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Cited by 217Abdominal vascular conditions and treatmentsPeripheral Artery Disease ManagementInfectious Aortic and Vascular Conditions

Surgical revascularization versus endovascular therapy for chronic mesenteric ischemia: a comparative experience

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Atkins, Marvin D., Kwolek, Christopher J., LaMuraglia, Glenn M., Brewster, David C., Chung, Thomas K., Cambria, Richard P.·2007·Journal of Vascular Surgery
DOI 10.1016/j.jvs.2007.01.067
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Abstract

Introduction Endovascular therapy (percutaneous transluminal angioplasty [PTA] with stenting) has been increasingly applied in patients with chronic mesenteric ischemia (CMI) to avoid morbidities associated with open repair (OR). The purpose of this study was to compare outcomes of PTA/Stent vs OR in patients with symptomatic CMI.Methods During the interval of January 1991 to December 2005, 80 consecutive patients presenting with symptomatic CMI underwent elective revascularization. Patients with acute mesenteric ischemia or those with mesenteric revascularization performed as part of complex aneurysm repair were excluded. PTA/Stent (with stenting in 87%) was the initial procedure in 31 patients (42 vessels). OR was performed in 49 patients (88 vessels) and consisted of bypass grafting in 31 (63%), transaortic endarterectomy in 7 (14%), patch angioplasty in 4 (8%), or combined in 7 (15%). Mean follow-up was 15 months in the PTA/Stent group and 42 months in the OR cohort. Study end points included perioperative morbidity, mortality, late survival (Kaplan-Meier), and symptomatic and radiographic recurrence.Results Baseline comorbidities, with the exception of heart disease (P=.025) and serum albumin<3.5 g/dL (P=.025), were similar between PTA/Stent and OR patients. The PTA/Stent group had fewer vessels revascularized (1.5 vs 1.8 vessels, P=.001). Hospital length of stay was less for the PTA/Stent group (5.6 vs 16.7 days, P=.001). No difference was noted in in-hospital major morbidity (4/31 vs 2/49, P=.23) or mortality (1/31 vs 1/49, P=.74). Actuarial survival at 2 years was similar between the groups (88% PTA/Stent vs 74% OR, P=.28). There was no difference in the incidence of symptomatic (7/31 [23%] vs 11/49 [22%], P=.98) or radiographic recurrence (10/31 [32%] vs 18/49 [37%], P=.40) between the two groups. Radiographic primary patency (58% vs 90%, P=.001) and primary assisted patency (65% vs 96%, P<.001) at 1 year were lower in the PTA/Stent group compared with OR. Five (16%) of 31 PTA/Stent patients compared with 11 (22%) of 49 OR patients required a second intervention on at least one index vessel at any time (P=.49).Conclusions Symptomatic recurrence requiring reintervention is common (overall 16/80 [20%]) after open and endovascular treatment for CMI. PTA/Stent was associated with decreased primary patency, primary assisted patency, and the need for earlier reintervention. In-hospital mortality or major morbidity were similar in patients undergoing PTA/Stent and OR. These findings suggest that OR and PTA/Stent should be applied selectively in CMI patients in accordance with individual patient anatomic and comorbidity considerations.

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  • Smaller CMI PTA/S series have reported mortality sometimes similar to and sometimes lower than surgery.

    “There has been an increasing number of small reports of the use of angioplasty with or without stenting (PTA/S) for treatment of CMI with mortality rates similar to surgery in some reports and lower than surgery in others.12–17”

    From Mesenteric revascularization: management and outcomes in the United States, 1988-2006 (2009) · cites this paper as [13]

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Research works printed but not linked: 1

  1. Mateo RB, O'Hara PJ, Hertzer NR, Mascha EJ, Beven EG, Krajewski LP. Elective surgical treatment of symptomatic chronic mesenteric occlusive disease: early results and late outcomes. J Vasc Surg 1999;29:821-32.

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Authors
Atkins, M. D., Kwolek, C. J., LaMuraglia, G. M., Brewster, D. C., Chung, T. K., & Cambria, R. P.
Affiliations
Harvard University (US)
Corresponding author
Cambria, Richard P.
ORCID
Venue
Journal of Vascular Surgery
Publisher
Elsevier BV
Published
2007-06
Volume
45
Issue
6
Pages
1162-1171
ISSN
0741-5214 (ISSN-L)
DOI
10.1016/j.jvs.2007.01.067
OpenAlex
W2049121950
Cited by
217
References
28
Citations by year
2026: 3 · 2025: 2 · 2024: 5 · 2023: 8 · 2022: 3 · 2021: 8 · 2020: 9 · 2019: 8 · 2018: 14 · 2017: 8 · 2016: 16 · 2015: 11 · 2014: 10 · 2013: 10 · 2012: 18
FWCI
20.91
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of Vascular Surgery (publishedVersion)
  • PubMed (publishedVersion)
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, surgical revascularization, endovascular treatment, percutaneous transluminal angioplasty, patch angioplasty, postoperative complications, survival, recurrence, length of hospital stay
MeSH terms
Aged, Aged, 80 and over, Angioplasty, Balloon, Chronic Disease, Endarterectomy, Female, Follow-Up Studies, Humans, Ischemia, Male, Mesenteric Vascular Occlusion, Mesentery, Middle Aged, Radiography, Recurrence, Retrospective Studies, Severity of Illness Index, Time Factors, Vascular Patency, Vascular Surgical Procedures, Stents, Treatment Outcome, Angioplasty, Patient Selection, Kaplan-Meier Estimate

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