L. Scott Dean

The correlation of aortic neck length to early and late outcomes in endovascular aneurysm repair patients

BACKGROUND Initially, patients with a short angulated aortic neck were considered unfit for endovascular aneurysm repair (EVAR). Recently, however, more liberal use of EVAR has been advocated. This study analyzes the correlation of aortic neck length to early and late outcomes. METHODS We analyzed 238 patients who underwent EVAR during a recent 7-year period. All patients were followed up clinically and underwent postoperative duplex ultrasound imaging or computed tomography angiography, which were repeated every 6 months. Aortic neck length was classified into >or=15 mm (L1, n = 195), 10 to <15 mm (L2, n = 24), and <10 mm (L3, n = 17). Kaplan-Meier methods were used to estimate freedom from late endoleak, early and late reintervention, and survival. RESULTS Analyzed were 49 Ancure, 47 AneuRx, 104 Excluder, and 38 Zenith grafts. The mean follow-up was 24.7 months (range, 1-87 months). The initial technical success was 99%. The perioperative complication rates for groups L1, L2, and L3 were 13%, 21%, and 24%, respectively (P = .289). Proximal type I early endoleaks occurred in 12%, 42%, and 53% in groups L1, L2, and L3, respectively (P < .001). Intraoperative proximal aortic cuffs were needed to seal proximal type I endoleaks in 10%, 38%, and 47% in L1, L2, and L3 groups, respectively (P < .0001). However, the rate of late reintervention was comparable in all groups. Postoperatively, the size of the abdominal aortic aneurysm decreased or remained unchanged in 95%, 94%, and 88% in L1, L2, and L3, respectively (P = .660). Rates of freedom from late type I endoleak at 1, 2, and 3 years were 84%, 82%, and 80% for L1; 68%, 54%, and 54% for L2; and 71%, 71%, and 53% for L3 (P = .0263). Rates of freedom from late intervention at 1, 2, and 3 years were 96%, 94%, and 92% for L1; and 94%, 83%, and 83% for L2; and 93%, 93%, and 93% for L3 (P = .5334). CONCLUSIONS EVAR can be used for patients with a short aortic neck; however, it was associated with a significantly higher rate of early and late type I endoleaks, resulting in an increased use of proximal aortic cuffs for sealing the endoleaks.

Clinical Outcomes for Hostile Versus Favorable Aortic Neck Anatomy in Endovascular Aortic Aneurysm Repair Using Modular Devices

BACKGROUND Endovascular aneurysm repair (EVAR) is not generally recommended for patients with hostile neck anatomy. This study analyzed the clinical implications of various clinical features of proximal aortic neck anatomy. METHODS Prospectively collected data from 258 EVAR patients using modular devices were analyzed. Patients were classified as having favorable neck anatomy (FNA) or hostile neck anatomy (HNA). HNA was defined as any or all of length of <10 mm, angle of >60°, diameter of >28 mm, ≥50% circumferential thrombus, ≥50% calcified neck, and reverse taper. Univariate, multivariate, and Kaplan-Meier analyses were used to compare early and late clinical outcomes. RESULTS FNA was present in 37% and HNA was present in 63%. Clinical and demographic characteristics were comparable. Technical success was 99%. Mean follow-up was 22 months (range, 1-78 months). Perioperative complication rates were 3% for FNA vs 16% for HNA (P = .0027). Perioperative deaths were 0% for FNA and 3% for HNA (P = .2997). Proximal type I early endoleaks (intraoperative) occurred in 9% of FNA vs 22% for HNA (P = .0202). Intraoperative proximal aortic cuffs were used to seal endoleaks in 9% of FNA vs 22% of HNA (P = .0093). At late follow-up, abdominal aortic aneurysm expansion was noted in 6% of FNA vs 7% of HNA (P = .8509). Rates of freedom from late type I endoleaks at 1, 2, 3, and 4 years were 97%, 97%, 97%, and 90% for FNA vs 89%, 89%, 89%, and 89% for HNA (P = .1224); rates for late interventions were 95%, 90%, 90%, and 90% for FNA vs 95%, 93%, 91%, and 85% for HNA (P = .6902). Graft patency at 1, 2, and 3 years was 99%, 99%, and 99% for FNA vs 97%, 92%, and 90% for HNA (P = .0925). The survival rates were 93%, 84%, 76%, and 76% for FNA vs 88%, 82%, 74%, and 66% for HNA (P = .2631). Reverse taper was a significant predictor for early type I endoleak (odds ratio [OR], 5.25, P < .0001), reverse taper (OR, 5.95; P < .0001) and neck length (OR, 4.15; P = .0146) were for aortic cuff use; circumferential thrombus (OR, 2.44; P = .0448), and neck angle (OR, 3.38; P = .009) were for perioperative complications. CONCLUSIONS Patients with HNA can be treated with EVAR, but with higher rates of early (intraoperative) type I endoleak and intervention. The midterm outcomes are similar to FNA.

Optimal carotid duplex velocity criteria for defining the severity of carotid in-stent restenosis

BACKGROUND The optimal duplex ultrasound (DUS) velocity criteria to determine in-stent carotid restenosis are controversial. We previously reported the optimal DUS velocities for >or=30% in-stent restenosis. This prospective study will further define the optimal velocities in detecting various severities of in-stent restenosis: >or=30%, >or=50%, and 80% to 99%. METHODS The analysis included 144 patients who underwent carotid artery stenting as a part of clinical trials. All patients had completion arteriograms and underwent postoperative carotid DUS imaging, which was repeated at 1 month and every 6 months thereafter. Patients with peak systolic velocities (PSVs) of the internal carotid artery (ICA) of >or=130 cm/s underwent carotid computed tomography (CT)/angiogram. The PSVs and end-diastolic velocities of the ICA and common carotid artery (CCA) and the PSV of the ICA/CCA ratios were recorded. Receiver operating characteristic curve (ROC) analysis was used to determine the optimal velocity criteria for the diagnosis of >or=30, >or=50, and >or=80% restenosis. RESULTS The mean follow-up was 20 months (range, 1-78 months). Available for analysis were 215 pairs of imaging (DUS vs CTA/angiography) studies. The accuracy of CTA vs carotid arteriogram was confirmed in a subset of 22 patients (kappa = 0.81). The ROC analysis demonstrated that an ICA PSV of >or=154 cm/s was optimal for >or=30% stenosis with a sensitivity of 99%, specificity of 89%, positive-predictive value (PPV) of 96%, negative-predictive value (NPV) of 97%, and overall accuracy (OA) of 96%. An ICA EDV of 42 cm/s had sensitivity, specificity, PPV, NPV, and OA in detecting >or=30% stenosis of 86%, 62%, 87%, 60%, and 80%, respectively. An ICA PSV of >or=224 cm/s was optimal for >50% stenosis with a sensitivity of 99%, specificity of 90%, PPV of 99%, NPV of 90%, and OA of 98%. An ICA EDV of 88 cm/s had sensitivity, specificity, PPV, NPV, and OA in detecting >or=50% stenosis of 96%, 100%, 100%, 100%, 53%, and 96%. An ICA/CCA ratio of 3.439 had sensitivity, specificity, PPV, NPV, and OA in detecting >or=50% stenosis of 96%, 100%, 100%, 100%, 58%, and 96%, respectively. An ICA PSV of >or=325 cm/s was optimal for >80% stenosis with a sensitivity of 100%, specificity of 99%, PPV of 100%, NPV of 88%, and OA of 99%. An ICA EDV of 119 cm/sec had sensitivity, specificity, PPV, NPV, and OA in detecting >or=80% stenosis of 99%, 100%, 100%, 100%, 75%, and 99%, respectively. The PSV of the stented artery was a better predictor for in-stent restenosis than the end-diastolic velocity or ICA/CCA ratio. CONCLUSION The optimal DUS velocity criteria for in-stent restenosis of >or=30%, >or=50%, and >or=80% were the PSVs of 154, 224, and 325 cm/s, respectively.

Angioplasty and Stenting versus Carotid-Subclavian Bypass for the Treatment of Isolated Subclavian Artery Disease

PURPOSE To compare the results of a large series of percutaneous transluminal angioplasty (PTA)/stenting procedures in the subclavian artery with the results of a series of carotid-subclavian bypass grafts (CSBG) performed at the same institution for subclavian artery disease. METHODS Between 1993 and 2006, 121 patients (43 men; mean age 63 years, range 38-85) underwent subclavian artery PTA/stenting and were compared to a group of 51 patients (29 men; mean age 62 years, range 46-75) with isolated subclavian artery occlusive disease treated with CSBG using polytetrafluoroethylene grafts. Graft or PTA/stenting patency was determined clinically and confirmed by Doppler pressures and/or duplex ultrasound/angiography. The cumulative patency and overall survival rates were calculated using the life-table method. RESULTS The mean follow-up for the PTA/stent group was 3.4 years versus 7.7 years for the CSBG group. The technical success rate for the CSBG group was 100% versus 98% (119/121) for the PTA/stent group. The overall perioperative complication rate in the stent group was 15.1% (18/119: 11 minor and 7 major complications) versus 5.9% (3/51: 2 phrenic nerve palsy and 1 myocardial infarction) in the bypass group (p=0.093). There was no perioperative stroke or mortality in the CSBG group. The major perioperative complications in the stent group included 4 thromboembolic events, 1 congestive heart failure, 1 reperfusion arm edema, and 1 pseudoaneurysm. There was 1 perioperative death in the stent group. The 30-day patency rate was 100% for the bypass group and 97% (118/121) for the PTA/stent group. The primary patency rates at 1, 3, and 5 years were 100%, 98%, and 96% for the CSBG group versus 93%, 78%, and 70% for the stent group, respectively (p<0.0001). Freedom from symptom recurrence was also statistically superior in the bypass group versus the stent group (p<0.0001). There were no significant differences in the survival rates between both groups at any time point (p=0.322). CONCLUSION Both CSBGs using PTFE grafts and subclavian PTA/stenting are safe, effective, and durable; however, CSBG is more durable in the long term. PTA/stenting of the subclavian artery should be the procedure of choice for high-risk patients; however, CSBG should be offered to good-risk surgical candidates who may be seeking a more durable procedure.

Critical appraisal of the Carotid Duplex Consensus criteria in the diagnosis of carotid artery stenosis

BACKGROUND Clinicians have relied on published institutional experience for interpreting carotid duplex ultrasound studies (CDUS). This study will validate the ultrasound imaging consensus criteria published in 2003. METHODS The CDUS and angiography results of 376 carotid arteries were analyzed. Receiver-operating characteristic (ROCs) curves were used to compare peak systolic velocities (PSVs), end-diastolic velocities (EDVs) of the internal carotid artery (ICA), and ICA/common carotid (CCA) ratios in detecting < 50%, 50% to 69% (ICA PSV of 125-230 cm/s), and 70% to 99% (PSV of ≥ 230 cm/s) stenosis according to the consensus criteria. RESULTS The consensus criteria uses a PSV of 125 to 230 cm/s for detecting angiographic stenosis of 50% to 69%, which has a sensitivity of 93%, specificity of 68%, and overall accuracy of 85%. A PSV of ≥ 230 cm/s for ≥ 70% stenosis had a sensitivity of 99%, specificity of 86%, and overall accuracy of 95%. ROC curves showed that the ICA PSV was significantly better (area under the curve [AUC], 0.97) than EDV (AUC, 0.94) or ICA/CCA ratio (AUC, 0.84; P = .036) in detecting ≥ 70% stenosis and ≥ 50% stenosis. Pearson correlations showed a statistical difference between the correlation of PSV with angiography (0.833; 95% confidence interval [CI], 0.8-0.86), EDV with angiography (0.755; 95% CI, 0.71-0.80), and ICA/CCA systolic ratio with angiography (0.601; 95% CI, 0.53-0.66; P < .0001) in detecting 70% to 99% stenosis. Adding the EDV values or the ratios to the PSV values did not improve accuracy. The consensus criteria for diagnosing 50% to 69% stenosis can be significantly improved by using an ICA PSV of 140 to 230 cm/s, with a sensitivity of 94%, specificity of 92%, and overall accuracy of 92%. CONCLUSIONS The consensus criteria can be accurately used for diagnosing ≥ 70% stenosis; however, the accuracy can be improved for detecting 50% to 69% stenosis if the ICA PSV is changed to 140 to < 230 cm/s.

Prospective randomized trial of routine versus selective shunting in carotid endarterectomy based on stump pressure

BACKGROUND The use of shunting in carotid endarterectomy (CEA) is controversial. This randomized trial compared the results of routine (RS) vs selective shunting (SS) based on stump pressure (SP). METHODS Two-hundred CEA patients under general anesthesia were randomized into RS (98 patients) or SS (102 patients), where shunting was used only if systolic SP (SSP) was <40 mm Hg. Clinical and demographic characteristics were comparable in both groups. Patients underwent immediate and 30-day postoperative duplex ultrasound follow-up. Analysis was by intention-to-treat. RESULTS Of 102 SS patients, 29 (28%) received shunting. Indications for CEA were similar (42% symptomatic for RS; 47% for SS, P = .458). The mean internal carotid artery diameter was comparable (5.5 vs 5.5 mm, P = .685). Mean preoperative ipsilateral and contralateral stenosis was 76% and 38% for RS (P = .268) vs 78% and 40% for SS (P = .528). Mean preoperative ipsilateral and contralateral stenosis was 79% and 56% in the shunted (P = .634) vs 78% and 34% in the nonshunted subgroup of SS patients (P = .002). The mean SSP was 55.9 mm Hg in RS vs 56.2 for SS (P = .915). The mean SSP was 33 mm Hg in the shunted vs 65 in the nonshunted subgroup (P < .0001). Mean clamp time in the nonshunted subgroup of SS was 32 minutes. Mean shunt time was 35 minutes in RS and 33 in SS (P = .354). Mean operative time was 113 minutes for RS and 109 for SS (P = .252), and 111 minutes in shunted and 108 in the nonshunted subgroup (P = .586). Mean arteriotomy length was 4.4 cm for RS and 4.2 for SS (P = .213). Perioperative stroke rate was 0% for RS vs 2% for SS (one major and one minor stroke, both related to carotid thrombosis; P = .498). No patients died perioperatively. Combined perioperative transient ischemic attack (TIA) and stroke rates were 2% in RS vs 2.9% in SS (P > .99). The overall perioperative complication rates were 8.3% in RS (2 TIA, 3 hemorrhage, 1 myocardial infarction [MI], and 1 asymptomatic carotid thrombosis) vs 7.8% in SS (2 strokes, 1 TIA, 3 hemorrhage, 1 MI, and 1 congestive heart failure; P = .917). CONCLUSIONS RS and SS were associated with a low stroke rate. Both methods are acceptable, and surgeons should select the method with which they are more comfortable.

Mesenteric/Celiac Duplex Ultrasound Interpretation Criteria Revisited

BACKGROUND Several published studies with a small sample size have reported differing results of duplex ultrasound (DUS) utilizing different threshold velocities in detecting significant stenosis of superior mesenteric (SMA) or celiac arteries (CA). The present study is based on the largest number of mesenteric duplex/angiography correlations reported to date for the diagnosis of SMA/CA stenosis. METHODS One hundred fifty-three patients (151 SMA and 150 CA) had both DUS and arteriography. Receiver operator curves (ROC) were used to analyze peak systolic velocity (PSV), end diastolic velocity (EDV), and SMA or CA/aortic PSV ratio in detecting ≥50% and ≥70% stenosis. RESULTS For SMA (151 arteries: 84 with ≥50% stenosis [54 of which had ≥70% stenosis] based on angiography): the PSV threshold that provided the highest overall accuracy (OA) for detecting ≥50% SMA stenosis was ≥295 cm/s (sensitivity [sens.] 87%, specificity [spec.] 89%, and OA 88%); and for detecting ≥70% SMA, it was ≥400 cm/s (sens. 72%, spec. 93%, and OA 85%). The EDV threshold that provided the highest OA for detecting ≥50% stenosis was ≥45 cm/s (sens. 79%, spec. 79%, and OA 79%); and for ≥70% stenosis was ≥70 cm/s (sens. 65%, spec. 95%, and OA 84%). ROC analysis showed that PSV was better than EDV and SMA/aortic PSV ratio for ≥50% stenosis of SMA (P = .003 and P = .0005). For celiac arteries (150 arteries: 105 with ≥50% stenosis [62 of which had ≥70% stenosis]): the PSV threshold that provided the highest OA for ≥50% stenosis was ≥240 cm/s (sens. 87, spec. 83%, and OA 86%); and for ≥70% stenosis was ≥320 cm/s (sens. 80%, spec. 89%, and OA 85%). The EDV threshold that provided the highest OA for ≥50% stenosis was ≥40 cm/s (sens. 84%, spec. 48%, and OA 73%); and for ≥70% stenosis was ≥100 cm/s (sens. 58%, spec. 91%, and OA 77%). ROC analysis showed that PSV was better than EDV and SMA/aortic PSV ratio for ≥50% stenosis of CA (P < .0001 and P = .0410.) CONCLUSIONS PSV values can be used in detecting ≥50% and ≥70% SMA/CA stenosis and were better than EDVs and ratios. Previously published data must be validated in individual vascular laboratories. Our results will need prospective validation.

The relationship of preoperative thrombus load and location to the development of type II endoleak and sac regression.

BACKGROUND Few studies have specifically correlated the amount of thrombus in the aneurysm sac and the presence of type II endoleaks (TIIE). This study examined the correlation of preoperative thrombus load and location to the incidence of TIIE and late sac regression. METHODS Prospectively collected data from 266 endovascular aneurysm repair (EVAR) patients were analyzed. Maximum thrombus thickness (MTT) and percentage of the circumference of the aortic wall lined by thrombus (thrombus-lined aneurysm circumference [TLAC]) were determined from preoperative computed tomography angiography (CTA) images at four levels: neck, maximum abdominal aortic aneurysms (AAA) diameter (zone B), zone A (between neck and zone B), and zone C (between zone B and aortic bifurcation). The number of aortic side branches (ASB) was also recorded (inferior mesenteric artery [IMA], accessory renals, lumbar, and middle sacral). Logistic regression was used to determine the association of TIIE with each variable. RESULTS Thirty-three (12%) early and 32 (13%) late TIIE were noted at a mean follow-up of 22 months (range, 1-87 months). The mean MTT at zone B was 19.7 mm in patients without early TIIE and 18.8 mm in patients without late TIIE vs 14.4 and 17.2 mm in patients with early and late TIIE (P = .0137 and P = .444, respectively). The mean percentage of TLAC was 76% and 75% vs 65% and 64% in patients without vs with early and late TIIE (P = .0329 and P = .044, respectively). There was no correlation of early and late TIIE and thrombus location by zones. The IMA was patent in 7% and 7% of patients without early and late TIIE vs 16% and 15% with TIIE (P = .0367 and P = .077, respectively). The mean number of ASB in patients without (early and late) TIIE was 5.8 and 5.6 vs 5.8 and 7 with endoleak (P = .932 and P = .001, respectively). Univariate analysis showed the following variables decreased the incidence of early TIIE: MTT for zone B (odds ratio [OR] 0.79 for 5-mm increase; P = .014), MTT zone A (OR, 0.78; P = .028), MTT zone C (OR, 0.82; P = .043), and percentage of TLAC (OR, 0.88 for 10% increase; P = .036). For late TIIE: percentage of TLAC (OR, 0.88 for 10% increase; P = .048), and ASB (OR, 1.39 for each additional vessel; P = .001). A multiple regression model showed only ASB (OR, 1.34; P = .009) was a predictor for late TIIE. Four of five patients (80%) with late sac expansion vs 24 of 208 (12%) without expansion had late TIIE (P = .001). CONCLUSIONS MTT, percentage of TLAC, number of ASB, and patent IMA influenced early TIIE; however, only the number of ASB influenced late TIIE.

Critical analysis of renal duplex ultrasound parameters in detecting significant renal artery stenosis.

BACKGROUND Several published studies have reported differing results of renal duplex ultrasound (RDU) imaging in detecting significant renal artery stenosis (RAS) using different Doppler parameters. This study is the largest to date to compare RDU imaging vs angiography and assess various published Doppler criteria. METHODS RDU imaging and angiography were both done in 313 patients (606 renal arteries). RAS was classified as normal, <60%, ≥ 60% to 99%, and occlusion. Main outcome measurements included renal peak systolic velocity (PSV), systolic renal-to-aortic ratio (RAR), end-diastolic velocity (EDV), and kidney lengths. RESULTS The mean PSVs and RARs for normal, <60%, and ≥ 60% stenosis were 173, 236, and 324 cm/s (P < .0001), and 2.2, 2.9, and 4.5, respectively (P < .0001). The PSV cutoff value that provided the best overall accuracy for ≥ 60% stenosis was 285 cm/s, with a sensitivity, specificity, and overall accuracy of 67%, 90%, and 81%, respectively. The RAR cutoff value with the best overall accuracy for ≥ 60% stenosis was 3.7, with a sensitivity, specificity, and overall accuracy of 69%, 91%, and 82%, respectively. A PSV of ≥ 180 cm/s and RAR of ≥ 3.5 had a sensitivity, specificity, and overall accuracy of 72%, 81%, and 78% in detecting ≥ 60% stenosis. A PSV of ≥ 200 cm/s with an RAR of ≥ 3.5 had a sensitivity, specificity, and overall accuracy of 72%, 83%, and 78% in detecting ≥ 60% stenosis. A receiver operator characteristic (ROC) curve analysis showed that the PSV and RAR were better than the EDV in detecting ≥ 60% stenosis: PSV area under the curve (AUC) was 0.85 (95% confidence interval [CI], 0.81-0.88), EDV AUC was 0.71, and RAR AUC was 0.82 (PSV vs EDV, P < .0001; PSV vs RAR, P = .075; EDV vs RAR, P < .0001). A PSV of 285 cm/s or RAR of 3.7 alone were better than any combination of PSVs, EDVs, or RARs in detecting ≥ 60% stenosis. The mean kidney length was 10.4 cm in patients with ≥ 60% stenosis vs 11.0 cm in patients with <60% stenosis (P < .0001). Twelve percent of patients with ≥ 60% stenosis had a kidney length of ≤ 8.5 cm vs 4% in patients with <60% stenosis (P = .0003), and 5.6% (34 of 606) had accessory renal arteries on angiography, with six detected on RDU imaging. The presence of accessory renal arteries, solitary kidneys, or renal fibromuscular dysplasia had no influence on overall accuracy of using PSV values for detecting ≥ 60% stenosis. CONCLUSIONS A PSV of 285 cm/s or an RAR of 3.7 alone can be used in detecting ≥ 60% RAS. Previously published data must be validated in individual vascular laboratories.

Perioperative and late clinical outcomes of percutaneous transluminal stentings of the celiac and superior mesenteric arteries over the past decade

BACKGROUND Several authorities have proposed stenting of the superior mesenteric artery (SMA)/celiac artery (CA) as the primary treatment for patients with chronic mesenteric ischemia. However, most of these reports had small samples and short follow-up periods. METHODS Eighty-three patients were treated over a 10-year period. Clinical follow-up and duplex ultrasound exams were done to evaluate long-term patency. We used our newly validated duplex criteria to detect ≥70% in-stent stenosis of the SMA and CA. A Kaplan-Meier life-table analysis was used to estimate freedom from in-stent stenosis and late symptom and survival rates. RESULTS Fifty-four SMA and 51 CA stents were analyzed. The initial technical and clinical success rates were 97% and 96%, respectively, with 2% procedure morbidity and 2% mortality. The primary late clinical success rate was 59%, and the late ≥70% in-stent stenosis rate was 51% at a mean follow-up of 31 months (range, 1-124). Freedom from late recurrent symptoms at 1, 2, 3, 4, and 5 years was 83, 77, 70, 70, and 65%, respectively. Survival rates at the same intervals were 88%, 82%, 70%, 64%, and 51%. Primary patency rates for the whole series were 69%, 48%, 39%, 28%, and 19% at 1, 2, 3, 4, and 5 years, respectively. Assisted primary patency rates for the whole series were 80%, 61%, 54%, 43%, and 34% at 1, 2, 3, 4, and 5 years, respectively. Primary patency rates for the SMA at 1, 2, 3, 4, and 5 years were 71%, 47%, 37%, 28%, and 18%, respectively; and assisted primary rates were 82%, 64%, 57%, 45%, and 32%, respectively. Primary patency rates for the CA were 68%, 50%, 40%, 29%, and 21%; and assisted primary rates were 79%, 58%, 52%, 42%, and 36% for 1, 2, 3, 4, and 5 years, respectively. There were no significant differences in either primary or assisted primary patency between the SMA and CA (P = .7729 and .8169). A secondary intervention was carried out in 30% of the series. Freedom from ≥70% in-stent stenosis for the SMA was 82%, 65%, 56%, 42%, and 34%, and that for the CA was 73%, 59%, 48%, 34%, and 25%, at 1, 2, 3, 4, and 5 years, respectively. CONCLUSIONS Stenting of SMA/CA stenosis has high technical/early clinical success rates with a satisfactory late clinical outcome; however, it is associated with high rates of late in-stent stenosis and intervention.