Visceral Artery Angioplasty / Stenting

Background and indications

Angioplasty with or without stenting of visceral arteries (celiac trunk, superior mesenteric artery - SMA, inferior mesenteric artery) is the endovascular treatment for chronic mesenteric ischemia (CMI). CMI is caused by atherosclerosis of digestive arteries and manifests with postprandial abdominal pain, weight loss, and food fear. Diagnosis is often delayed as symptoms are non-specific.

Angioplasty is also indicated for celiac trunk stenosis from extrinsic compression (median arcuate ligament - Dunbar syndrome), complementing surgical ligament release.

Pre-procedure assessment

Assessment includes abdominal CT angiography (digestive artery stenoses, collateralization), Doppler ultrasound of digestive arteries (elevated systolic velocities), and exclusion of other causes of abdominal pain. At least 2 of 3 major digestive arteries must be stenosed or occluded to explain symptoms.

Procedure

Under local anesthesia and sedation, femoral or brachial arterial access is obtained. Under fluoroscopic guidance, the stenosis is crossed and a stent (self-expanding or balloon-mounted) is placed in the SMA and/or celiac trunk. SMA is the priority artery to treat. Stenting is preferred over plain angioplasty due to better patency rates. The procedure takes 1 to 2 hours.

Results and scientific evidence

Mesenteric artery stenting offers 95% technical success rate and symptom relief in 80-90% of cases. 3-year primary patency rate is 60-80%, with 20-30% restenosis rate requiring reintervention. Endovascular stenting has lower morbidity and mortality than surgical bypass.

Risks and complications

Distal embolization (2-5%), arterial dissection (2-3%), stent thrombosis (< 2%), access site complications (3-5%). Post-procedural acute mesenteric ischemia is rare (< 1%) but serious. Peri-procedural mortality is 1-3%.

Recovery

1-2 night hospitalization. Progressive dietary resumption. Dual antiplatelet therapy for 3 months then single agent long-term. Control Doppler ultrasound at 3, 6, and 12 months.

Practical information

The procedure is performed as a short inpatient stay. It is performed by a vascular interventional radiologist, in coordination with the gastroenterologist and vascular surgeon.