The Society of Interventional Radiology (SIR) has published guidelines for quality-improvement programs to assess mesenteric angioplasty and stent placement procedures for treating chronic mesenteric ischemia (CMI). CMI typically occurs as a result of mesenteric arterial stenosis or occlusion, primarily in the elderly and in women.
The most common cause of CMI is atherosclerosis, but it may also be caused by vasculitis, fibromuscular dysplasia, segmental arterial mediolysis, and median arcuate ligament syndrome. Most patients are asymptomatic. Catheter angiography is the gold standard for diagnosing mesenteric arterial stenosis/occlusion, although computed tomographic angiography (CTA) with three-dimensional reconstructions has a sensitivity of 96% and a specificity of 94%.
Mesenteric angioplasty and stent placement are replacing surgical revascularization as the preferred treatments of CMI, according to lead author Anil K. Pillai, MD, of the University of Texas Health Science Center’s Department of Diagnostic and Interventional Imaging in Houston. These treatments should be made based on anatomical considerations, nutritional status, and the presence of comorbidities.
The guidelines in the May issue of the Journal of Vascular and Interventional Radiology focus on patient selection, performance of the procedure, and follow-up care of the patient, the most important aspects of care that affect quality of the intervention.
Patient selection indications include unintentional weight loss, postprandial abdominal pain, two-vessel disease on imaging for symptomatic patients. Symptomatic patients may also have aortic dissection or spontaneous mesenteric artery dissection causing compromised mesenteric perfusion.
Contraindications resulting in resulting in potentially increased complications and/or lower technical success rates include highly tortuous aortoiliac arteries, long-segment occlusion, small-diameter distal vessels, heavily calcified stenosis/occlusion and/or extrinsic compression.
The guidelines discuss success rates, complications, and complication rates and thresholds. Extensive references are included.
SIR guidelines to assess mesenteric angioplasty and stent placement procedures. Appl Radiol.