Faculty Collaboration Database

Chronic mesenteric ischemia: endovascular versus open revascularization. J Endovasc Ther 2010 Aug;17(4):540-9

Date

08/05/2010

Pubmed ID

20681773

DOI

10.1583/09-2935.1

Scopus ID

2-s2.0-77957834646 (requires institutional sign-in at Scopus site)   48 Citations

Abstract

UNLABELLED: To review 20 years of literature on chronic mesenteric ischemia (CMI), examining its complex clinical presentation and comparing open and endovascular treatment options.

METHODS: The PubMed and EBSCOHost electronic databases were queried to identify English-language articles published over the last 20 years. Scrutiny of the retrieved articles identified 1939 patients (mean age 65 years). Of these, 1163 patients underwent open surgery: 714 between 2000 and 2009 and 449 between 1990 and 1999. Of the 776 patients undergoing endovascular repairs, the majority (684) were performed between 2000 and 2009; 92 patients were treated between 1990 and 1999. Data were entered in an electronic database and were pooled for categorical analysis.

RESULTS: No major differences were seen among open surgeries or among endovascular surgeries performed when comparing the 2 time periods. On comparing open and endovascular surgeries performed between 2000 and 2009, symptom improvement was 2.4 times more likely after open compared to endovascular surgery (95% CI 1.5 to 3.6, p<0.001). Five-year primary patency and 5-year assisted primary patency were 3.8 (95% CI 2.4 to 5.8, p<0.001) and 6.4 (95% CI 1.3 to 30.1, p = 0.02) times greater in the open group. Freedom from symptoms at 5 years was 4.4 times greater for open versus endovascular (95% CI 2.8 to 7.0, p<0.001). The complication rate for open versus endovascular surgery was 3.2 times greater (95% CI 2.5 to 4.2, p<0.001). The difference in mortality was not statistically significant (p = 0.75).

CONCLUSION: Our data demonstrate that open revascularization surpasses endovascular procedures in long-term vessel patency and control of symptoms. Patients undergoing open procedures do, however, develop increased complications perioperatively. The preferred revascularization approach used in treating this condition should be tailored to the anatomy and physiology of each patient.

Author List

Gupta PK, Horan SM, Turaga KK, Miller WJ, Pipinos II

MESH terms used to index this publication - Major topics in bold

Adult
Aged
Blood Vessel Prosthesis Implantation
Chronic Disease
Humans
Ischemia
Mesenteric Vascular Occlusion
Middle Aged
Odds Ratio
Patient Selection
Reoperation
Risk Assessment
Risk Factors
Time Factors
Treatment Outcome
Vascular Patency
Vascular Surgical Procedures