Percutaneous Intervention of Superior Mesenteric Artery Stenosis in Elderly Patients

Abstract

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.

Management of Pseudoaneurysm as a Delayed Complication after Using Rotational Atherectomy in Popliteal Artery Atherosclerosis: A Case Report

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Superior Mesenteric Artery Stenosis Presenting as Chest Pain: Danger in Disguise

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