RESUMEN
PURPOSE: To evaluate the safety and outcomes of endovascular recanalization of chronic total occlusions (CTOs) of the superior mesenteric artery (SMA) in patients with chronic mesenteric ischemia (CMI). MATERIALS AND METHODS: A single-institution retrospective review was performed of 47 consecutive patients (18 male, 29 female) who underwent endovascular stent placement for CTOs of the SMA between February 2006 and November 2012. All patients had symptoms of CMI. Procedural and follow-up data were collected for assessment of technical success, safety, and outcome. RESULTS: Technical success was achieved in 41 of 47 patients (87%). Forty-two of the 47 procedures were performed from a femoral approach. Fifteen patients underwent concurrent revascularization of the celiac artery. All patients who underwent successful recanalization reported symptomatic improvement. Kaplan-Meier analysis revealed primary freedom from symptomatic recurrence of 95% at 12 months and 78% at 24 months. Symptomatic recurrence was observed in seven patients, all of whom underwent successful assisted or secondary endovascular procedures. Secondary freedom from symptomatic recurrence rates were 100% at 12 months and 88% 24 months. There were three (7%) minor access-related complications and no major complications. CONCLUSIONS: Endovascular stent-assisted recanalization of chronic SMA occlusions is safe and effective, with an acceptable rate of technical success and excellent midterm clinical outcomes.
Asunto(s)
Procedimientos Endovasculares , Isquemia Mesentérica/terapia , Oclusión Vascular Mesentérica/terapia , Adulto , Anciano , Anciano de 80 o más Años , Angiografía de Substracción Digital , Enfermedad Crónica , Delaware , Supervivencia sin Enfermedad , Procedimientos Endovasculares/efectos adversos , Procedimientos Endovasculares/instrumentación , Femenino , Humanos , Estimación de Kaplan-Meier , Masculino , Arteria Mesentérica Superior/fisiopatología , Isquemia Mesentérica/diagnóstico , Isquemia Mesentérica/fisiopatología , Oclusión Vascular Mesentérica/diagnóstico , Oclusión Vascular Mesentérica/fisiopatología , Persona de Mediana Edad , Recurrencia , Estudios Retrospectivos , Factores de Riesgo , Stents , Factores de Tiempo , Resultado del Tratamiento , Ultrasonografía Doppler , Grado de Desobstrucción VascularRESUMEN
Cholecystoenteric fistulas are a complication of biliary disease, having an estimated incidence in the range of 0.1 - 0.5 percent. Roughly 8-27 percent of these are of the cholecystocolonic type,1 occurring most commonly at the hepatic flexure. An 82-year-old male presented to our tertiary hospital emergency department and was diagnosed with a cholecystocolonic fistula (CCF) by CT imaging. Surgical evaluation confirmed the CT diagnosis with subsequent removal of the fistula and gallbladder, which was curative.
