Multicenter study of retrograde open mesenteric artery stenting through laparotomy for treatment of acute and chronic mesenteric ischemia.
Multicenter study of retrograde open mesenteric artery stenting through laparotomy for treatment of acute and chronic mesenteric ischemia.
- 2018
Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006
CONCLUSIONS: ROMS offers an alternative to bypass or percutaneous stenting in patients with AMI who require abdominal exploration and in those who have flush mesenteric occlusions and have failed to respond to or are considered unsuitable for stenting by a percutaneous approach. Despite high technical success, mortality remains elevated in patients with AMI. Patency rates and freedom from symptom recurrence and reinterventions are comparable to the results achieved with stenting using percutaneous technique. Copyright (c) 2018 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved. METHODS: We reviewed the clinical data and outcomes of all consecutive patients treated by ROMS in seven academic centers from 2001 to 2013. ROMS was performed through laparotomy with retrograde access into the target mesenteric artery and stent placement using a retrograde or antegrade approach. End points were early (<30 days) and late mortality, morbidity, patency rates, and freedom from symptom recurrence and reintervention. OBJECTIVE: Retrograde open mesenteric stenting (ROMS) through laparotomy was introduced as an alternative to surgical bypass in patients with acute mesenteric ischemia (AMI). The purpose of this study was to evaluate the indications and outcomes of ROMS for treatment of AMI and chronic mesenteric ischemia. RESULTS: There were 54 patients, 13 male and 41 female, with a mean age of 72 +/- 11 years. Indications for ROMS were AMI in 44 patients (81%) and subacute-on-chronic mesenteric ischemia with flush mesenteric occlusion in 10 patients (19%). A total of 56 target mesenteric vessels were stented, including 52 superior mesenteric arteries and 4 celiac axis lesions, with a mean treatment length of 42 +/- 26 mm. Retrograde mesenteric access was used in all patients, but 16 patients also required a simultaneous antegrade brachial approach. The retrograde puncture was closed primarily in 34 patients and with patch angioplasty in 17 patients; 1 patient had manual compression. Bowel resection was needed in 29 patients (66%) with AMI because of perforation or gangrene. Technical success was achieved in all (98%) except one patient for whom ROMS failed, who was treated by bypass. Early mortality was 45% (20/44) for AMI and 10% (1/10) for subacute-on-chronic mesenteric ischemia (P = .04). Early morbidity was 73% for AMI and 50% for subacute-on-chronic mesenteric ischemia (P = .27). Patient survival for the entire cohort was 43% +/- 9% at 2 years. Primary patency and secondary patency at 2 years were 76% +/- 8% and 90% +/- 8%, respectively. Freedom from symptom recurrence and freedom from reinterventions were 72% +/- 8% and 74% +/- 8% at the same interval.
English
0741-5214
*Endovascular Procedures/is [Instrumentation]
*Laparotomy
*Mesenteric Artery, Superior/su [Surgery]
*Mesenteric Ischemia/su [Surgery]
*Mesenteric Vascular Occlusion/su [Surgery]
*Stents
Academic Medical Centers
Acute Disease
Aged
Aged, 80 and over
Angiography
Chronic Disease
Disease-Free Survival
Endovascular Procedures/ae [Adverse Effects]
Endovascular Procedures/mt [Methods]
Female
Humans
Kaplan-Meier Estimate
Laparotomy/ae [Adverse Effects]
Laparotomy/mo [Mortality]
Male
Mesenteric Artery, Superior/dg [Diagnostic Imaging]
Mesenteric Artery, Superior/pp [Physiopathology]
Mesenteric Ischemia/dg [Diagnostic Imaging]
Mesenteric Ischemia/mo [Mortality]
Mesenteric Ischemia/pp [Physiopathology]
Mesenteric Vascular Occlusion/dg [Diagnostic Imaging]
Mesenteric Vascular Occlusion/mo [Mortality]
Mesenteric Vascular Occlusion/pp [Physiopathology]
Middle Aged
Postoperative Complications/mo [Mortality]
Postoperative Complications/th [Therapy]
Retreatment
Retrospective Studies
Risk Factors
Splanchnic Circulation
Time Factors
Treatment Outcome
United States
Vascular Patency
MedStar Washington Hospital Center
Surgery/Vascular Surgery
Journal Article
Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006
CONCLUSIONS: ROMS offers an alternative to bypass or percutaneous stenting in patients with AMI who require abdominal exploration and in those who have flush mesenteric occlusions and have failed to respond to or are considered unsuitable for stenting by a percutaneous approach. Despite high technical success, mortality remains elevated in patients with AMI. Patency rates and freedom from symptom recurrence and reinterventions are comparable to the results achieved with stenting using percutaneous technique. Copyright (c) 2018 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved. METHODS: We reviewed the clinical data and outcomes of all consecutive patients treated by ROMS in seven academic centers from 2001 to 2013. ROMS was performed through laparotomy with retrograde access into the target mesenteric artery and stent placement using a retrograde or antegrade approach. End points were early (<30 days) and late mortality, morbidity, patency rates, and freedom from symptom recurrence and reintervention. OBJECTIVE: Retrograde open mesenteric stenting (ROMS) through laparotomy was introduced as an alternative to surgical bypass in patients with acute mesenteric ischemia (AMI). The purpose of this study was to evaluate the indications and outcomes of ROMS for treatment of AMI and chronic mesenteric ischemia. RESULTS: There were 54 patients, 13 male and 41 female, with a mean age of 72 +/- 11 years. Indications for ROMS were AMI in 44 patients (81%) and subacute-on-chronic mesenteric ischemia with flush mesenteric occlusion in 10 patients (19%). A total of 56 target mesenteric vessels were stented, including 52 superior mesenteric arteries and 4 celiac axis lesions, with a mean treatment length of 42 +/- 26 mm. Retrograde mesenteric access was used in all patients, but 16 patients also required a simultaneous antegrade brachial approach. The retrograde puncture was closed primarily in 34 patients and with patch angioplasty in 17 patients; 1 patient had manual compression. Bowel resection was needed in 29 patients (66%) with AMI because of perforation or gangrene. Technical success was achieved in all (98%) except one patient for whom ROMS failed, who was treated by bypass. Early mortality was 45% (20/44) for AMI and 10% (1/10) for subacute-on-chronic mesenteric ischemia (P = .04). Early morbidity was 73% for AMI and 50% for subacute-on-chronic mesenteric ischemia (P = .27). Patient survival for the entire cohort was 43% +/- 9% at 2 years. Primary patency and secondary patency at 2 years were 76% +/- 8% and 90% +/- 8%, respectively. Freedom from symptom recurrence and freedom from reinterventions were 72% +/- 8% and 74% +/- 8% at the same interval.
English
0741-5214
*Endovascular Procedures/is [Instrumentation]
*Laparotomy
*Mesenteric Artery, Superior/su [Surgery]
*Mesenteric Ischemia/su [Surgery]
*Mesenteric Vascular Occlusion/su [Surgery]
*Stents
Academic Medical Centers
Acute Disease
Aged
Aged, 80 and over
Angiography
Chronic Disease
Disease-Free Survival
Endovascular Procedures/ae [Adverse Effects]
Endovascular Procedures/mt [Methods]
Female
Humans
Kaplan-Meier Estimate
Laparotomy/ae [Adverse Effects]
Laparotomy/mo [Mortality]
Male
Mesenteric Artery, Superior/dg [Diagnostic Imaging]
Mesenteric Artery, Superior/pp [Physiopathology]
Mesenteric Ischemia/dg [Diagnostic Imaging]
Mesenteric Ischemia/mo [Mortality]
Mesenteric Ischemia/pp [Physiopathology]
Mesenteric Vascular Occlusion/dg [Diagnostic Imaging]
Mesenteric Vascular Occlusion/mo [Mortality]
Mesenteric Vascular Occlusion/pp [Physiopathology]
Middle Aged
Postoperative Complications/mo [Mortality]
Postoperative Complications/th [Therapy]
Retreatment
Retrospective Studies
Risk Factors
Splanchnic Circulation
Time Factors
Treatment Outcome
United States
Vascular Patency
MedStar Washington Hospital Center
Surgery/Vascular Surgery
Journal Article