Retrograde Open Mesenteric Stenting: A Case Report and Literature Review

Abstract

Objective

Retrograde open mesenteric stenting (ROMS) is an alternative to mesenteric bypass/antegrade angioplasty and stenting in patients with acute and chronic mesenteric ischemia. We present a case and literature review utilizing ROMS in a patient with severe vascular occlusive disease to treat her superior mesenteric artery (SMA) stenosis.

Case report

A 63-year-old woman with a history of severe vascular occlusive disease and previous extensive surgical interventions required ROMS due to SMA stenosis for acute on chronic mesenteric ischemia. There were no in-hospital complications. We also performed a review of the literature to assess the technical success and clinical outcomes of ROMS.

Results

A total of six articles with 210 patients (92 males, 118 females) were included. In the studies where the celiac artery and SMA were implicated, technical success was 92.9%, conversion to bypass was 4.3%, and 30-day mortality was 29.5%. In the studies where only the SMA was implicated, technical success was 90.7%, conversion to bypass was 7.2%, and 30-day mortality was 23.7%. In cases of acute mesenteric ischemia, the 30-day mortality rate was 34.2%.

Conclusion

Though open surgical bypass and antegrade endovascular angioplasty and stenting have been the first-line treatment options for mesenteric ischemia, ROMS is an excellent alternative option with a high technical success rate that can be utilized when conventional treatment modalities are not technically feasible or in the setting of concomitant open abdominal exploration for the assessment of bowel ischemia.