A Decade’s Experience with Retrograde Open Mesenteric Stenting for Acute Mesenteric Ischemia

Objective Retrograde open mesenteric stenting (ROMS) is an alternative to mesenteric bypass in patients with acute mesenteric ischemia (AMI) with variable reported 30-day mortality rates. Large studies evaluating patient outcomes following ROMS are scarce. Our study aims to assess the results of this approach among patients presenting with AMI. Methods We reviewed all the patients with AMI who were treated with ROMS (2011-2022). Patient demographics, presentation, operative details, and outcomes were analyzed. Primary endpoints were in-hospital, 30-day and 1-year mortality. Kaplan-Meier estimate for 1-year mortality and primary patency loss were generated. Secondary endpoints included postoperative 30-day complications. Results Between 2011 and 2022, ROMS was attempted on a total of 42 patients. The median age was 70 ±15 years and the majority of patients were female. Pain out of proportion to the physical exam was the most common presenting symptom (n=18 ,42.9%) followed by peritonitis (n= 14, 33.4%). All patients had pre-operative IV contrast computed tomography imaging. In-situ thrombosis was identified as the etiology of AMI in 36 (85.7%) patients. Technical success was achieved in 40 (95.2%) patients. Conventional, non-hybrid operating rooms were utilized for the majority of cases. Revascularization of all 40 patients involved angioplasty and stenting of superior mesenteric artery (SMA): A single stent was placed in 35 (87.5%) patients and the reminder had more than one stent. 80% of patients required bowel resection. A second-look laparotomy was required in 34 (85.0%) patients. The mean operative time, including both the general surgery and vascular surgery portions of the index procedure, was 192 ± 57 minutes. Sepsis was the most common complication observed within 30 days, occurring in 8 (20.0%) patients. In terms of mortality, 13 (32.5%) patients died during their index hospitalization, while 9 (22.5%) died within 30 days. On Kaplan-Meier analysis, the 1-year overall patient survival rate was 58.6%, and the primary patency rate for stents was 51.4%. Conclusion ROMS has excellent technical success rate in management of AMI with lower than traditionally reported mortality rates for AMI. The dual benefits of rapid revascularization and bowel evaluation should make this surgical modality an alternative approach for treatment of AMI.