Improving midterm results justify the continued use of bare-metal stents for endovascular therapy for chronic mesenteric ischemia

Abstract

ObjectiveThe objective of this study was to evaluate the contemporary results of interventions in the celiac axis (CA) and superior mesenteric artery (SMA) for chronic mesenteric ischemia (CMI) and factors associated with patency and symptom-free survival. MethodsA retrospective review of patients with CMI treated with angioplasty and stenting with bare-metal stents from 2003 to 2014 was conducted. Demographic, history, risk factor, preoperative testing, and technical variables were collected and subject to univariate analysis, with end points of patency loss. The patients were divided into early (2003-2008) and late (2009-2014) groups to compare early and contemporary results. Correlates of patency were then subject to further univariate and multivariable analysis. ResultsFrom 2003 to 2014, there were 150 patients (39 men, 111 women; age, 70.7 ± 11.1 years) with CMI who underwent interventions on the CA (56 vessels) and the SMA (133 vessels); 38 patients had both CA and SMA intervention. Primary patency for the CA was 86% (95% confidence interval [CI], 73-99) at 1 year and 66% (95% CI, 46-87) 3 years; for the SMA, primary patency was 81% (95% CI, 72-89) at 1 year and 69.0% (95% CI, 58-81) at 3 years. Increased age was associated with improved results in the SMA (hazard ratio [HR], 0.96; 95% CI, 0.92-1.00; P = .028). Chronic total occlusion in the SMA conferred worse patency compared with stenosis (HR, 2.38; 95% CI, 1.03-5.47; P = .042), and younger patients (<70 years) had a higher proportion of SMA occlusion (38.9% vs 22.8; P = .045). In the SMA, comparing early (2003-2008; 68 patients) vs late (2009-2014; 65 patients), primary patency was better in the late experience (3 years, 59% vs 77%; P = .016). The late cohort was older (early, 68.1 ± 12.5 years vs 72.5 ± 9.7 years; P = .024). The late cohort had a higher incidence of ostial flaring of the stent (early, 44.1%; late, 72.3%; P < .001). Multivariable analysis revealed only ostial flaring to be associated with improved patency in the SMA (HR, 0.29; 95% CI, 0.12-0.69; P = .006). ConclusionsIntervention for CMI has acceptable midterm results, and with experience and adoption of newer techniques, the results appear to be improving. Patients older than 70 years have better results than younger patients, and this may reflect a more malignant presentation in the younger patients. Ostial flaring proved to be the single factor on multivariate analysis associated with improved patency and was adopted in the late group. These data support the continued use of bare-metal stents in the treatment of CMI.