Successful endovascular treatment of severe chronic mesenteric ischemia by concurrent triple-vessel mesenteric artery revascularization

We report the clinical details, imaging findings, and management for a 39-year-old female presenting with recurrent episodes of pain in abdomen due to systemic lupus erythematous vasculitis associated with spontaneous isolated inferior mesenteric dissection. Spontaneous mesenteric artery dissection is an uncommon cause of mesenteric ischemia. Symptomatic spontaneous isolated inferior mesenteric artery (IMA) dissection is a rare condition, and its association with systemic lupus erythematosus is not previously described in the English literature. The optimal treatment options are debatable and include medical management, surgical reconstruction, and endovascular therapy. We wish to highlight spontaneous isolated IMA dissection as a rare etiology for chronic mesenteric ischemia and its management by endovascular methods.

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Mid-term outcomes of endovascular treatment for symptomatic chronic mesenteric ischemia

Surgical Techniques Development ◽

10.4081/std.2011.e2 ◽

2011 ◽

Vol 1 (1) ◽

pp. 2 ◽

Cited By ~ 1

Author(s):

Eva Schönefeld ◽

Susanne Szesny ◽

Konstantinos P. Donas ◽

Georgios A. Pitoulias ◽

Giovanni Torsello

Keyword(s):

Endovascular Treatment ◽

Mesenteric Ischemia ◽

Primary Patency ◽

Mesenteric Arteries ◽

Primary Study ◽

Symptom Improvement ◽

Initial Symptom ◽

Secondary Patency ◽

Chronic Mesenteric Ischemia

The authors would present the mid-term outcomes with the use of stent-supported angioplasty in the treatment of symptomatic chronic mesenteric ischemia (CMI). The present study is a retrospective analysis of 36 patients undergoing endovascular treatment of symptomatic CMI, between November 2000 and September 2009. Primary study endpoints were defined as primary patency, periprocedural and midterm mortality and complications, and symptom improvement after intervention. Forty-one mesenteric arteries (77.3% stenotic and 22.7% occluded vessels) were treated in 36 patients with 42 stents. In 30 patients (83.3%) one visceral artery and in 6 cases (16.7%) two visceral arteries were treated. Overall mortality was 16.7% (n=6) after a 60-month follow-up (mean follow-up period 30.1 months). Two early (<30-day) deaths were caused by visceral ischemia (n=2: 5.5%). Late death was procedure-related in one patient with re-occlusion of the superior mesenteric artery after 12 months. The other 3 patients died from non procedure-related causes; e.g. twice myocardial infarction. Initial symptom relief was observed in 29 patients (80.5%); 7 patients reported no change. Primary patency was 83.3% after 5 years and secondary patency was 90.5% (38 out of 42 stents) among all patients. Two conversions to open surgery were documented. First-line endovascular approach of CMI is a reasonable strategy. Close follow-up is mandatory due to symptom recurrence and restenosis.

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Chronic Mesenteric Ischemia Treated by Isolated Angioplasty of the Inferior Mesenteric Artery

CardioVascular and Interventional Radiology ◽

10.1007/s00270-004-0214-2 ◽

2005 ◽

Vol 28 (4) ◽

pp. 536-538 ◽

Cited By ~ 3

Author(s):

A. Alam ◽

R. Uberoi

Keyword(s):

Mesenteric Artery ◽

Inferior Mesenteric Artery ◽

Mesenteric Ischemia ◽

Chronic Mesenteric Ischemia

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Combined Endovascular and Surgical Retrograde Superior Mesenteric Artery Recanalization

10.1093/med/9780199986071.003.0027 ◽

2018 ◽

Author(s):

Syed M. Peeran

Keyword(s):

Superior Mesenteric Artery ◽

Mesenteric Artery ◽

Mesenteric Ischemia ◽

Atherosclerotic Lesion ◽

Acute Mesenteric Ischemia ◽

Exploratory Laparotomy ◽

Chronic Mesenteric Ischemia ◽

Hybrid Technique ◽

Current Standard ◽

Stent Deployment

Acute mesenteric ischemia is a life-threatening vascular emergency associated with a very high mortality rate. In the setting of necrotic bowel, the current standard of care requires a laparotomy with bowel resection and surgical or endovascular revascularization of the superior mesenteric artery. Unfortunately, mesenteric bypass confers high perioperative mortality, in some reports up to 45%. A hybrid technique that employs an exploratory laparotomy, catheterization of the distal superior mesenteric artery, and stent deployment across the atherosclerotic lesion was first described in 2004 for the treatment of acute-on-chronic mesenteric ischemia. This chapter describes the appropriate clinical indications, the technical aspects of performing this hybrid procedure, as well as the challenges and common pitfalls encountered.

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