Percutaneous transluminal angioplasty in the treatment of chronic mesenteric ischemia: Results and 3 years of follow-up in 23 patients

background: we evaluated the clinical efficacy of visceral angioplasty in the treatment of chronic mesenteric ischemia. methods: over a 14-year period, we performed percutaneous transluminal angioplasty of 41 occlusive diseases of visceral arteries founded by angiography in 23 patients with chronic mesenteric ischemia. All but one (fibrodysplasic) stenoses were atherosclerotic, and 13 were localized in the ostial tract. clinical follow-up was evaluated at 2, 6, 12, 24, and 36 months (mean followupa Å 27 months). results: angioplasty demonstrated a residual stenosis of 30% or less in 37 procedures, for a technical success rate of 90%. seventeen of 20 patients had symptom remission after the first treatment, for a short-term clinical success of 77%; two patients needed a reangioplasty after 2 months, and one was referred for aortomesenteric bypass. during a mean follow-up of 27 months (range Å 2–36), the clinical success was 88%; 2/15 patients underwent successful repeat angioplasty at 24 and 36 months, for a 100% secondary long-term clinical success. only two minor complications were encountered. conclusion: although surgical results are undoubtedly positive, visceral angioplasty is justified in relation to both the high surgical mortality and the low incidence of complications arising from visceral angioplasty. key words: mesenteric artery—chronic mesenteric ischemia—percutaneous transluminal angioplasty. correspondence to: F. maspes chronic mesenteric ischemia (CMI) is related to a lack of blood supply in the splanchnic region and is caused by different kinds of occlusive diseases in one or more visceral arteries: the celiac trunk (CT), the superior mesenteric artery (SMA), and the inferior mesenteric artery (IMA). the disease develops during the 60s and 70s of an adult’s life and mainly in women in whom the incidence is three times greater than in men. the incidence of such disease is low and represents 2% of the revascularization operations for atheromatous lesions [1]. the occlusive diseases of the visceral vessels are usually atherosclerotic. other types of arterial diseases (fibromuscolar dysplasia, nodose panarteritis, arteritis) are unusual and have an incidence of 1/9 compared with that of atherosclerosis. the diagnosis of this disease is based on the clinical pattern and is confirmed by the angiographic findings, which show the nature, site, and extension of the occlusive disease and the morphologic and hemodynamic evaluations of the collateral pathways. the possibility provided by vascular interventional radiology to integrate the therapeutic phase into the diagnostic one has led several investigators [2–12] to evaluate the results of percutaneous transluminal angioplasty (PTA) for treatment of stenosic lesions in the splanchnic location and other anatomic locations. even though surgical revascularization (bypass, endoarterectomy of splanchnic occlusive disease) is still considered the treatment of choice for CMI, it has high mortality and morbidity rates due to frequent widespread atherosclerotic lesions; in some patients, the operation is not recommended. therapy of visceral vessel occlusive diseases finds a valid alternative in PTA. many investigators [2–12] have documented the promising results of PTA and its low procedural risks.