Thurner Annette, Peter Dominik, Flemming Sven, Kickuth Ralph
Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Germany.
Department of General, Visceral, Transplantation, Vascular and Pediatric Surgery, University Hospital Würzburg, Germany.
Vasa. 2025 Sep;54(5):322-330. doi: 10.1024/0301-1526/a001204. Epub 2025 May 28.
Experience on endovascular inferior mesenteric artery (IMA) revascularisation for atherosclerotic chronic mesenteric ischaemia (CMI) is limited and its clinical benefit remains uncertain. This retrospective single-centre study included 12 patients with CMI who underwent endovascular IMA revascularisation between January 2014 and January 2024. Indications were: (1) IMA stenosis with endoscopically confirmed colonic ischaemia, (2) IMA stenosis with retrograde filling of a proximally occluded superior mesenteric artery ineligible for revascularisation, and (3) overall improvement of collateralisation in critical CMI due to multi-vessel disease. Technical success, clinical success and primary clinical patency were assessed. Procedure-related adverse events, symptom recurrence, mortality and survival rates were also analysed. Seven isolated IMA interventions and five IMA revascularisations as part of a multi-vessel approach were performed. Balloon-expandable stents were used in 11 cases; one patient underwent balloon angioplasty with intravascular lithotripsy. Technical success was 83% (10/12); two cases had >50% residual stenosis due to annular aortic calcification impeding stent expansion. Median final residual stenosis was 27% (IQR 23.5). Four minor procedure-related adverse events occurred. Clinical success was 92% (11/12). Median follow-up was 17 months (IQR 20.7). The all-cause mortality rate was 25% (3/12). The mesenteric ischaemia-related mortality rate was 8% (1/12). The symptom recurrence rate was 33% (4/12). At 6 and 12 months, primary clinical patency rates were 71% and 54%, and survival rates were 83% and 72%. Endovascular IMA revascularisation is a viable treatment for CMI in selected scenarios where other options are inappropriate. Despite the specific calcification pattern at the IMA origin predisposing to residual stenosis, most patients had symptom resolution and acceptable clinical patency with low recurrence and mortality rates. However, 33% of patients had early symptom recurrence requiring treatment. It remains difficult to assess whether IMA revascularisation is curative or a bridge to open revascularisation.
关于血管内肠系膜下动脉（IMA）血运重建治疗动脉粥样硬化性慢性肠系膜缺血（CMI）的经验有限，其临床益处仍不确定。这项回顾性单中心研究纳入了12例在2014年1月至2024年1月期间接受血管内IMA血运重建的CMI患者。适应症包括：（1）经内镜证实有结肠缺血的IMA狭窄；（2）IMA狭窄且近端闭塞的肠系膜上动脉逆行充盈，不适合进行血运重建；（3）因多支血管病变导致的严重CMI中侧支循环的整体改善。评估了技术成功率、临床成功率和原发性临床通畅率。还分析了与手术相关的不良事件、症状复发、死亡率和生存率。共进行了7例单纯IMA干预和5例作为多支血管治疗一部分的IMA血运重建。11例使用了球囊扩张支架；1例患者接受了球囊血管成形术联合血管内碎石术。技术成功率为83%（10/12）；2例由于环状主动脉钙化阻碍支架扩张，残留狭窄>50%。最终残余狭窄的中位数为27%（四分位间距23.5）。发生了4例与手术相关的轻微不良事件。临床成功率为92%（11/12）。中位随访时间为17个月（四分位间距20.7）。全因死亡率为25%（3/12）。肠系膜缺血相关死亡率为8%（1/12）。症状复发率为33%（4/12）。在6个月和12个月时，原发性临床通畅率分别为71%和54%，生存率分别为83%和72%。在其他选择不合适的特定情况下，血管内IMA血运重建是CMI的一种可行治疗方法。尽管IMA起始处的特定钙化模式易导致残留狭窄，但大多数患者症状缓解，临床通畅情况可接受，复发率和死亡率较低。然而，33%的患者早期症状复发需要治疗。仍然难以评估IMA血运重建是治愈性的还是开放血运重建的桥梁。
