Comparative analysis of celiac versus mesenteric artery outcomes after angioplasty and stenting

Abstract

Background: Open bypass is the gold standard for treatment of mesenteric ischemia. With the refinement of endovascular therapy, visceral stenting is an attractive minimally invasive alternative, but the data are limited and which vessel responds best to stenting has not been addressed. This study compares the outcomes of superior mesenteric artery (SMA) and celiac artery (CA) stenting.

Methods: All consecutive patients who underwent visceral stenting between January 2002 and May 2009 were reviewed. Standard statistical analyses, including Kaplan-Meier tests, were performed. Primary patency was defined as peak systolic velocities <350 cm/s for CAs and <450 cm/s for SMAs. Clinical patency was maintenance of either primary patency or the absence of recurrent symptoms. At arteriography, stenosis ≥70% was considered a loss of primary patency.

Results: One hundred twenty-one patients received 140 visceral stents in the SMA (n = 92; 65.7%), the CA (n = 40; 28.6%), and the inferior mesenteric artery (n = 8; 5.7%). Twenty-nine stents were placed in men (20.7%) and 111 stents were placed in women (79.3%) with a mean age of 72.9 years (range, 20.5-93.9). The combined SMA/CA stent mean follow-up was 12.8 months. Technical success was 100% for all. Overall 30-day morbidity and mortality rates were 14% and 0.8%, respectively. One-year primary patency was significantly higher for SMA than for CA stents: 55% versus 18%, respectively (P < .0001). Six-month clinical patency was 86% for the SMA and 67% for the CA (P < .005). Loss of CA primary patency was associated with stent diameter <6 mm (P = .042) and age <50 years (two patients; P = .038). These factors did not correlate with loss of primary patency for SMA. Overall freedom from bypass was 93% at 4 years.

Conclusions: Visceral stenting has an exceptionally high technical success rate with low procedural morbidity and mortality. Clinical primary patency and primary patency were significantly higher for the SMA group than for the CA group. Our data suggest that CA atherosclerotic lesions do not respond well to endovascular stenting, bringing into question its clinical utility.