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Cited by 186Abdominal vascular conditions and treatmentsPeripheral Artery Disease ManagementVascular anomalies and interventions

Open versus endovascular revascularization for chronic mesenteric ischemia: Risk-stratified outcomes

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Oderich, Gustavo S., Bower, Thomas C., Sullivan, Timothy M., Bjarnason, Haraldur, Cha, Stephen, Gloviczki, Peter·2009·Journal of Vascular Surgery
DOI 10.1016/j.jvs.2009.02.006
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Abstract

Objective Outcomes of open (OR) and endovascular revascularization (ER) for chronic mesenteric ischemia (CMI) were analyzed with respect to clinical risk stratification.Methods The data of 229 consecutive patients treated for CMI with OR (146 patients/265 vessels) or ER (83 patients/105 vessels) between 1991 and 2005 were reviewed. Patients were classified as low-risk or high-risk using standard scoring systems. End points were mortality and morbidity, recurrence-free survival, and patency rates. A subset analysis compared 111 patients (208 vessels) who had OR with 58 patients (76 vessels) who had stenting.Results The ER patients were significantly older (71 +/- 15 vs 65 +/- 11 years; P < .05), had higher risk (58% vs 31%), and fewer vessels revascularized (1.3 +/- 0.5 vs 1.8 +/- 0.4). Four (2.7%) procedurally related deaths occurred in the OR and two (2.4%) in the ER group (P = NS). Mortality was higher for high-risk patients (OR, 6.7% vs 0.9%; ER, 4.8% vs 0%; P < .05), but differences were not significant among low-risk or high-risk OR vs ER patients. OR patients had more complications (36% vs 18%; P < .001) and longer hospitalization (12 +/- 8 vs 3 +/- 5 days; P < .001). At 5 years, OR had improved (P < .05) recurrence-free survival (89% +/- 4% vs 51% +/- 9%), and primary (88% +/- 3% vs 41% +/- 9%) and secondary patency rates (97% +/- 2% vs 88% +/- 4%). More restenoses (hazard ratio [HR], 5.1; 95% confidence interval [CI], 2.4-10.2), recurrences (HR, 6.7; 95% CI, 3.3-13.8), and reinterventions occurred in the ER group (HR, 4.3; 95% CI, 1.9-9.7). At last follow-up, significant symptom improvement was noted in 137 OR (96%) and 72 ER patients (92%, P = NS). In the subset analysis of patients having first-time operations vs stenting, OR resulted in improved (P < .05) recurrence-free survival (91% +/- 3% vs 56% +/- 8% at 5 years) and better primary and secondary patency rates (93% +/- 2% and 98% +/- 1% vs 52% +/- 8% and 93% +/- 4% at 3 years).Conclusion OR has similar mortality but higher morbidity and longer hospitalization than ER in low-risk or high-risk patients with CMI. Both treatments effectively improved symptoms, but restenosis, recurrent symptoms, and reinterventions were more likely in ER patients. These findings may guide treatment selection and counseling of low-risk and high-risk CMI patients undergoing OR or ER procedures.

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  1. [15]15. Busquet J. Intravascular stenting in the superior mesenteric artery for chronic abdominal angina. J Endovasc Surg 1997;4:380-4.

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Authors
Oderich, G. S., Bower, T. C., Sullivan, T. M., Bjarnason, H., Cha, S., & Gloviczki, P.
Affiliations
  • Mayo Clinic (US)
  • Abbott Northwestern Hospital (US)
Corresponding author
Oderich, Gustavo S.
ORCID
Venue
Journal of Vascular Surgery
Publisher
Elsevier BV
Published
2009-06
Volume
49
Issue
6
Pages
1472-1479.e3
ISSN
0741-5214 (ISSN-L)
DOI
10.1016/j.jvs.2009.02.006
OpenAlex
W1993386696
Cited by
186
References
26
Citations by year
2026: 9 · 2025: 15 · 2024: 6 · 2023: 12 · 2022: 5 · 2021: 9 · 2020: 14 · 2019: 12 · 2018: 13 · 2017: 16 · 2016: 10 · 2015: 9 · 2014: 15 · 2013: 8 · 2012: 8
FWCI
10.79
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 › Vascular anomalies and interventions
Keywords
chronic mesenteric ischemia, open surgical revascularization, endovascular revascularization, risk stratification, mortality, restenosis, recurrence-free survival, patency rate, reintervention, postoperative complications, length of hospital stay, procedural mortality, risk scoring, small bowel ischemia, mesenteric arteries
MeSH terms
Aged, Aged, 80 and over, Angioplasty, Balloon, Chronic Disease, Female, Humans, Ischemia, Length of Stay, Male, Mesenteric Vascular Occlusion, Middle Aged, Recurrence, Reoperation, Retrospective Studies, Risk Factors, Time Factors, Vascular Patency, Vascular Surgical Procedures, Stents, Proportional Hazards Models, Treatment Outcome, Risk Assessment, Patient Selection, Kaplan-Meier Estimate

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