Arnaud Roussel1, Nellie Della Schiava2, Raphaël Coscas3, Quentin Pellenc4, Tarek Boudjelit2, Olivier Goëau-Brissonnière3, Olivier Corcos5, Patrick Lermusiaux2, Marc Coggia3, Yves Castier4. 1. Department of Vascular and Thoracic Surgery, Bichat Hospital, Assistance Publique Hôpitaux de Paris (AP-HP), Paris, France; SURVI (Structure d'URgences Vasculaires Intestinales)-Intestinal Stroke Center, Assistance Publique Hôpitaux de Paris (AP-HP), Paris, France; Faculté de Médecine Denis Diderot-Paris 7, Paris, France. Electronic address: arnaudkiem.roussel@gmail.com. 2. Department of Vascular Surgery, Edouard Herriot Hospital, Lyon, France; Faculté de Médecine Lyon Est-Université Lyon 1, Lyon, France. 3. Department of Vascular Surgery, Ambroise Paré Hospital, AP-HP, Boulogne-Billancourt, France; Faculté de Médecine Paris Ile-de-France Ouest, Paris, France. 4. Department of Vascular and Thoracic Surgery, Bichat Hospital, Assistance Publique Hôpitaux de Paris (AP-HP), Paris, France; SURVI (Structure d'URgences Vasculaires Intestinales)-Intestinal Stroke Center, Assistance Publique Hôpitaux de Paris (AP-HP), Paris, France; Faculté de Médecine Denis Diderot-Paris 7, Paris, France. 5. SURVI (Structure d'URgences Vasculaires Intestinales)-Intestinal Stroke Center, Assistance Publique Hôpitaux de Paris (AP-HP), Paris, France; Faculté de Médecine Denis Diderot-Paris 7, Paris, France.
Abstract
OBJECTIVE: Acute mesenteric ischemia (AMI) is an emergent event with a high mortality rate; survivors have high rates of intestinal failure. Restoration of blood flow using endovascular or surgical revascularization is associated with better outcome in terms of survival rate and intestinal resection. Retrograde open mesenteric stenting (ROMS), which is a hybrid technique, combines two benefits: prompt blood flow restoration with an endovascular approach and inspection and resection of the small bowel. The aim of the study was to assess the results of ROMS in thrombotic AMI in a retrospective multicenter study. METHODS: We retrospectively enrolled all consecutive patients who underwent ROMS revascularization for occlusive thrombotic AMI in three participating tertiary care centers between November 2012 and March 2017. RESULTS: Twenty-five patients (14 men and 11 women; mean age, 64.9 ± 11.6 years) were included. In two patients, ROMS was not possible because of failure of re-entry in the aortic lumen (technical success, 92%). One patient required revascularization of two visceral arteries and underwent an aortohepatic bypass. Five patients (20%) underwent endarterectomy and patch angioplasty of the superior mesenteric artery before retrograde stenting. Thirteen patients (52%) required bowel or colon resection (11 patients required both resections) during the initial procedure with a mean length of small bowel resection of 52 ± 87 cm. The 30-day operative mortality rate was 25%, and the overall 1-year survival rate was 65%. The 1-year primary patency rate was 92%. In one patient, postoperative imaging at 1 month showed stent migration in the aortic bifurcation. CONCLUSIONS: ROMS for thrombotic AMI has a high technical success rate and a high midterm primary patency rate. It could be an alternative procedure to retrograde superior mesenteric artery bypass for patients when percutaneous endovascular revascularization is not indicated or has failed.
OBJECTIVE: Acute mesenteric ischemia (AMI) is an emergent event with a high mortality rate; survivors have high rates of intestinal failure. Restoration of blood flow using endovascular or surgical revascularization is associated with better outcome in terms of survival rate and intestinal resection. Retrograde open mesenteric stenting (ROMS), which is a hybrid technique, combines two benefits: prompt blood flow restoration with an endovascular approach and inspection and resection of the small bowel. The aim of the study was to assess the results of ROMS in thrombotic AMI in a retrospective multicenter study. METHODS: We retrospectively enrolled all consecutive patients who underwent ROMS revascularization for occlusive thrombotic AMI in three participating tertiary care centers between November 2012 and March 2017. RESULTS: Twenty-five patients (14 men and 11 women; mean age, 64.9 ± 11.6 years) were included. In two patients, ROMS was not possible because of failure of re-entry in the aortic lumen (technical success, 92%). One patient required revascularization of two visceral arteries and underwent an aortohepatic bypass. Five patients (20%) underwent endarterectomy and patch angioplasty of the superior mesenteric artery before retrograde stenting. Thirteen patients (52%) required bowel or colon resection (11 patients required both resections) during the initial procedure with a mean length of small bowel resection of 52 ± 87 cm. The 30-day operative mortality rate was 25%, and the overall 1-year survival rate was 65%. The 1-year primary patency rate was 92%. In one patient, postoperative imaging at 1 month showed stent migration in the aortic bifurcation. CONCLUSIONS: ROMS for thrombotic AMI has a high technical success rate and a high midterm primary patency rate. It could be an alternative procedure to retrograde superior mesenteric artery bypass for patients when percutaneous endovascular revascularization is not indicated or has failed.