Stenting of Superior Mesenteric Artery
Chronic Total Occlusions in Patients
with Chronic Mesenteric Ischemia:
Technical and Clinical Outcomes
Grilli CJ, Fedele CR, Tahir OM, Velez JD, Wrigley C, McGarry
M, Ali MA, Agriantonis D, Kimbiris G, Garcia MJ, Leung DA
Christiana Care Health System, Newark DE/US
Chronic Mesenteric Ischemia
• Bowel manifestation of PAD
• Atherosclerosis
– hardening of arteries
– plaque buildup  blockage
• Blockage of arteries supplying bowel
–
–
–
–
pain after eating
fear of food
weight loss
death
Chronic Mesenteric Ischemia
• Bowel arteries
– celiac artery
– superior mesenteric artery
– inferior mesenteric artery
• Grading arterial blockages:
– progressive atherosclerotic plaque
– stenosis: 60-99% blockage
• amenable to endovascular stenting
– occlusion: 100% blockage
• usually managed surgically
Background
CMI1
SMA
Occlusion
SMA Stenosis
Surgery
Endovascular
Surgery
Endovascular
Stent
Celiac/IMA
stenosis
1. Sreenarasimhaiah J: Chronic Mesenteric Ischemia. Best Pract Res
Clin Gastroenterol. 19(2):283-95, 2005
Stent SMA
occlusion
Purpose
• To investigate the feasibility and effectiveness of
endovascular stenting of superior mesenteric
artery occlusions (100% blockages) in patients
with chronic mesenteric ischemia
Methods
• 47 patients
– 18 male, 29 female
– mean age 73 yrs, range 44-87
• All patients with clinical symptoms of CMI > 1mo
N
%
Postprandial pain
47
100
Weight loss (>5lb)
33
70
Food fear
18
38
Early satiety
16
34
Diarrhea
21
45
Nausea/vomiting
20
43
72 y/o female, food fear, 45 lb weight loss
Results
PROCEDURE SUCCESS
• Achieved in 41/47 (87%)
• 6 unsuccessful procedures:
– 2 went on to bypass
– 3 received celiac stents
– 1 lost to follow-up
Success
Failure
Results
INITIAL SYMPTOM IMPROVEMENT
40
• Symptom Improvement < 30 d
– 4 point scale
1 significant improvement
2 partial improvement
3 no change
4 worsening of symptoms
N=41
1
1
2
0
3
0
4
Results
FOLLOW-UP BY ULTRASOUND
• Primary patency (months):
– 97% @ 12
– 75% @ 24
• Recurrent blockage of SMA:
– 7 patients
– all had repeat endovascular
procedures
• Secondary patency
– 100% @ 12
– 97% @ 24
Results
SYMPTOMS
• Symptom-free
– 100% @ 12 mo
– 88% @ 24 mo
Conclusions
• Endovascular stenting of complete blockages of
the SMA is a safe and effective procedure
–
–
–
–
minimally-invasive
good technical success rate
easily repeatable
excellent clinical outcomes