesenteric Ischemia. Best Pract Res Clin Gastroenterol. 19(2):283-95, 2005

BackgroundBackground

PurposePurpose

• To investigate the feasibility and effectiveness of endovascular stenting of superior mesenteric artery occlusions (100% blockages) in patients with chronic mesenteric ischemia

• 47 patients – 18 male, 29 female– mean age 73 yrs, range 44-87

• All patients with clinical symptoms of CMI > 1mo

MethodsMethods

72 y/o female, food fear, 45 lb weight loss

•Achieved in 41/47 (87%)

•6 unsuccessful procedures:– 2 went on to bypass– 3 received celiac stents– 1 lost to follow-up

ResultsResultsPROCEDURE SUCCESSPROCEDURE SUCCESS

• Symptom Improvement < 30 d– 4 point scale

1 significant improvement

2 partial improvement

3 no change

4 worsening of symptoms

N=41

ResultsResultsINITIAL SYMPTOM IMPROVEMENTINITIAL SYMPTOM IMPROVEMENT

• Primary patency (months):– 97% @ 12

– 75% @ 24

• Recurrent blockage of SMA:– 7 patients

– all had repeat endovascular procedures

• Secondary patency– 100% @ 12

– 97% @ 24

ResultsResultsFOLLOW-UP BY ULTRASOUNDFOLLOW-UP BY ULTRASOUND

• Symptom-free– 100% @ 12 mo

– 88% @ 24 mo

ResultsResultsSYMPTOMSSYMPTOMS

• Endovascular stenting of complete blockages of the SMA is a safe and effective procedure– minimally-invasive– good technical success rate– easily repeatable– excellent clinical outcomes

ConclusionsConclusions