Mesenteric artery complications during angioplasty and stent placement for atherosclerotic chronic mesenteric ischemia

Abstract

Objective The purpose of this study was to describe the incidence, management, and outcomes of mesenteric artery complications (MACs) during angioplasty and stent placement (MAS) for chronic mesenteric ischemia (CMI). Methods We retrospectively reviewed the clinical data of 156 patients treated with 173 MAS for CMI (1998–2010). MACs were defined as procedure-related mesenteric artery dissection, stent dislodgement, embolization, thrombosis, or perforation. End points were procedure-related morbidity and death. Results There were 113 women and 43 men (mean age, 73 ± 14 years). Eleven patients (7%) developed 14 MACs, including distal mesenteric embolization in six, branch perforation in three, dissection in two, stent dislodgement in two, and stent thrombosis in one. Five patients required adjunctive endovascular procedures, including in two patients each, catheter-directed thrombolysis or aspiration, retrieval of dislodged stents, and placement of additional stents for dissection. Five patients (45%) required conversion to open repair: two required evacuation of mesenteric hematoma, two required mesenteric revascularization, and one required bowel resection. There were four early deaths (2.5%) due to mesenteric embolization or myocardial infarction in two patients each. Patients with MACs had higher rates of mortality (18% vs 1.5%) and morbidity (64% vs 19%; P <.05) and a longer hospital length of stay (6.3 ± 4.2 vs 1.6 ± 1.2 days) than those without MACs. Periprocedural use of antiplatelet therapy was associated with lower risk of distal embolization or vessel thrombosis (odds ratio, 0.2; 95% confidence interval, 0.06–0.90). Patients treated by a large-profile system had a trend toward more MACs (odds ratio, 1.8; 95% confidence interval, 0.7–26.5; P = .07). Conclusions MACs occurred in 7% of patients who underwent MAS for CMI and resulted in higher mortality, morbidity, and longer hospital length of stay. Use of antiplatelet therapy reduced the risk of distal embolization or vessel thrombosis. There was a trend toward more MACs in patients who underwent interventions performed with a large-profile system.

The Ongoing Challenge of Acute Mesenteric Ischemia

“…Rarer are perforation of the target vessels (19%), dissections (10%), as well as acute stent dislocations and acute in-stent thrombosis (10%) [22]. A significant drawback of ET are the early and late outcomes, which are worse compared to open repair, although they are not relevant for the short-term prognosis of AMI [23].…”

Recanalization of superior mesenteric artery chronic total occlusion using hybrid algorithm and dissection reentry device

“…Oderich et al reported 7% major complication rate in 156 patients who underwent mesenteric artery angioplasty and stenting, mostly (98%) with balloon expandable bare metal stents (BMS). Six patients had distal mesenteric embolization, three with jejunal branch perforation, two with isolated dissection, two with stent dislodgement associated with severe SMA angulation and one with stent thrombosis …”

Mesenteric ischemia: Pathogenesis and challenging diagnostic and therapeutic modalities

“…Parenteral nutrition is warranted because of the long period of malnutrition [5,28] . Open revascularization (OR) and endovascular revascularization (ER) are the alternative modalities of treatment in patients with CMI [50][51][52] . ER appears to have lower postoperative mortality and morbidity rates and shorter intensive care unit and hospital stay.…”

“…An embolic protection device may be considered in the presence of a large thrombus burden. However, there is limited evidence showing its efficacy during ER for CMI [37,50,51] .…”