Stenting of Superior Mesenteric Artery Chronic Total Occlusions in Patients with Chronic Mesenteric Ischemia: Technical and Clinical Outcomes - PowerPoint PPT Presentation

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Stenting of Superior Mesenteric Artery Chronic Total Occlusions in Patients with Chronic Mesenteric Ischemia: Technical and Clinical Outcomes

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Stenting of Superior Mesenteric Artery Chronic Total Occlusions in Patients with Chronic Mesenteric Ischemia: ... (omniflush) flush occlusion without stump, ... – PowerPoint PPT presentation

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Title: Stenting of Superior Mesenteric Artery Chronic Total Occlusions in Patients with Chronic Mesenteric Ischemia: Technical and Clinical Outcomes


1
Stenting of Superior Mesenteric Artery Chronic
Total Occlusions in Patients with Chronic
Mesenteric Ischemia Technical and Clinical
Outcomes
Grilli CJ, Fedele CR, Tahir OM, Velez JD, Wrigley
C, McGarry M, Ali MA, Agriantonis D, Kimbiris G,
Garcia MJ, Leung DA Christiana Care Health
System, Newark DE/US
2
Chronic Mesenteric Ischemia
  • Bowel manifestation of PAD
  • Atherosclerosis
  • hardening of arteries
  • plaque buildup ? blockage
  • Blockage of arteries supplying bowel
  • pain after eating
  • fear of food
  • weight loss
  • death

3
Chronic Mesenteric Ischemia
  • Bowel arteries
  • celiac artery
  • superior mesenteric artery
  • inferior mesenteric artery
  • Grading arterial blockages
  • progressive atherosclerotic plaque
  • stenosis 60-99 blockage
  • amenable to endovascular stenting
  • occlusion 100 blockage
  • usually managed surgically

4
Background

1. Sreenarasimhaiah J Chronic Mesenteric
Ischemia. Best Pract Res Clin Gastroenterol.
19(2)283-95, 2005
5
Purpose
  • To investigate the feasibility and effectiveness
    of endovascular stenting of superior mesenteric
    artery occlusions (100 blockages) in patients
    with chronic mesenteric ischemia

6
Methods
  • 47 patients
  • 18 male, 29 female
  • mean age 73 yrs, range 44-87
  • All patients with clinical symptoms of CMI gt 1mo

N
Postprandial pain 47 100
Weight loss (gt5lb) 33 70
Food fear 18 38
Early satiety 16 34
Diarrhea 21 45
Nausea/vomiting 20 43
7
72 y/o female, food fear, 45 lb weight loss
8
ResultsPROCEDURE SUCCESS
  • Achieved in 41/47 (87)
  • 6 unsuccessful procedures
  • 2 went on to bypass
  • 3 received celiac stents
  • 1 lost to follow-up

9
ResultsINITIAL SYMPTOM IMPROVEMENT
  • Symptom Improvement lt 30 d
  • 4 point scale
  • significant improvement
  • partial improvement
  • no change
  • worsening of symptoms

N41
10
ResultsFOLLOW-UP BY ULTRASOUND
  • Primary patency (months)
  • 97 _at_ 12
  • 75 _at_ 24
  • Recurrent blockage of SMA
  • 7 patients
  • all had repeat endovascular procedures
  • Secondary patency
  • 100 _at_ 12
  • 97 _at_ 24

11
ResultsSYMPTOMS
  • Symptom-free
  • 100 _at_ 12 mo
  • 88 _at_ 24 mo

12
Conclusions
  • Endovascular stenting of complete blockages of
    the SMA is a safe and effective procedure
  • minimally-invasive
  • good technical success rate
  • easily repeatable
  • excellent clinical outcomes
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