Minimally invasive treatment of chronic mesenteric ischemia

Using catheter techniques perfected in the arteries of the heart, interventional cardiologists are successfully treating chronic mesenteric ischemia, a condition akin to intestinal angina.

According to a study reported at the 30th Annual Scientific Sessions of the Society for Cardiovascular Angiography and Interventions (SCAI), angioplasty and stenting of clogged arteries in the abdomen successfully restored blood flow to the intestines and relieved painful symptoms in more than 90 percent of patients, without major complications.

"Chronic mesenteric ischemia is an ideal condition for treatment with nonsurgical interventions," said David E. Allie, M.D., director of cardiothoracic, vascular and endovascular surgery at the Cardiovascular Institute of the South in Lafayette, LA. "Angioplasty and stenting are simple and safe, and many times today can be done as an outpatient procedure."

Chronic mesenteric ischemia can be tricky to diagnose. Patients may suffer nausea, vomiting, or pain after eating symptoms often mistaken for gallbladder disease or gastroenteritis. Eventually they may develop a fear of eating and lose large amounts of weight. Surgical treatment of chronic mesenteric ischemia results in death in as many as 15 percent of patients, in part because the procedure is complex it typically takes four to eight hours to perform but also because patients are debilitated by the time the diagnosis is finally made. In about one-third of patients, the diseased artery suddenly becomes completely blocked, gangrene develops in the bowel, and infection spreads throughout the body. More than half of such patients die, even with surgery.

To evaluate the effectiveness of stenting for chronic mesenteric ischemia, Dr. Allie and his colleagues recruited 50 patients with a total of 74 areas of narrowing, or stenosis, in the superior mesenteric or celiac arteries. In most cases, the procedure was performed by passing a catheter from the femoral artery in the groin up through the abdominal aorta and into the arteries supplying blood to the intestines. (In some cases, the catheter was introduced into the brachial artery in the arm and passed downward through the aorta.) A balloon was inflated to expand a large bare metal stent, which was left in place to prop open the artery at the site of the blockage.

Angioplasty and stenting were successful in 96 percent of patients, without major complications. More than 90 percent of patients reported relief of abdominal pain, and a similar percentage reported gaining weight. Fifteen patients (19 percent) later developed renarrowing of the stented artery. Of these, 3 were treated medically and 12 (92 percent) had repeat procedures to reopen the artery, including laser treatment in 8. At 1 year, 91 percent of patients were alive and free of symptoms. Two- and 3-year symptom-free survival rates were 88 percent and 82 percent, respectively.

Dr. Allie said that greater awareness and early diagnosis are critical. "We now have the tools for minimally invasive treatment of chronic mesenteric ischemia," he said. "Patients and physicians need to know that this condition exists, is common, and is often confused with other conditions of the digestive tract."

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