1. Stenting of Superior Mesenteric Artery Chronic Total Occlusions in Patients with Chronic Mesenteric Ischemia: Technical and Clinical Outcomes Grilli CJ, Fedele CR, Tahir OM, Velez JD, Wrigley C, McGarry M, Ali MA, Agriantonis D, Kimbiris G, Garcia MJ, Leung DA Christiana Care Health System, Newark DE/US

2. Bowel manifestation of PAD Atherosclerosis –hardening of arteries –plaque buildup  blockage Blockage of arteries supplying bowel –pain after eating –fear of food –weight loss –death Chronic Mesenteric Ischemia

3. Bowel arteries –celiac artery –superior mesenteric artery –inferior mesenteric artery Grading arterial blockages: –progressive atherosclerotic plaque –stenosis: 60-99% blockage amenable to endovascular stenting –occlusion: 100% blockage usually managed surgically

4. 1. Sreenarasimhaiah J: Chronic Mesenteric Ischemia. Best Pract Res Clin Gastroenterol. 19(2):283-95, 2005 CMI 1 SMA StenosisSurgeryEndovascular SMA Occlusion SurgeryEndovascular Stent Celiac/IMA stenosis Stent SMA occlusion Background

5. Purpose To investigate the feasibility and effectiveness of endovascular stenting of superior mesenteric artery occlusions (100% blockages) in patients with chronic mesenteric ischemia

6. 47 patients –18 male, 29 female –mean age 73 yrs, range 44-87 All patients with clinical symptoms of CMI > 1mo Methods

7. 72 y/o female, food fear, 45 lb weight loss

8. Achieved in 41/47 (87%) 6 unsuccessful procedures: –2 went on to bypass –3 received celiac stents –1 lost to follow-up Results PROCEDURE SUCCESS

9. Symptom Improvement < 30 d –4 point scale 1significant improvement 2partial improvement 3no change 4worsening of symptoms N=41 Results INITIAL SYMPTOM IMPROVEMENT

10. Primary patency (months): –97% @ 12 –75% @ 24 Recurrent blockage of SMA: –7 patients –all had repeat endovascular procedures Secondary patency –100% @ 12 –97% @ 24 Results FOLLOW-UP BY ULTRASOUND

11. Symptom-free –100% @ 12 mo –88% @ 24 mo Results SYMPTOMS

12. Endovascular stenting of complete blockages of the SMA is a safe and effective procedure –minimally-invasive –good technical success rate –easily repeatable –excellent clinical outcomes Conclusions