A Systematic Review of Endovascular Repair Outcomes in Atherosclerotic Chronic Mesenteric Ischaemia
Open accessAbstract
Objective Chronic mesenteric ischaemia (CMI) treatment focuses on symptom relief and prevention of disease progression. Endovascular repair represents the main treatment modality, while data on the associated antiplatelet regimen are scarce. The aim of this meta-analysis was to assess the early and midterm outcomes of endovascular repair in patients with CMI. Data sources Randomised controlled trials and observational studies (1990 - 2022) reporting on early and midterm endovascular repair outcomes in patients with atherosclerotic CMI. Review methods The PRISMA guidelines and PICO model were followed. The protocol was registered to PROSPERO (CRD42023401685). Medline, Embase (via Ovid), and Cochrane databases were searched (end date 21 February 2023). The Newcastle-Ottawa Scale was used for risk of bias assessment, and GRADE for evidence quality assessment. Primary outcomes were technical success, 30 day mortality, and symptom relief, assessed using prevalence meta-analysis. The role of dual antiplatelet therapy (DAPT) was investigated using meta-regression analysis. Results Sixteen retrospective studies (1 224 patients; mean age 69.8 ± 10.6 years; 60.3% female) reporting on 1 368 target vessels (57.8% superior mesenteric arteries) were included. Technical success was 95.0% (95% CI 93 - 97%, p = .28, I 2 19%, low certainty), the 30 day mortality rate was 2.0% (95% CI 2 - 4%, p = .93, I 2 36%, low certainty), and immediate symptom relief was 87.0% (95% CI 80 - 92%, p < .010, I 2 85%, very low certainty). At mean follow up of 28 months, the mortality rate was 15.0% (95% CI 9 - 25%, p = .010, I 2 86%, very low certainty), symptom recurrence 25.0% (95% CI 21 - 31%, p < .010, I 2 68%, very low certainty) and re-intervention rate 26.0% (95% CI 17 - 37%, p < .010, I 2 92%, very low certainty). Single antiplatelet therapy (SAPT) and DAPT performed similarly in the investigated outcomes. Conclusion Endovascular repair for CMI appears to be safe as first line treatment, with a low peri-operative mortality rate and acceptable immediate symptom relief. During midterm follow up, symptom recurrence and need for re-intervention are not uncommon. SAPT appears to be equal to DAPT in post-operative outcomes.
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The long term risk of becoming symptomatic in patients with asymptomatic MAOD is low, even in patients with multivessel disease.
“Prophylactic revascularisation in patients with asymptomatic MAOD is controversial, and rarely performed, because the long term risk of becoming symptomatic is low, even in patients with multivessel disease whose prognosis is determined by events in other vascular territories, other comorbidities, and age.”
In patients with single vessel disease, the probability of progression to CMI and AMI is very low.
“In patients with single vessel disease, the probability of progression to CMI and AMI is very low.”
Meta-regression comparing SAPT and DAPT after endovascular treatment of CMI showed similar outcomes, irrespective of the type of antithrombotic treatment, in terms of technical success (98% vs. 94%), immediate symptom relief (82% vs. 91%), early death (3% vs. 2%), and morbidity (16% vs. 8%).
“Meta-regression comparing SAPT and DAPT after endovascular treatment of CMI showed similar outcomes, irrespective of the type of antithrombotic treatment (either SAPTor DAPT), in terms of technical success (98% vs. 94%), immediate symptomrelief (82% vs. 91%), early death (3% vs. 2%), and morbidity (16% vs. 8%).”
In a systematic review, the clinical success of mesenteric artery revascularisation, defined as improvement or disappearance of symptoms, was 87% (95% CI 80-92%).
“In a systematic review, the clinical success of mesenteric artery revascularisation, defined as improvement or disappearance of symptoms, was 87% (95% CI 80 e 92%).”
The meta-analysis of 1,224 patients with CMI who had endovascular treatment showed a technical success rate of 95% (95% CI 93-97%), an immediate symptom relief rate of 87% (95% CI 80-92%), and an early mortality rate of 2% (95% CI 1-4%).
“The meta-analysis of 1 224 patients with CMI who had endovascular treatment showed a technical success rate of 95% (95% CI 93 e 97%), an immediate symptom relief rate of 87% (95% CI 80 e 92%), and an early mortality rate of 2% (95% CI 1 e 4%).”
A recent meta-analysis estimated the re-intervention and symptom recurrence rates to be 26.0% (95% CI 17-37%) and 25.0% (95% CI 21-31%), respectively, after a mean follow up of 28 months.
“A recent meta-analysis estimated the re-intervention and symptom recurrence rates to be 26.0% (95% CI 17 e 37%) and 25.0% (95% CI 21 e 31%), respectively, after a mean follow up of 28 months.”
In a systematic review of 1,224 endovascular procedures, only 90 (7.4%) were done by angioplasty alone.
“In a systematic review of 1 224 endovascular procedures, only 90 (7.4%) were done by angioplasty alone.”
The re-intervention rate after endovascular revascularisation for CMI was 26% (95% CI 17-37%), and was by endovascular means in 278 of 316 cases and by open conversion in 38 cases.
“The re-intervention rate was 26% (95% CI 17 e 37%), and was by endovascular means in 278 of 316 cases and by open conversion in 38 cases.”
In a systematic review of outcomes after endovascular revascularisation for CMI, symptom recurrence occurred in 25% (95% CI 21-31%) of patients after a mean follow up of 28 months.
“In a systematic review of outcomes after endovascular revascularisation for CMI, symptom recurrence occurred in 25% (95% CI 21 e 31%) of patients after a mean follow up of 28 months.”
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Koelemay, M. J., Geelkerken, R. H., Kärkkäinen, J., Leone, N., Antoniou, G. A., de Bruin, J. L., Gombert, A., Gottsätter, A., Iborra, E., Ronchey, S., et al. (2025) · European Journal of Vascular and Endovascular Surgery · doi:10.1016/j.ejvs.2025.06.010 · Cited by 123 · see citing works
Self-citation
- Authors
- Nana, P., Koelemay, M. J. W., Leone, N., Brodis, A., van den Berg, J. C., de Bruin, J. L., Geelkerken, R. H., & Spanos, K.
- Affiliations
- University of Thessaly (GR)
- Amsterdam UMC Location University of Amsterdam (NL)
- University of Modena and Reggio Emilia (IT)
- Medisch Spectrum Twente (NL)
- Corresponding author
- Nana, Petroula
- ORCID
- Venue
- European Journal of Vascular and Endovascular Surgery
- Publisher
- Elsevier BV
- Published
- 2023-11
- Volume
- 66
- Issue
- 5
- Pages
- 632-643
- ISSN
- 1078-5884 (ISSN-L)
- OpenAlex
- W4384023687
- Cited by
- 13
- References
- 8
- Citations by year
- 2026: 5 · 2025: 8
- FWCI
- 0.84
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- European Journal of Vascular and Endovascular Surgery (publishedVersion)
- PubMed (publishedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (publishedVersion, other-oa)
- BORIS (University Library Bern) (submittedVersion, cc-by-nc-nd)
- Archivio istituzionale della ricerca (Alma Mater Studiorum Università di Bologna) (submittedVersion)
- IRIS UNIMORE (University of Modena and Reggio Emilia) (submittedVersion)
- Pure Amsterdam UMC (submittedVersion, other-oa)
- University of Twente Research Information (submittedVersion)
- Open Access CRIS of the University of Bern
- Topics
- Health Sciences › Medicine › Surgery › Abdominal vascular conditions and treatments
- Health Sciences › Medicine › Surgery › Peripheral Artery Disease Management
- Health Sciences › Medicine › Surgery › Infectious Aortic and Vascular Conditions
- Keywords
- chronic mesenteric ischemia, endovascular repair, atherosclerosis, superior mesenteric artery, dual antiplatelet therapy, technical success, 30-day mortality, symptom relief, symptom recurrence, reintervention, long-term outcomes, antiplatelet therapy duration, covered stent, endovascular stenting, coil embolization, mechanical thrombectomy
- MeSH terms
- Aged, Aged, 80 and over, Chronic Disease, Female, Humans, Male, Middle Aged, Platelet Aggregation Inhibitors, Retrospective Studies, Atherosclerosis, Endovascular Procedures, Mesenteric Ischemia
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