Interventional radiology in the treatment of acute and chronic mesenteric ischemia [La radiologia interventistica nel trattamento dell'ischemia mesenterica acuta e cronica.]

Radiologic revascularization procedures--i.e., percutaneous transluminal angioplasty (PTA) and fibrinolysis--are a valuable alternative to surgery in the treatment of stenoses and occlusions of the visceral vessels, that is the celiac tripod and the superior and inferior mesenteric arteries. We treated 32 patients, 10 of them with acute mesenteric ischemia and 22 with chronic mesenteric ischemia and clinical signs of angina abdominis. Grüntzig or pre-shaped Cobra or Simmons balloons were employed (diameter: 5-7 mm, with variable length) when PTA was performed. Urokinase or rtPA was employed for fibrinolysis. In 3 cases acute mesenteric ischemia was not occlusive and could be successfully treated with papaverine infusion. In 7 cases, acute mesenteric ischemia was occlusive: in 5 of these patients it was successfully treated by PTA and/or fibrinolysis. Our results were positive in 80% of the cases, with remission of clinical signs in 4 of 5 patients treated for acute mesenteric ischemia. In 22 patients with chronic mesenteric ischemia, 26 stenotic occlusions were observed at angiography and 22 were treated with PTA, which was technically successful in 21 instances (early success rate: 85-95%). At 24 months, 10% of restenosis was observed. In our experience, PTA of the visceral district, possibly preceded by loco-regional infusion of fibrinolytic drugs, can be widely applied and yields excellent therapeutic results.