Endovascular inferior mesenteric artery revascularisation for chronic mesenteric ischaemia in selected clinical scenarios.

Background: Experience on endovascular inferior mesenteric artery (IMA) revascularisation for atherosclerotic chronic mesenteric ischaemia (CMI) is limited and its clinical benefit remains uncertain. Patients and

Methods: This retrospective single-centre study included 12 patients with CMI who underwent endovascular IMA revascularisation between January 2014 and January 2024. Indications were: (1) IMA stenosis with endoscopically confirmed colonic ischaemia, (2) IMA stenosis with retrograde filling of a proximally occluded superior mesenteric artery ineligible for revascularisation, and (3) overall improvement of collateralisation in critical CMI due to multi-vessel disease. Technical success, clinical success and primary clinical patency were assessed. Procedure-related adverse events, symptom recurrence, mortality and survival rates were also analysed.

Results: Seven isolated IMA interventions and five IMA revascularisations as part of a multi-vessel approach were performed. Balloon-expandable stents were used in 11 cases; one patient underwent balloon angioplasty with intravascular lithotripsy. Technical success was 83% (10/12); two cases had >50% residual stenosis due to annular aortic calcification impeding stent expansion. Median final residual stenosis was 27% (IQR 23.5). Four minor procedure-related adverse events occurred. Clinical success was 92% (11/12). Median follow-up was 17 months (IQR 20.7). The all-cause mortality rate was 25% (3/12). The mesenteric ischaemia-related mortality rate was 8% (1/12). The symptom recurrence rate was 33% (4/12). At 6 and 12 months, primary clinical patency rates were 71% and 54%, and survival rates were 83% and 72%.

Conclusions: Endovascular IMA revascularisation is a viable treatment for CMI in selected scenarios where other options are inappropriate. Despite the specific calcification pattern at the IMA origin predisposing to residual stenosis, most patients had symptom resolution and acceptable clinical patency with low recurrence and mortality rates. However, 33% of patients had early symptom recurrence requiring treatment. It remains difficult to assess whether IMA revascularisation is curative or a bridge to open revascularisation.