Long-term Stent Outcomes for Chronic Mesenteric Ischemia

Abstract

Chronic mesenteric ischemia is a disease process that has significant morbidity and mortality. Stent placement for treatment of mesenteric occlusive disease had offered a minimally invasive alternative to open surgery. The objectives of this study were to identify long-term outcomes for mesenteric stenting in the setting of chronic mesenteric ischemia. A single vascular group’s database was retrospectively reviewed for all patients who underwent mesenteric artery stenting for chronic mesenteric ischemia between 2000 and 2019. Demographics, indications, operative details, and long-term results were recorded and compared. Standard statistics using life tables and t-tests were used. There were 275 patients who had stents placed: 186 superior mesenteric artery (SMA) stents, 61 celiac stents, and 28 both SMA and celiac stents. Average age was 71 years (range, 30-91 years). Demographic characteristics were as follows: hypertension, 39% (106/275); hyperlipidemia, 26% (70/275); tobacco, 20% (56/275); coronary disease, 21% (57/275); chronic obstructive pulmonary disease, 10% (28/275); and diabetes, 15% (41/275). Median follow-up was 60 months (range, 1-120 months). Celiac stent patency was 100%, 98%, 97%, 93%, and 87% at 1 month, 3 months, 6 months, 12 months, and 24 months, respectively. SMA stent patency was 97%, 96%, 93%, 90%, and 83% at 1 month, 3 months, 6 months, 12 months, and 24 months. Reintervention was required in 28% (77/275), of which 66% (51/77) was repeated angioplasty and 34% (26/77) was stent graft placement. The SMA stent length was 34.4 mm, and the celiac stent length was 33.7 mm. In the reintervention group, stent length was 33.7 mm; in the nonreintervention group, stent length was 42.3 mm (P = .001). Twenty-two patients crossed over to open mesenteric bypass (14 SMA, 8 celiac). Of the crossover patients, all 22 had reinterventions before converting to open repair (9 repeated stent placements as a reintervention before failure and 13 angioplasty procedures). Stenting for treatment of chronic mesenteric ischemia offers excellent patency and freedom from open bypass surgery. Very few stents fail and require open surgery. Shorter stent lengths appear to require statistically more reinterventions to maintain patency.