Survival, Reintervention, and Value of Open and Endovascular Repair for Chronic Mesenteric Ischemia
Abstract
Background There are limited analyses of survival and postoperative outcomes in chronic mesenteric ischemia (CMI) using data from large cohorts. Current guidelines recommend open repair (OR) for younger, healthier patients when long-term benefits outweigh increased perioperative risks or for poor endovascular repair (ER) candidates. This study investigates whether long-term survival, reintervention, and value differ between these treatment modalities.Methods A retrospective cohort analysis was performed on data extracted from the Statewide Planning and Research Cooperative System, the New York statewide all-payer database containing demographics, diagnoses, treatments, and charges. Patients were selected for CMI and subsequent ER or OR using International Classification of Diseases, Ninth Revision codes. Patients with peripheral arterial disease were excluded to account for ambiguity in the International Classification of Diseases, Ninth Revision procedure code for angioplasty of noncoronary vessels, which includes angioplasty of upper and lower extremity vessels. Kaplan-Meier analysis was used to compare 1-year and 5-year survival and reintervention between treatment modalities using a propensity-matched cohort. Cox proportional hazards testing was performed to find factors associated with 1-year and 5-year survival and reintervention. Analysis of procedural value was performed using linear regression.Results From 2000 to 2014, 744 patients met inclusion criteria. Of these, 209 (28.1%) underwent OR and 535 (71.9%) ER. No difference between propensity-matched groups was found in 1-year (P = 0.46) or 5-year (P = 0.91) survival. Congestive heart failure (hazard ratio [HR]: 2.8, 95% confidence interval [CI]: 1.7-4.4; P < 0.01), cancer (HR: 2.8, 95% CI: 1.3-5.8; P < 0.01), and dysrhythmia (HR: 1.8, 95% CI: 1.1-2.8; P = 0.02) correlated with 1-year mortality. Cancer (HR: 2.9, 95% CI: 1.6-5.5; P < 0.01), congestive heart failure (HR: 2.2, 95% CI: 1.5-3.2; P < 0.01), chronic pulmonary disease (HR: 1.4, 95% CI: 1.0-2.0; P = 0.04), and age (HR: 1.03, 95% CI: 1.01-1.05; P < 0.01) correlated with 5-year mortality. Treatment modality was not associated with reintervention at 1 year on Kaplan-Meier analysis (P = 0.29). However, ER showed increased instances of reintervention at 5 years (P < 0.01). Additionally, ER was associated with an increased 5-year value (0.7 ± 0.9 vs. 0.5 ± 0.5 life years/charges at index admission [$10k], P < 0.01; b coefficient: 0.2, 95% CI: 0.1-0.4, P < 0.01).Conclusions This is the largest retrospective propensity-matched single-study cohort to analyze long-term survival outcomes after intervention for CMI. Long-term mortality was independent of treatment modality and rather was associated with patient comorbidities. Therefore, treatment selection should depend on anatomic considerations and long-term value. ER should be considered over OR in patients with amenable anatomy based on the superior procedural value.
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Patient comorbidities often play a significant role in long-term mortality in chronic mesenteric ischemia.
“Patient comorbidities often play a significant role in long-term mortality.”
From Revascularization Strategies for Acute and Chronic Mesenteric Ischemia: A Narrative Review (2024) · cites this paper as [68]
Congestive heart failure, malignancy, age, and chronic pulmonary diseases have been linked to different mortality rates independent of treatment modality.
“Factors like congestive heart failure, malignancy, age, and chronic pulmonary diseases have been linked to different mortality rates independent of treatment modality [68].”
From Revascularization Strategies for Acute and Chronic Mesenteric Ischemia: A Narrative Review (2024) · cites this paper as [68]
Cites
Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data
Quan, H., Sundararajan, V., Halfon, P., Fong, A., Burnand, B., Luthi, J.-C., Saunders, L. D., Beck, C. A., Feasby, T. E., & Ghali, W. A. (2005) · Medical Care · doi:10.1097/01.mlr.0000182534.19832.83 · Cited by 10,669 · see citing works
Hulot, J., Collet, J., Silvain, J., Peña, A., Bellemain-Appaix, A., Barthélémy, O., Cayla, G., Beygui, F., & Montalescot, G. (2010) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2009.12.071 · Cited by 379 · see citing works
Mesenteric revascularization: management and outcomes in the United States, 1988-2006
Schermerhorn, M. L., Giles, K. A., Hamdan, A. D., Wyers, M. C., & Pomposelli, F. B. (2009) · Journal of Vascular Surgery · doi:10.1016/j.jvs.2009.03.004 · Cited by 311 · see citing works
Chronic mesenteric ischemia: open surgery versus percutaneous angioplasty and stenting
Kasirajan, K., O'Hara, P. J., Gray, B. H., Hertzer, N. R., Clair, D. G., Greenberg, R. K., Krajewski, L. P., Beven, E. G., & Ouriel, K. (2001) · Journal of Vascular Surgery · doi:10.1067/mva.2001.111808 · Cited by 275 · see citing works
Mechanisms of Coronary Thrombosis in Cigarette Smoke Exposure
Barua, R. S., & Ambrose, J. A. (2013) · Arteriosclerosis Thrombosis and Vascular Biology · doi:10.1161/atvbaha.112.300154 · Cited by 243 · see citing works
Comparison of Omeprazole and Pantoprazole Influence on a High 150-mg Clopidogrel Maintenance Dose
Cuisset, T., Frère, C., Quilici, J., Poyet, R., Gaborit, B., Bali, L., Brissy, O., Morange, P., Alessi, M., & Bonnet, J. (2009) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2009.05.050 · Cited by 221 · see citing works
Atkins, M. D., Kwolek, C. J., LaMuraglia, G. M., Brewster, D. C., Chung, T. K., & Cambria, R. P. (2007) · Journal of Vascular Surgery · doi:10.1016/j.jvs.2007.01.067 · Cited by 217 · see citing works
Open versus endovascular revascularization for chronic mesenteric ischemia: Risk-stratified outcomes
Oderich, G. S., Bower, T. C., Sullivan, T. M., Bjarnason, H., Cha, S., & Gloviczki, P. (2009) · Journal of Vascular Surgery · doi:10.1016/j.jvs.2009.02.006 · Cited by 186 · see citing works
Quinn, A. D. (1993) · Critical Care Nursing Clinics of North America · doi:10.1016/s0899-5885(18)30596-3 · Cited by 156 · see citing works
Chronic mesenteric ischemia: Clinical practice guidelines from the Society for Vascular Surgery
Huber, T. S., Björck, M., Chandra, A., Clouse, W. D., Dalsing, M. C., Oderich, G. S., Smeds, M. R., & Murad, M. H. (2021) · Journal of Vascular Surgery · doi:10.1016/j.jvs.2020.10.029 · Cited by 152 · see citing works
Mesenteric stenting for chronic mesenteric ischemia
Brown, D. J., Schermerhorn, M. L., Powell, R. J., Fillinger, M. F., Rzucidlo, E. M., Walsh, D. B., Wyers, M. C., Zwolak, R. M., & Cronenwett, J. L. (2005) · Journal of Vascular Surgery · doi:10.1016/j.jvs.2005.03.054 · Cited by 151 · see citing works
Alahdab, F., Arwani, R., Pasha, A. K., Razouki, Z. A., Prokop, L. J., Huber, T. S., & Murad, M. H. (2018) · Journal of Vascular Surgery · doi:10.1016/j.jvs.2017.12.046 · Cited by 114 · see citing works
Trends in treatment and mortality for mesenteric ischemia in the United States from 2000 to 2012
Zettervall, S. L., Lo, R. C., Soden, P. A., Deery, S. E., Ultee, K. H., Pinto, D. S., Wyers, M. C., & Schermerhorn, M. L. (2017) · Annals of Vascular Surgery · doi:10.1016/j.avsg.2017.01.007 · Cited by 88 · see citing works
Tallarita, T., Oderich, G. S., Gloviczki, P., Duncan, A. A., Kalra, M., Cha, S., Misra, S., & Bower, T. C. (2013) · Journal of Vascular Surgery · doi:10.1016/j.jvs.2012.09.047 · Cited by 83 · see citing works
Lima, F. V., Kolte, D., Kennedy, K., Louis, D. W., Abbott, J., Soukas, P., Hyder, O., Mamdani, S. T., & Aronow, H. (2017) · JACC: Cardiovascular Interventions · doi:10.1016/j.jcin.2017.09.033 · Cited by 59 · see citing works
Cai, W., Li, X., Shu, C., Qiu, J. H., Fang, K., Li, M., Chen, Y., & Liu, D. (2015) · Annals of Vascular Surgery · doi:10.1016/j.avsg.2015.01.010 · Cited by 55 · see citing works
Hogendoorn, W., Hunink, M. G. M., Schlösser, F. J. V., Moll, F. L., Muhs, B. E., & Sumpio, B. E. (2014) · Journal of Vascular Surgery · doi:10.1016/j.jvs.2014.03.009 · Cited by 46 · see citing works
Terlouw, L. G., Verbeten, M., van Noord, D., Brusse-Keizer, M., Beumer, R. R., Geelkerken, R. H., Bruno, M. J., Kolkman, J. J., & Dutch Mesenteric Ischemia Study Group (2020) · Clinical and Translational Gastroenterology · doi:10.14309/ctg.0000000000000200 · Cited by 39 · see citing works
Geiger, J. T., Fleming, F. J., Stoner, M. C., & Doyle, A. J. (2021) · Journal of Vascular Surgery · doi:10.1016/j.jvs.2021.08.077 · Cited by 39 · see citing works
Self-citationChronic mesenteric ischemia outcome analysis and predictors of endovascular failure
Zacharias, N., Eghbalieh, S. D., Chang, B. B., Kreienberg, P. B., Roddy, S. P., Taggert, J. B., Sternbach, Y., & Darling, R. C. (2016) · Journal of Vascular Surgery · doi:10.1016/j.jvs.2016.02.051 · Cited by 35 · see citing works
Arya, S., Kingman, S., Knepper, J. P., Eliason, J. L., Henke, P. K., & Rectenwald, J. E. (2015) · Annals of Vascular Surgery · doi:10.1016/j.avsg.2015.07.038 · Cited by 26 · see citing works
Esce, A. R., Medhekar, A. N., Fleming, F. J., Noyes, K., Glocker, R. J., Ellis, J., Raman, K. G., Stoner, M. C., & Doyle, A. J. (2017) · Annals of Vascular Surgery · doi:10.1016/j.avsg.2017.08.017 · Cited by 19 · see citing works
Self-citationMansukhani, N. A., Hekman, K. E., Yoon, D. Y., Helenowski, I. B., Hoel, A. W., Rodriguez, H. E., Pearce, W. H., Eskandari, M. K., & Tomita, T. M. (2018) · Annals of Vascular Surgery · doi:10.1016/j.avsg.2017.09.026 · Cited by 9 · see citing works
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Revascularization Strategies for Acute and Chronic Mesenteric Ischemia: A Narrative Review
Gries, J. J., Sakamoto, T., Chen, B., Virk, H. U. H., Alam, M., & Krittanawong, C. (2024) · Journal of Clinical Medicine · doi:10.3390/jcm13051217 · Cited by 19 · see citing works
“The advent of new diagnostic and revascularization techniques for both acute and chronic conditions invites provides ample opportunity for future novel or supporting research.”
BackgroundJacobs, C. R., Scali, S. T., Jacobs, B. N., Filiberto, A. C., Anderson, E. M., Fazzone, B. J., Back, M. R., Upchurch, G. R., Giles, K. A., & Huber, T. S. (2024) · Journal of Vascular Surgery · doi:10.1016/j.jvs.2024.03.028 · Cited by 3 · see citing works
Chronische Mesenterialischämie: postoperatives Überleben und Zweiteingriffe
(2024) · Gefäßmedizin Scan - Zeitschrift für Angiologie Gefäßchirurgie diagnostische und interventionelle Radiologie · doi:10.1055/a-2279-5587
Galyfos, G. C., Chamzin, A., Moisidis, I., Chatzopoulou, D., Kravari, I., Kapoutsi, M.-C., Palaios, A., Sigala, F., & Filis, K. (2025) · Journal of Endovascular Therapy · doi:10.1177/15266028251333627
Balceniuk, M. D. (2026) · Journal of Vascular Surgery · doi:10.1016/j.jvs.2026.04.002
Kuo, C., Chang, L.-C., Liao, C., & Yang, D.-H. (2026) · Journal of Investigative Surgery · doi:10.1080/08941939.2026.2748718
- Authors
- Lehane, D. J., Geiger, J. T., Zottola, Z. R., Newhall, K. A., Mix, D. S., Doyle, A. J., & Stoner, M. C.
- Affiliations
- University of Rochester Medicine (US)
- Corresponding author
- Stoner, Michael C.
- ORCID
- Venue
- Annals of Vascular Surgery
- Publisher
- Elsevier BV
- Published
- 2023-11
- Volume
- 97
- Pages
- 203-210
- ISSN
- 0890-5096 (ISSN-L)
- OpenAlex
- W4386374860
- Cited by
- 5
- References
- 23
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 3
- FWCI
- 1.34
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- Locations
- Annals of Vascular Surgery (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Abdominal vascular conditions and treatments
- Health Sciences › Medicine › Gastroenterology › Gastrointestinal Bleeding Diagnosis and Treatment
- Health Sciences › Medicine › Surgery › Vascular anomalies and interventions
- Keywords
- chronic mesenteric ischemia, open surgical repair, endovascular repair, survival, reintervention, treatment selection, congestive heart failure, cancer, cardiac arrhythmias, chronic lung disease, mortality risk factors, New York State, propensity score matching, cost-effectiveness, quality-adjusted life years, health care utilization, hospital readmission
- MeSH terms
- Chronic Disease, Heart Failure, Humans, Neoplasms, Retrospective Studies, Risk Factors, Treatment Outcome, Risk Assessment, Kaplan-Meier Estimate, Endovascular Procedures, Mesenteric Ischemia
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