Chronic mesenteric ischemia: When and how to intervene on patients with celiac/SMA stenosis

Juliëtte Blauw, Tomas Bulut, Paul Eenhoorn, Roland J. Beuk, Marjolein Brusse-Keizer, Jeroen Kolkman, Robert H. Geelkerken*

*Corresponding author for this work

    Research output: Contribution to journalArticleAcademicpeer-review

    5 Citations (Scopus)

    Abstract

    BACKGROUND: Studies that compared open surgical mesenteric artery repair (OSMAR) with percutaneous mesenteric artery stenting (PMAS) in patients with chronic mesenteric ischemia (CMI) are based on merely older studies in which only a minority of patients received PMAS. This does not reflect the current PMAS-first choice treatment paradigm. This article focused on the present opinions and changes in outcomes of OSMAR for CMI in the era of preferred use of PMAS.

    METHODS: Patients who received OSMAR for CMI from 1997 until 2014 in a tertiary referral centre for chronic mesenteric ischemia were included in this report. Patients were divided into two groups, the historical OSMAR preferred group and present PMAS preferred group.

    RESULTS: Patient characteristics, SVS comorbidity severity score, clinical presentation and number of diseased mesenteric arteries were not significantly changed after the widespread introduction of PMAS. In the present PMAS first era there were trends of less open surgical mesenteric artery multivessel repair, less antegrade situated bypasses, decreased clinical success but improved survival after OSMAR.

    CONCLUSIONS: Elective OSMAR should only be used in patients with substantial physiologic reserve and who have unfavourable mesenteric lesions, failed PMAS or multiple recurrences of in-stent stenosis/occlusion. PMAS in CMI patients is evolved from "bridge to surgery" to nowadays first choice treatment and "bridge to repeated PMAS" in almost all patients with CMI.

    Original languageEnglish
    Pages (from-to)321-328
    Number of pages8
    JournalJournal of Cardiovascular Surgery
    Volume58
    Issue number2
    DOIs
    Publication statusPublished - 1 Apr 2017

    Keywords

    • Mesenteric ischemia
    • Vascular diseases
    • Vascular patency
    • Vascular surgical procedures

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