Management of chronic XXXX : an endovascular approach.

@entity1 @entity5327
BACKGROUND: In @entity1 with chronic @entity5327 (CMI), traditional bypass surgery carries a high operative mortality. Endovascular therapy for reconstruction of the mesenteric vascular system has high technical success but poor long-term patency. Secondary procedures are often mandatory for recurrent disease. The purpose of this study was to evaluate an endovascular-first treatment strategy for CMI, reserving open reconstruction for complex disease patterns without an endovascular option. STUDY DESIGN: Data for consecutive adult @entity1 (N = 107) initially treated with endovascular techniques for CMI were reviewed. The management algorithm consisted of postoperative and biannual ultrasound and clinical follow-up. RESULTS: A total of 107 @entity1 with CMI were treated from April 2004 through June 2010. Technical success for endovascular reconstruction was 100%. Long-term follow-up data were available on 90% of @entity1 . After the index procedure, 57% of @entity1 (n = 55) had complete resolution of the preoperative symptoms. During the management phase, 83% of @entity1 had elevated velocities on duplex evaluation. During this interval, 53% of @entity1 required no further intervention after the index procedure, and the remaining @entity1 required an additional 78 procedures. Five @entity1 required open revascularization for recurrent disease, and only 2 @entity1 died from complications of @entity5327 . CONCLUSIONS: Endovascular management for CMI has a high technical success rate with low morbidity and mortality. Regular follow-up is essential to optimize @entity1 outcomes. Ultrasound findings alone are a poor predictor of recurrent disease. Long-term success requires adaptation of a management program to elicit recurrent symptoms and offer prompt treatment.
