■ FEATURED ABSTRACT Stenting of superior mesenteric artery chronic total occlusions in patients with chronic mesenteric ischemia: technical and clinical outcomes

Purpose While endovascular treatment of chronic mesenteric arterial stenosis is well accepted, management of chronic total occlusions (CTO) remains controversial with historical mainstays of treatment consisting of bypass or endarterectomy. Our goal is to evaluate the clinical and technical outcomes of endovascular recanalization and stenting of CTOs of the superior mesenteric artery (SMA). Materials and Methods We performed a retrospective review of 46 patients (18 M, 28 F) who underwent endovascular stenting of CTOs of the SMA between February 2008 and July 2012. All patients had symptoms of chronic mesenteric ischemia. Procedural and follow-up data were collected for assessment of technical success, safety and outcomes. Technical success was defined as the ability to traverse and stent the SMA occlusion without significant residual stenosis. Patency and freedom from symptom recurrence were calculated by Kaplan Meier analysis. Results Technical success was achieved in 40 of 46 patients (87%). Twelve patients underwent concurrent stenting of the celiac artery. Of the 6 technical failures, 2 were referred for bypass, 3 underwent celiac artery stenting, and 1 was lost to followup. Within 24 hours of the procedure, complete symptomatic relief was reported by 39 of 40 (97%) patients, while 1 patient (3%) reported partial improvement. No patients reported stable or worsening of symptoms. Imaging followup (22 US, 8 CTA) was obtained in 30 of 40 (75%) patients with a mean followup of 11.2 months. Kaplan Meier analysis revealed a primary patency of 100% at 3mo, 96% at 6mo, 80% at 1yr, and 72% at 2yrs. Symptomatic recurrences, which was observed in 5 patients, correlated to restenosis/reocclusion on imaging. All 5 patients underwent successful assisted or secondary PTA and/or stenting procedures. Kaplan Meier analysis of freedom from symptom recurrence showed primary and assisted rates of 80% and 100% at 1 year, and 77% and 97% at 2 years. There were 3 (7%) minor access-related complications and no major complications. Conclusion Endovascular stenting of CTOs of the SMA is a safe and effective procedure with an acceptable technical success rate and excellent mid-term clinical outcomes.