Long-Term Results of Endovascular Treatment of Atherosclerotic Stenoses or Occlusions of the Coeliac and Superior Mesenteric Artery in Patients With Mesenteric Ischaemia.

INTRODUCTION: Over the past decade, primary percutaneous mesenteric artery stenting (PMAS) has become an alternative to open revascularisation for treatment of mesenteric ischaemia. Institutes have presented favourable short-term outcomes after PMAS, but there is a lack of data on long-term stent patency. METHODS: One hundred and forty-one patients treated by PMAS for acute and chronic mesenteric ischaemia over an 8 year period were studied. Anatomical success was assessed by duplex ultrasound and/or CT angiography. A stenosis ≥70% was considered to be a failure. RESULTS: Eighty-six coeliac arteries (CA) and 99 superior mesenteric arteries (SMA) were treated with PMAS in 141 patients. Nine CAs (10%) and 30 SMAs (30%) were occluded at the time of treatment. Median follow-up was 32 months (IQR 20-46). The overall primary patency rate at 12 and 60 months was 77.0% and 45.0%. The overall primary assisted patency rate was 90.3% and 69.8%. Overall secondary patency was 98.3% and 93.6%. CONCLUSION: This study shows excellent long-term secondary patencies after PMAS, comparable with published data on long-term patencies after open surgical revascularisation.

[Flank pain caused by a renal artery dissection]. / Flankpijn door een nierarteriedissectie.

BACKGROUND: A spontaneous renal artery dissection is a very rare diagnosis. The clinical presentation can vary and its course can be atypical. There are no guidelines available regarding treatment; however, the options are a conservative (medication) or interventional (radiological or surgical) approach. CASE DESCRIPTION: A 45-year-old man presented to the emergency department with hypertensive urgency after earlier episodes of flank pain. The cause appeared to be a spontaneous bilateral renal artery dissection with infarction. After a multidisciplinary consultation, the decision was made to manage the patient conservatively since symptoms had subsided, blood pressure was acceptable and renal function remained stable. Eventually, kidney function restored to normal and CT images showed almost complete recovery of the previously damaged renal parenchyma. CONCLUSION: This case demonstrates that in the event of renal artery dissection, a conservative medication policy may be a good option in clinically stable patients with non-deteriorating renal function. Timely recognition and adequate follow-up are important to prevent serious complications, such as renal ischaemia or renal infarction that could necessitate a nephrectomy.