Mesenteric stenting for chronic mesenteric ischemia

Brown, D J; Schermerhorn, Marc L.; Powell, Richard J.; Fillinger, Mark F.; Rzucidlo, Eva M.; Walsh, Daniel B.; Wyers, Mark C.; Zwolak, Robert M.; Cronenwett, Jack L.

doi:10.1016/j.jvs.2005.03.054

Cited by 147 publications

(106 citation statements)

References 16 publications

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“…However, stent patients were 7 times as likely to develop restenosis (p<0.01), 4 times more likely to develop recurrent symptoms (p<0.01), and 15 times more likely to undergo reintervention (Table 1). 5 …”

Section: Discussionmentioning

confidence: 99%

“…The recent availability of embolic protection and low-profile devices with the theoretical ability to decrease perioperative bowel necrosis, led us to begin using mesenteric stenting for patients with CMI. 5 Endovascular therapy seems to be a valid alternative, mainly in high-risk patients, but potentially for all patients, with good immediate and medium-term results. 4 Mesenteric stenting for CMI can be performed with low perioperative risk.…”

Section: Discussionmentioning

confidence: 99%

“…6,12 Patients with severe nutritional depletion or high surgical risk benefit from mesenteric stenting for CMI, but close follow-up is required. 5 Surgical treatment has superior long-term patency and requires fewer reinterventions, but it is also more invasive with greater morbidity and mortality compared to endovascular treatment. 8 Patients older than 70 y with other comorbidities and poor nutritional status had increased operative mortality and decreased survival rates.…”

Section: Discussionmentioning

confidence: 99%

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Percutaneous Intervention of Superior Mesenteric Artery Stenosis in Elderly Patients

Penugonda

Gardi

Schreiber

2009

Clinical Cardiology

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This review article focuses on stent placement in mesenteric arteries in older patients with an increasingly common diagnosis of chronic mesenteric ischemia (CMI). We reviewed the articles that focused on the treatment of this gastrointestinal disorder by stenting/open surgical revascularization to avoid further ischemic episodes and bowel infarction and necrosis. The advantages of stent placement in mesenteric arteries are discussed in comparison to open surgical revascularization. In summary, the low morbidity and high technical success rate of catheter-based techniques have made this approach the first line of therapy for CMI due to superior mesenteric artery stenosis for many elderly patients especially high-risk operative candidates. BackgroundClinical manifestations of chronic mesenteric ischemia (CMI) can range from vague abdominal pain to debilitating states of intestinal angina resulting in significant weight loss and morbidity. CMI due to atherosclerotic occlusive disease was first reported in 1936 and is a relatively uncommon disorder. This entity usually occurs in patients over 60 y of age with other atherosclerotic symptoms. The rise in an aging population in the coming years could result in an increasing prevalence of chronic mesenteric ischemia. 1 Once the condition has been diagnosed, treatment is usually elective, except in rare cases of rapid progression to acute mesenteric ischemia. Medical management of CMI is mostly supportive. 2 If CMI is diagnosed, there are two therapeutic options: (1) surgical revascularization of 1 of the stenosed or occluded mesenteric arteries or (2) radiological intervention employing percutaneous transluminal angioplasty (PTA) with or without stent placement of 1 or more mesenteric arteries. The success of surgery or radiological intervention is determined by the relief of symptoms and the durability of such relief. 3 Traditional treatment consists of open surgical (OS) revascularization. Despite significant perioperative morbidity and mortality rates, OS revascularization has traditionally been the treatment of choice. The most frequent indications include pain relief, improvement of nutritional status, and prevention of intestinal infarction. Endovascular therapy seems to be a valid alternative, mainly in high-risk patients, with good immediate and medium-term results.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Percutaneous Intervention of Superior Mesenteric Artery Stenosis in Elderly Patients

Penugonda

Gardi

Schreiber

2009

Clinical Cardiology

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“…However, endovascular www.intechopen.com management remains largely limited to patients with CMI. Balloon angioplasty and stenting are the most common interventions, and recent reports have documented excellent technical results with low patient morbidity.Endovascular therapy should be the treatment of choice in high-risk patients with CMI (13,14,15,16). High technical success rates and decreased patient morbidity and mortality rates have been reasonably well established in such individuals.…”

Section: Endovascular Treatmentmentioning

confidence: 99%

Mesenteric Vascular Disease

Jomha¹

2012

New Advances in the Basic and Clinical Gastroenterology

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“…Heparin anticoagulation and antibiotics should be continued. Papaverine may be administered to reduce vasospasm (Ward et al 1995;Brown et al 2005).…”

Section: Treatmentmentioning

confidence: 99%

Mesenteric Ischemia: Still a Deadly Puzzle for the Medical Community

Stamatakos

Stefanaki

Mastrokalos

et al. 2008

Tohoku J. Exp. Med.

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The main goal of this article is to update etiology, epidemiology, diagnosis, treatment and outcome of the various causes of mesenteric ischemia in order to elucidate its labyrinthine clinical riddle, by reviewing the current English medical literature. Mesenteric ischemia is a quite uncommon disorder, observed in the emergency department. It is a lifethreatening vascular emergency that requires early diagnosis and intervention to restore mesenteric blood flow and to prevent bowel necrosis and patient death. Consequently, it is a vital diagnosis to make because of its high mortality rate and its thorny complications. The underlying causes vary, and the prognosis depends on the specific findings during clinical examination. Vague and nonspecific clinical findings and limitations of diagnostic studies make the diagnosis a significant challenge. The prognosis of acute mesenteric ischemia of any type is grave. The complications following this medical jigsaw puzzle are also severe. Patients in whom the diagnosis is missed until infarction occurs have a mortality rate of 90%. Even with good treatment, up to 50-80% of patients die. Survivors of extensive bowel resection face lifelong disability. Despite the progress in understanding the pathogenesis of mesenteric ischemia and the development of treatment modalities, the entity remains a diagnostic challenge for clinicians. Delay in diagnosis contributes to a high mortality rate. Early diagnosis and adequate treatment can improve the clinical outcome. Even if diagnostic modalities have improved since the first successful attempts to confront effectively this clinical entity, mesenteric ischemia still remains a lethal diagnostic enigma for the medical community.Mesenteric Ischemia; thrombosis; bowel infarction; atherosclerosis; mesenteric venous thrombosis; mesenteric thromboendarterectomy.Tohoku

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Mesenteric stenting for chronic mesenteric ischemia

Cited by 147 publications

References 16 publications

Percutaneous Intervention of Superior Mesenteric Artery Stenosis in Elderly Patients

Percutaneous Intervention of Superior Mesenteric Artery Stenosis in Elderly Patients

Mesenteric Vascular Disease

Mesenteric Ischemia: Still a Deadly Puzzle for the Medical Community

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