Intravascular shockwave lithotripsy as a treatment modality for symptomatic mesenteric ischemia

2021 ◽  
Author(s):  
Robert Sogomonian ◽  
Logan Bernhardt ◽  
Abhinav Sood ◽  
Lucas Bazi ◽  
Vikaas Kataria ◽  
...  
Keyword(s):  
Mesenteric Ischemia ◽  
Adjunctive Treatment ◽  
Shockwave Lithotripsy ◽  
Chronic Mesenteric Ischemia ◽  
Excellent Outcome ◽  
Arterial Lesions ◽  
Calcified Plaque ◽  
Coronary Arterial Lesions ◽  
Peripheral Arterial

Chronic mesenteric ischemia has traditionally been treated with either open surgical revascularization or endovascular therapy. Endovascular surgery has typically been preferred due to the lower rates of peri-procedural and post-procedural morbidity, yet this comes at the expense of long-term durability. Intravascular shockwave lithotripsy is a technique utilized to modify intimal and medial calcified plaque in order to improve vessel expansion and patency. Intravascular lithotripsy has been investigated as both primary and adjunctive treatment for peripheral arterial and coronary arterial lesions, however, its use in the treatment of chronic mesenteric ischemia requires further investigation. We present a case of a 75-year-old woman with symptomatic mesenteric ischemia who underwent intravascular shockwave lithotripsy of a 99% stenosis superior mesenteric artery with an excellent outcome.

scholarly journals Long-term Stent Outcomes for Chronic Mesenteric Ischemia

2020 ◽  
Vol 72 (1) ◽  
pp. e40
Author(s):  
Nicholas Russo ◽  
Tigran Divanyan ◽  
Neil Patel ◽  
R. Clement Darling ◽  
Jeffrey Hnath
Keyword(s):  
Mesenteric Ischemia ◽  
Chronic Mesenteric Ischemia

scholarly journals Role for Endovascular Therapy in Chronic Mesenteric Ischemia

2009 ◽  
Vol 23 (5) ◽  
pp. 365-373 ◽  
Author(s):  
Romaric Loffroy ◽  
Eric Steinmetz ◽  
Boris Guiu ◽  
Valérie Molin ◽  
Benjamin Kretz ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Mesenteric Ischemia ◽  
Rare Condition ◽  
Primary Treatment ◽  
Transluminal Angioplasty ◽  
Mesenteric Arteries ◽  
Long Term Results ◽  
Chronic Mesenteric Ischemia ◽  
Interventional Devices

Chronic mesenteric ischemia is a rare condition that is caused by stenosis or occlusion of the mesenteric arteries and usually manifests as abdominal pain. While surgical revascularization has been the standard treatment for symptomatic patients, recent advances in interventional devices and techniques have made endovascular treatment feasible and effective. Percutaneous transluminal angioplasty with stent placement is now recognized as a minimally invasive means of obtaining good long-term results with an acceptable recurrence rate; consequently, the technique is suggested for the primary treatment of chronic mesenteric ischemia. The present article discusses the indications and principles of endovascular treatment, and reviews the literature, with emphasis on short- and long-term outcomes, particularly morbidity and mortality rates.

scholarly journals Long‐Term Prognostic Risk in Lower Extremity Peripheral Arterial Disease as a Function of the Number of Peripheral Arterial Lesions

2015 ◽  
Vol 4 (10) ◽  
Author(s):  
Kim G. Smolderen ◽  
Moniek van Zitteren ◽  
Philip G. Jones ◽  
John A. Spertus ◽  
Jan M. Heyligers ◽  
...  
Keyword(s):  
Peripheral Arterial Disease ◽  
Lower Extremity ◽  
Arterial Disease ◽  
Arterial Lesions ◽  
Peripheral Arterial

scholarly journals Early Outcome of Treatment of Chronic Mesenteric Ischemia

2015 ◽  
Vol 81 (11) ◽  
pp. 1149-1156 ◽  
Author(s):  
Zhobin Moghadamyeghaneh ◽  
Joseph C. Carmichael ◽  
Steven D. Mills ◽  
Matthew O. Dolich ◽  
Alessio Pigazzi ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Odds Ratio ◽  
Open Surgery ◽  
Mesenteric Ischemia ◽  
Chronic Mesenteric Ischemia ◽  
Limited Data ◽  
Long Term Outcomes ◽  
Mortality And Morbidity ◽  
Vascular Insufficiency

There are limited data regarding long-term outcomes of chronic mesenteric ischemia (CMI) of the intestine. We sought to identify treatment outcomes of CMI. The NIS database was used to identify patients admitted for the diagnosis of CMI between 2002 and 2012. Multivariate analysis using logistic regression was performed to quantify outcomes of CMI. A total of 160,889 patients were admitted for chronic vascular insufficiency of intestine; of which 7,906 patients underwent surgical/endovascular treatment for CMI. Among patients who underwent surgery 62 per cent had endovascular treatment and 38 per cent had open vascular treatment. Need of open surgery (adjusted odds ratio (AOR): 5.13, P < 0.01) and age ≥70 years (AOR: 3.41, P < 0.01) had strong associations with mortality of patients. Open vascular treatment has higher mortality (AOR: 5.07, P < 0.01) and morbidity (AOR: 2.14, P < 0.01). However, endovascular treatment had higher risk of postoperative wound hematoma (AOR: 2.81, P < 0.01). Most patients admitted for CMI are treated with endovascular treatment. Endovascular treatment has the advantage of lower mortality and morbidity. Need to open surgery and age ≥70 years have strong associations with mortality of patients.

Endovascular-First for Chronic Mesenteric Ischemia and the Importance of Long-Term Surveillance

Angiology ◽  
2016 ◽  
Vol 68 (10) ◽  
pp. 841-842
Author(s):  
Jesse A. Columbo ◽  
Ravinder Kang ◽  
Philip P. Goodney
Keyword(s):  
Mesenteric Ischemia ◽  
Chronic Mesenteric Ischemia

Factors predicting long-term outcomes of percutaneous angioplasty and stenting of the superior mesenteric artery for chronic mesenteric ischemia

VASA ◽  
2021 ◽  
Author(s):  
Joris Awouters ◽  
Thomas Jardinet ◽  
Martin Hiele ◽  
Annouschka Laenen ◽  
Steven Dymarkowski ◽  
...  
Keyword(s):  
Mesenteric Artery ◽  
Mesenteric Ischemia ◽  
Chronic Mesenteric Ischemia ◽  
Percutaneous Angioplasty ◽  
Long Term Outcomes ◽  
Relapse Free Survival ◽  
Free Survival ◽  
Angioplasty And Stenting

Summary: Background: To analyse the long-term outcomes of percutaneous angioplasty and stenting of the superior mesenteric artery (SMA) in the treatment of chronic mesenteric ischemia (CMI), and to assess predictive factors for a better clinical outcome. Patients and methods: Retrospective analysis of 76 consecutive patients, treated percutaneously for CMI between January 1999 and January 2018 and followed up until the end of 2018. Patients’ pre-, peri- and post-interventional clinical and radiological data were gathered from the institutional electronic medical records. The Kaplan Meier method with log rank test or the Cox model were used to analyse overall survival; the cumulative incidence function with Pepe and Mori test or the Fine and Grey model were used to analyse relapse-free survival, considering death as a competing event. Results: Seventy-six consecutive patients with a mean age of 72 years were included in the study. Catheter-angiography revealed an ostial or non-ostial >90% stenosis in n=23 (29.7%) and n=53 (69.7%) of included patients, respectively. Immediate clinical success was achieved in n=68 (89.5%), and procedural complications were observed in n=13 (17.1%) patients. Long-term follow-up revealed relapse of symptoms in n=21 (28.8%) patients, and overall survival estimates are 81.8%, 57.0% and 28.2% after two, five and ten years of follow-up, respectively. A trend towards longer relapse-free survival was found in the circumferential stenosis group (78.2% at five years) compared with the non-circumferential stenosis group (55.5%) (P=0.063). Conclusions: Angioplasty and stenting of the SMA for CMI is relatively safe and effective despite a substantial number of patients experiencing clinical relapse over time. Patients with focal, circumferential stenosis might have longer relapse-free survival than patients with non-circumferential stenosis.

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