Midterm Clinical Outcomes Of Retrograde Open Mesenteric Stenting For Mesenteric Ischemia

Abstract

<h3>INTRODUCTION AND OBJECTIVES</h3> Retrograde open mesenteric stenting (ROMS) has become a mainstay in treatment of mesenteric ischemia, however, follow-up in contemporary studies is limited. <h3>METHODS</h3> Single-center retrospective review of patients undergoing ROMS from 2007-2020 was conducted. Demographics, presentation, procedural details were reviewed. Endpoints were morbidity and mortality, technical success, primary patency, reinterventions, and freedom from clinical recurrence. <h3>RESULTS</h3> ROMS was performed in 34 patients, 19 female (56%). Mean age was 71±10 years. Eighteen patients (53%) presented with acute mesenteric ischemia (AMI), eleven (32%) with acute-on-chronic (ACMI), and five (15%) with chronic mesenteric ischemia (CMI). Etiology was chronic atherosclerosis with/without in-situ thrombosis in 28 patients (82%), SMA dissection in three, and one each with embolic, vasculitic, and non-occlusive ischemia. Four patients (12%) had prior mesenteric procedures (3 Celiac/1 SMA stent) and one had unsuccessful transbrachial stenting attempt. Technical success, defined as successful stenting through retrograde approach was 91%; three remaining patients were treated with transbrachial stenting in two patients and iliomesenteric bypass in one. Covered stents were utilized in 21 patients(64%). Eight patients(23%) required thromboembolectomy and nine(26%) underwent patch angioplasty. Thirty-day mortality rate was 35%, all in patients with AMI (10) or ACMI (2). Eighteen patients (53%) underwent bowel resection, all presenting acutely. Early reinterventions were required in 5 patients (15%); two redo ROMS with thrombectomy and endarterectomy, two percutaneous stent extensions, one aortic septum fenestration. At a median follow-up of 3.7(0.1-8.4) years, cumulative reintervention rate was 24% (8 patients, all four late reinterventions were endovascular with no conversion to bypass), primary patency was 73%(primary-assisted patency 91%, secondary patency 97%), and freedom from clinical recurrence was 95%. <h3>CONCLUSIONS</h3> ROMS carries high rates of technical success in patients with mesenteric ischemia, despite high chronic atherosclerotic burden. While mid-term patency rates are acceptable, early mortality and bowel resection remain common in acute presentations.