MIDTERM RESULTS AFTER COVERED STENTING OF THE SUPERIOR MESENTERIC ARTERY.

ABSTRACT Objective Despite the continuing controversy of covered (CS) versus bare metal mesenteric stents (BMS), the use of CS in mesenteric occlusive disease (MOD) has been recommended by expert centers. The aim of this study was to report mid-term results with CS of the superior mesenteric artery (SMA). Methods Between January 2014 and October 2019, MOD patients with a severe atheromatous stenosis or occlusion of the SMA treated by mesenteric CS were included. Clinical presentation included both acute mesenteric ischemia (AMI), chronic mesenteric ischemia (CMI) and asymptomatic patients planned for major surgery. Demographics, procedure details and follow-up data were prospectively collected and retrospectively reviewed. Study end points included primary patency (PP), primary assisted patency (PAP), and secondary patency (SP). Results During the study period, 86 patients (mean age, 70 +/- 9 years; 57% males) were included. Clinical presentation was AMI (n=42, 49%), CMI (n=31, 36%) and asymptomatic (n=13, 15%). Technical success was 97%. A total of 96 stents were implanted, including 86 proximal CS (Advanta V12, n=73; Lifestream, n=13). Mean length and mean diameter of CS were 31.5 +/- 6.3 mm and 6.9 +/- 0.5 mm, respectively. Additional distal BMS were used in 10 patients (12%) to overcome a kinking (n=9) or a dissection (n=1) downstream of the CS. All postoperative deaths occurred in AMI patients (n=11, 13%). During a median follow-up of 15,6 months (95%IC = 15,6 +/- 3,6 months). 12 patients (14%) underwent reinterventions for either stent misplacement (n=3), stent recoil (n=3), stent thrombosis (n=2), de novo stenosis at the distal edge of the CS (n=2) or gastric ischemia (n=1). At one year, overall PP, PAP and SP rates were 83% (95%IC = 83% +/- 9%), 99% (95%IC = 99% +/- 3%) and 99% (95%IC = 99% +/- 3%), respectively. At two years, overall PP, PAP and SP rates were 76% (95%IC = 76% +/- 13%), 95% (95%IC = 95% +/- 8%) and 95% (95%IC = 95% +/- 8%), respectively. Conclusion Mesenteric CS provide very satisfactory mid-term results in MOD patients, with an excellent primary assisted patency rate at two years at the price of a significant reintervention rate.