Intestinal angina: percutaneous transluminal angioplasty of the celiac and superior mesenteric arteries.

Abstract

Percutaneous transluminal angioplasty (PTA) was performed in ten patients with chronic ischemia of the mesenteric arteries and stenoses of the celiac artery and/or the superior mesenteric artery (SMA). PTA was performed on 14 occasions, with attempted dilation of 19 arteries. PTA was technically unsuccessful in two patients. Seventeen of 19 arteries (90%) were successfully dilated in eight patients, resulting in relief of symptoms that lasted from 6 to 24 months. Symptoms recurred in five patients, and redilation in three of them relieved the symptoms. Three patients, one of them following redilation, remained asymptomatic 7-9 months following PTA. An asymptomatic intimal dissection of the SMA was the only complication attributable to the procedure. PTA of celiac and SMA stenoses is an alternative to surgical revascularization and can be repeated if symptoms recur.

Endovascular Treatment of Chronic Mesenteric Ischemia

“…[2][3][4] Balloon angioplasty for CMI has been reported occasionally after it was first used in 1980, 5 but patency in the chronic phase (6-24 months) is generally insufficient (about 50-80%). [6][7][8][9] The outcome of this procedure has been improved by the development of stents, and a review of recent reports [10][11][12][13][14][15] indicates a procedural success rate of 88-100% and a clinical success rate of 82-100%, with a complication rate of 3-16%. Twelve patients experienced complications in these reports: in 8 (67%) the complication occurred at a vascular access site (false aneurysm and hematoma in 4 and 4 patients, respectively), and arterial dissection, multiorgan failure, contrast medium-associated renal disorder, and arterial occlusion each occurred in 1 case.…”

Angioplastia com implante de "stent" na artéria mesentérica superior

“…1 A abordagem cirúrgica, entretanto, é provida de significativas taxas de morbidade e mortalidade (3% a 8%), especialmente nos pacientes idosos. 3,4 Desta forma, a ATP pode ser uma atraente alternativa terapêutica. 3,4 A maior experiência com a prática da ATP em vasos viscerais tem sido adquirida com dilatação de lesões do terço proximal das artérias renais.…”

“…3,4 Desta forma, a ATP pode ser uma atraente alternativa terapêutica. 3,4 A maior experiência com a prática da ATP em vasos viscerais tem sido adquirida com dilatação de lesões do terço proximal das artérias renais. Esta prática tem mostrado que a dilatação de lesões estenóticas ostiais apresentam maiores índices de insucesso que as estenoses mais distais, 1,4 em consequência da retração elástica própria da parede aórtica.…”

“…Os casos de recorrência podem ainda sofrer nova ATP com sucesso em sua maioria. 3,4 O tratamento da isquemia mesentérica crônica por ATP tem apresentado taxa de sucesso técnico de 30% a 100%, com sucesso clínico imediato de 75% a 100%.…”

Spontaneous Isolated Dissection of the Superior Mesenteric Artery.

“…Indications for surgery ( 1 8) seem to be : an increasing size of the aneurismal dilatation of the SMA,thrombosis of the lumen of the SMAor symptoms persisting despite anticoagulation therapy. Other invasive, but effective therapies, such as laparoscopic operations (19) and catheter intervention (20), have been reported. The prognosis of peripheral artery dissections is still unclear, and the results of non-operative cases with this condition are also unknown.…”