Results of single- and two-vessel mesenteric artery stents for chronic mesenteric ischemia.

摘要

BACKGROUND: To describe the outcomes of single- and two-vessel mesenteric artery stents in patients with chronic mesenteric ischemia (CMI). METHODS: We reviewed 101 patients (41 men and 60 women; mean age, 73 +/- 13 years) treated with mesenteric artery stents for atherosclerotic CMI between 1998 and 2008. Clinical data and outcomes were reviewed in patients treated with single superior mesenteric artery (SMA) stent (group A) or two-vessel celiac artery (CA) and SMA stent (group B). Isolated CA stenting was analyzed as a separate group (group C). End-points were taken as differences in morbidity and mortality and freedom from recurrent symptoms and reinterventions. RESULTS: There were 61 patients in group A, 24 in group B, and 16 in group C. All three groups had similar demographics, cardiovascular risk factors, and clinical presentation. There were no differences in early mortality (2%, 4%, and 0%), morbidity (18%, 26%, and 12%), and symptom relief (95%, 78%, and 100%) between groups A, B, and C, respectively (p value was not significant). Mean follow-up was 41 +/- 17 months. Freedom for reintervention at 1 and 3 years was similar among patients in groups A (86 +/- 5% and 50 +/- 9%), B (67 +/- 11% and 67 +/- 11%), and C (63 +/- 13% and 63 +/- 13%), respectively (p value was not significant). There were no significant differences in freedom from restenosis at 1 and 3 years among patients in groups A (54 +/- 7% and 44 +/- 9%), B (47 +/- 12% and 39 +/- 12%), and C (43 +/- 13% and 34 +/- 13%), respectively. Primary and secondary patency rates at 3 years were 57% and 96% for SMA and 61% and 87% for CA stents, respectively (p value was not significant). CA stent alone was associated with symptom recurrence in 6 of 16 patients (38%), as compared with the recurrence rate of 18% (11 of 61) in patients who underwent SMA stent placement (p = 0.06). CONCLUSION: Two-vessel CA and SMA stenting do not reduce the incidence of recurrent symptoms or reinterventions when compared with single-vessel SMA stents in patients with CMI. CA stent alone carries a high risk of recurrence.