Print this pageChanges In Management Of Chronic Mesenteric Ischemia
Dartmouth Hitchcock Medical School, Lebanon, NH
Background: The role of percutaneous catheter-based intervention (PCI) in treatment of chronic mesenteric ischemia (CMI) is not well defined. With the recent availability of embolic protection, we began treating more patients with CMI using PCI. We therefore reviewed our experience with open revascularization (OR) and PCI for patients with CMI to compare short-term outcomes.
Methods: We reviewed all patients treated with OR or PCI for CMI from 1990-2004 by vascular surgeons at our institution. We evaluated the perioperative mortality, restenosis, recurrent symptoms, and re-intervention.
Results: Forty-four patients (33 OR, 11 PCI) underwent revascularization. The mean age was 66 and 80% were women. Of those who underwent OR, there were 28 bypass grafts (85%), 4 endarterectomies (12%) and 1 thrombectomy (3%). Of those who underwent PCI, 10 had SMA stents and 7 had Celiac stents. Perioperative mortality was 0% with PCI, and 9.1% with OR. Mean length of stay was 2.2 days with PCI and 22.5 days for OR. Mean follow-up was 34 months for OR and 13 months for PCI. Recurrent or persistent abdominal pain was seen in 18% of PCI patients and 0% of OR patients. Primary patency without restenosis was 76% in OR patients and 46% in PCI patients. Secondary revascularization procedures were performed in 9% of OR patients and 46% of PCI patients. One PCI patient whose nutritional status was optimized after PCI, subsequently underwent OR for restenosis.
Conclusion: PCI for CMI appears to be associated with lower initial mortality compared to OR. However, PCI is associated with substantial restenosis, recurrent symptoms, and requirement for secondary procedures. Patients with severe nutritional depletion and comorbidity may benefit from initial PCI treatment of CMI with close follow-up and later OR for restenosis when nutritional status and comorbidity are optimized.