Angioplasty

• An alternative to surgical reconstruction may be angioplasty with or without the use of a stent.

• Favourable results have been reported with early success rates between 79% and 80%.

• It appears that surgical reconstruction is still superior to angioplasty [32, 48]. However, the number of patients treated is still small and long-term results are not available yet.

The combination of angioplasty with the placement of a stent seems to have a better result than angioplasty alone.

Sheeran et al. [50] reported on the treatment of 12 patients. Initial technical success was achieved in 11 of the 12 patients (92%). There was one post-procedural death (<30 days) due to bowel ischaemia and infarction, despite a technically successful procedure. Primary patency and up to 18 months was 74% but subsequent interventions were required to obtain a secondary patency of 83% at 3 years [50]. Favourable results have also been reported in 27 patients with chronic splanchnic syndrome treated with coeliac and or superior mesenteric artery stenting. The primary clinical success was 67%, secondary clinical success was 81%, primary patency was 81% and the secondary patency was 100% after a mean follow-up of 19 months [55].

Chronic Mesenteric Ischaemia I "Abdominal Angina"

Fig. 6.1.3 Algorithm for diagnosis and treatment of occlusive disease of the coeliac and superior mesenteric artery

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