P-043 - MORPHOLOGICAL STUDY OF THE SUPERIOR MESENTERIC ARTERY IN MESENTERIC OCCLUSIVE DISEASE

TOPIC:
Vascular Imaging
AUTHORS:
Corniquet M. (Université Paris Cité - Assistance Publique Hôpitaux de Paris.Centre, Hôpital Européen Georges Pompidou, Service de chirurgie vasculaire et endovasculaire - Inserm UMR_S 1140, laboratoire de recherches biochirurgicales, Fondation Carpentier ~ Paris ~ Fran) , Ben Abdallah I. (Université Paris Cité - Assistance Publique Hôpitaux de Paris.Nord, Hôpital Bichat, Service de chirurgie vasculaire et thoracique - Structure d'URgences Vasculaires Intestinales (SURVI) - Inserm UMR_S 1140, laboratoire de recherches biochirurgicales, Fond) , Craiem D. (Université Paris Cité ~ Paris ~ France) , Nuzzo A. (Université Paris Cité - Assistance Publique Hôpitaux de Paris.Nord, Hôpital Beaujon - Structure d'URgences Vasculaires Intestinales (SURVI) ~ Paris ~ France) , Ronot M. (Université Paris Cité - Assistance Publique Hôpitaux de Paris.Nord, Hôpital Beaujon - Structure d'URgences Vasculaires Intestinales (SURVI) ~ Paris ~ France) , Corcos O. (Université Paris Cité - Assistance Publique Hôpitaux de Paris.Nord, Hôpital Beaujon - Structure d'URgences Vasculaires Intestinales (SURVI) ~ Paris ~ France) , Castier Y. (Université Paris Cité - Assistance Publique Hôpitaux de Paris.Nord, Hôpital Bichat, Service de chirurgie vasculaire et thoracique - Structure d'URgences Vasculaires Intestinales (SURVI) ~ Paris ~ France) , El Batti S. (Université Paris Cité - Assistance Publique Hôpitaux de Paris.Centre, Hôpital Européen Georges Pompidou, Service de chirurgie vasculaire et endovasculaire - Structure d'URgences Vasculaires Intestinales (SURVI) - Inserm UMR_S 1140, laboratoire de recherch)
Introduction:
Whereas first-line treatment of mesenteric occlusive disease (MOD) is stenting of the superior mesenteric artery (SMA), stent related issues and reinterventions remain frequent. In order to further improve technical success of mesenteric stenting, the aim of this study was to analyse the morphological characteristics of SMA lesions in MOD patients.
Methods:
Between 2016 and 2021, MOD patients with acute or chronic mesenteric ischemia (AMI/CMI) and treated by anterograde SMA stenting were included. Patients treated by retrograde open mesenteric stenting or bypasses as well as embolic AMI were not included. Based on preoperative computed tomography angiograms, a morphological 2D cartography of the SMA was achieved by means of a central line reconstruction using the Carestream software. Three anatomical points were defined: P1, SMA ostium ; P2, first SMA collateral ; P3, ileocolic artery ostium. Morphological data used for procedure planning were analysed.
Results:
Overall, 107 patients (men, 60% ; median age, 70 years [62-77]) were included - CMI (n=56, 52%) ; AMI (n=51, 48%). The projection of the SMA ostium on vertebral bodies was as follows: L1 (n=82, 77%), L2 (n=23, 21%) and T12 (n=2, 2%). The median aortomesenteric angle was 41 degrees [29-57]. Median diameters at P1 and P2 were 8.8mm [7.6-10] and 6.5mm [6-8]. Diameter degression between P1 and P2 diameters was 20% [8-32]. Atherothrombotic lesions involved the SMA ostium in 92 patients (86%). MOD was either bitroncular (49%), tritruncular (27%) or monotruncular -SMA- (24%). Median lengths between P1-P2 and P1-P3 were 31mm [26-38] and 82mm [73-93], respectively. Median length of the SMA lesions was 19mm [12-26], with longer lesions in AMI patients (22mm vs 18mm, p=0.045). Complete SMA occlusion was observed in 33% of patients (AMI, 41%; CMI, 27%, p = 0.22). No other significant morphological difference was found between CMI and AMI patients.
Conclusion:
This study provides data to optimise stent sizing and SMA catheterism. The ideal stent sizing should be based on P2 diameter and at least P1-P2 length, therefore including proximal stent placement within the aorta and the covering of the entire lesion. Owing to the diameter degression of the proximal SMA, a proximal stent flaring might be considered.