Cirugía convencional tras el fracaso del tratamiento endovascular en la isquemia mesentérica crónica

Introduction. Mesenteric angina is an infrequent symptom of atherosclerosis. The classical signs and symptoms have been reported as: post-prandial pain, weight loss and fear of intake. Standard treatment has consisted in open revascularisation of the mesenteric vessels. Endovascular techniques have opened up new opportunities for treatment, although with lower patency outcomes. We report the case of a female patient with chronic mesenteric ischaemia and short-term failure of endovascular treatment. Case report. A 77-year-old woman with multiple cardiovascular risk factors and signs and symptoms of a classic abdominal angina. In 2006 she underwent an operation involving an angioplasty and stent in the superior mesenteric artery (SMA) to treat a sub-occlusive lesion at its origin. Clinical recurrence occurred 10 months after the treatment due to occlusion of the stent and a progression of the existing lesion at the origin of the celiac trunk. A diagnostic-therapeutic arteriography scan was used to treat a lesion > 70% of the celiac trunk with angioplasty and stent, although it was not possible to rechannel the previous stent in the SMA. The episodes of pain reappeared eight months after the last intervention. The clinical recurrence caused by the endovascular treatment meant that the decision was taken to perform a retrograde aortomesenteric bypass in the SMA. Conclusion. The aim of revascularisation is to relieve the symptoms, prevent intestinal infarction and improve the nutritional status. The patient that we report here suffered from recurring abdominal pains following failure of the endovascular techniques. Conventional surgery has been clinically satisfactory and with 18 months' patency. [ANGIOLOGÍA 2009; 61: 99-103]