Management of chronic mesenteric vascular insufficiency: an endovascular approach.
| Autor: | Schoch DM; Department of Surgery, University of Tennessee College of Medicine, Chattanooga Unit, Chattanooga, Tennessee, USA., LeSar CJ, Joels CS, Erdoes LS, Sprouse LR, Fugate MW, Greer MS, Fisher DF, Mixon H, Hogan M, Burns RP |
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| Jazyk: | angličtina |
| Zdroj: | Journal of the American College of Surgeons [J Am Coll Surg] 2011 Apr; Vol. 212 (4), pp. 668-75; discussion 675-7. |
| DOI: | 10.1016/j.jamcollsurg.2010.12.043 |
| Abstrakt: | Background: In patients with chronic mesenteric insufficiency (CMI), traditional bypass surgery carries a high operative mortality. Endovascular therapy for reconstruction of the mesenteric vascular system has high technical success but poor long-term patency. Secondary procedures are often mandatory for recurrent disease. The purpose of this study was to evaluate an endovascular-first treatment strategy for CMI, reserving open reconstruction for complex disease patterns without an endovascular option. Study Design: Data for consecutive adult patients (N = 107) initially treated with endovascular techniques for CMI were reviewed. The management algorithm consisted of postoperative and biannual ultrasound and clinical follow-up. Results: A total of 107 patients with CMI were treated from April 2004 through June 2010. Technical success for endovascular reconstruction was 100%. Long-term follow-up data were available on 90% of patients. After the index procedure, 57% of patients (n = 55) had complete resolution of the preoperative symptoms. During the management phase, 83% of patients had elevated velocities on duplex evaluation. During this interval, 53% of patients required no further intervention after the index procedure, and the remaining patients required an additional 78 procedures. Five patients required open revascularization for recurrent disease, and only 2 patients died from complications of mesenteric insufficiency. Conclusions: Endovascular management for CMI has a high technical success rate with low morbidity and mortality. Regular follow-up is essential to optimize patient outcomes. Ultrasound findings alone are a poor predictor of recurrent disease. Long-term success requires adaptation of a management program to elicit recurrent symptoms and offer prompt treatment. (Copyright © 2011. Published by Elsevier Inc.) |
| Databáze: | MEDLINE |
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