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THE JOURNAL OF CARDIOVASCULAR SURGERY

Rivista di Chirurgia Cardiaca, Vascolare e Toracica


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The Journal of Cardiovascular Surgery 2017 April;58(2):321-8

DOI: 10.23736/S0021-9509.16.09829-3

Copyright © 2016 EDIZIONI MINERVA MEDICA

lingua: Inglese

Chronic mesenteric ischemia: when and how to intervene on patients with celiac/SMA stenosis

Juliëtte BLAUW 1, 2, Tomas BULUT 3, Paul EENHOORN 1, Roland J. BEUK 1, Marjolein BRUSSE-KEIZER 4, Jeroen J. KOLKMAN 5, 6, Robert H. GEELKERKEN 1, 7

1 Division of Vascular Surgery, Department of Surgery, Medical Spectrum Twente, Enschede, The Netherlands; 2 Department of Surgery, Isala Clinics, Zwolle, The Netherlands; 3 Department of Radiology, Medical Spectrum Twente, Enschede, The Netherlands; 4 Department of Epidemiology, Medical Spectrum Twente, Enschede, The Netherlands; 5 Department of Gastroenterology, Medical Spectrum Twente, Enschede, The Netherlands; 6 Department of Gastroenterology, University Medical Center Groningen, University of Groningen, Groningen, Belgium; 7 Experimental Center of Technical Medicine, Faculty of Science and Technology, University Twente, Enschede, The Netherlands


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BACKGROUND: Studies that compared open surgical mesenteric artery repair (OSMAR) with percutaneous mesenteric artery stenting (PMAS) in patients with chronic mesenteric ischemia (CMI) are based on merely older studies in which only a minority of patients received PMAS. This does not reflect the current PMAS-first choice treatment paradigm. This article focused on the present opinions and changes in outcomes of OSMAR for CMI in the era of preferred use of PMAS.
METHODS: Patients who received OSMAR for CMI from 1997 until 2014 in a tertiary referral centre for chronic mesenteric ischemia were included in this report. Patients were divided into two groups, the historical OSMAR preferred group and present PMAS preferred group.
RESULTS: Patient characteristics, SVS comorbidity severity score, clinical presentation and number of diseased mesenteric arteries were not significantly changed after the widespread introduction of PMAS. In the present PMAS first era there were trends of less open surgical mesenteric artery multivessel repair, less antegrade situated bypasses, decreased clinical success but improved survival after OSMAR.
CONCLUSIONS: Elective OSMAR should only be used in patients with substantial physiologic reserve and who have unfavourable mesenteric lesions, failed PMAS or multiple recurrences of in-stent stenosis/occlusion. PMAS in CMI patients is evolved from “bridge to surgery” to nowadays first choice treatment and “bridge to repeated PMAS” in almost all patients with CMI.


KEY WORDS: Mesenteric ischemia - Vascular diseases - Vascular surgical procedures - Vascular patency

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Publication History

Issue published online: February 27, 2017
Article first published online: December 19, 2016

Per citare questo articolo

Blauw J, Bulut T, Eenhoorn P, Beuk RJ, Brusse-Keizer M, Kolkman JJ, et al. Chronic mesenteric ischemia: when and how to intervene on patients with celiac/SMA stenosis. J Cardiovasc Surg 2017;58:321-8. DOI: 10.23736/S0021-9509.16.09829-3

Corresponding author e-mail

r.geelkerken@mst.nl