Percutaneous Transluminal Angioplasty and Stenting in the Treatment of Chronic Mesenteric Ischemia: Results and Longterm Followup Alan H Matsumoto, MD, J Fritz Angle, MD, David J Spinosa, MD, Klaus D Hagspiel, MD, Dorothy L Cage, MSN, ACNP-CS, Daniel A Leung, MD, John A Kern, MD, Curtis G Tribble, MD, Irving L Kron, MD BACKGROUND: The purpose of this study was to review the results of percutaneous transluminal angioplasty (PTA), stenting, or both in the treatment of patients who present with symptoms and angio- graphic findings most consistent with chronic mesenteric ischemia. STUDY DESIGN: A retrospective analysis of 33 consecutive patients from a single institution who underwent PTA, stenting, or both for treatment of symptoms most characteristic of chronic mesenteric ischemia was performed. RESULTS: There were 12 men and 21 women with a mean age of 63 years (range 40 to 89 years). Median weight loss was 28 lb (range 6 to 80 lb). Postprandial pain was present in 88% of the patients (29 of 33). All lesions treated were stenoses. PTA alone was performed in 21 patients (32 vessels), and PTA and stenting were performed in 12 patients (15 vessels). PTA was technically successful in 26 of 32 vessels (81.3%); PTA plus stenting was technically successful in 15 of 15 vessels (100%) (p = 0.073). Complete alleviation of symptoms occurred immediately in 27 of the patients (82%), and 2 patients (6%) had significant improvement in symptoms. There were four immediate clinical failures (12%): two patients were found to have occult malignancy and one had immediate relief of symptoms after surgical release of the median arcuate ligament. Followup data were obtained in all patients with clinically successful procedures (mean 38 months, median 25 months, range 1 to 123 months). Angiographic followup was available in 52% of the patients (15 of 29), at a mean of 20 months. The primary longterm clinical success rate was 83.3% (24 of 29). Four of the five patients with recurrent symptoms were successfully retreated with endovascular therapy. The primary assisted longterm clinical success rate was 96.6% (28 of 29). The 5-year survival rate was 76.1%. Major complications occurred in 13% of the procedures, with a 30-day mortality rate of 0%. CONCLUSIONS: Endovascular therapy for treatment of mesenteric arterial stenoses is effective in the treatment of patients with symptoms and angiographic findings characteristic of chronic mesenteric ischemia. Gradual and progressive stenosis of one or more of the major mesenteric vessels is generally well tolerated because of the abundant collateral circulation that exists among the mesenteric vessels. But when intestinal blood flow is unable to support the physiologic demands of the gastrointestinal tract, mesenteric ischemia will occur. Although bowel via- bility is usually not acutely compromised when chronic mesenteric ischemia develops, a delay in diagnosis and treatment may result in bowel infarction. Once bowel in- farction occurs, the prognosis for the patient worsens sig- nificantly. 1,2 So all patients with symptoms and angio- graphic findings consistent with intestinal angina should undergo revascularization of the mesenteric circulation as soon as possible. The purpose of this article is to review our experience with percutaneous transluminal angioplasty (PTA), or stenting, or both in the treatment of patients with symptoms characteristic of chronic mesenteric ischemia. Dr Matsumoto owns stock in Johnson and Johnson, and Boston Scientific. Received May 4, 2001; Accepted August 3, 2001. From the Division of Angiography, Interventional Radiology, and Special Procedures, Department of Radiology (Matsumoto, Angle, Spinosa, Hag- spiel, Cage, Leung) and the Division of Cardiovascular and Thoracic Surgery, Department of Surgery (Kern, Tribble, Kron), University of Virginia Health System, Charlottesville, VA. Correspondence address: Alan H Matsumoto, MD, UVA Health Systems, Department of Radiology/Box 800170, Jefferson Park Ave, Charlottesville, VA 22908. S22 © 2002 by the American College of Surgeons ISSN 1072-7515/02/$21.00 Published by Elsevier Science Inc. PII S1072-7515(01)01062-6