Patient survival after open and endovascular mesenteric revascularization for chronic mesenteric ischemia
Open accessAbstract
Objective To evaluate long-term patient survival and causes of death after open (OR) or endovascular (ER) mesenteric revascularization for atherosclerotic chronic mesenteric ischemia using propensity score-matched comparison and clinical risk stratification. Methods The clinical data of 343 patients treated with mesenteric revascularization for chronic mesenteric ischemia between 1991 and 2010 were retrospectively reviewed. Clinical, anatomical, and procedure-related variables were analyzed using a multivariate model to identify independent predictors of any-cause early and late (>30 days) mortality. Cause of death was retrieved from review of the National Death Index. Patient survival was analyzed using Society for Vascular Surgery (SVS) comorbidity scores and propensity score-matched comparison based on independent predictors of any-cause mortality. Results There were 187 patients treated by OR and 156 patients treated by ER. Early procedure-related mortality was 2.6% (9/343), including five OR (2.7%) and four ER (2.6%) patients. Median follow-up was 96 ± 54 months (range, 1-168 months). There were 144 late deaths, most commonly from cardiac causes in 35% (51/144), followed by cancer in 15% (21/144), pulmonary complications in 13% (19/144), and mesenteric ischemia in 11% (16/144). A further 21 patients died from various identifiable causes, and 14 patients (10%) died of unknown causes. Overall, 25 patients (7.3%) died of mesenteric-related causes, including nine early and 16 late deaths (OR, 10/187; 8.0%, and ER, 6/156; 6.4%). Multivariate analysis identified age >80, diabetes, chronic kidney disease (CKD) stage IV or V, and home oxygen therapy as independent predictors (P < .05) of any cause of death. Diabetes and CKD stage IV or V were independently associated with mesenteric-related death (P < .05). Late patient survival at 5 years in the OR and ER groups was 75% ± 4% and 60% ± 9% for low SVS risk (<9), 52% ± 8% and 43% ± 9% for intermediate SVS risk (9-16), and 67% ± 15% and 30% ± 8% for high SVS risk (>16). Using propensity matched scores, 5-year survival was nearly identical for patients treated by OR (60%) or ER (57%; P = .7). Conclusions Long-term patient survival after mesenteric revascularization was not influenced by type of arterial reconstruction. Age >80 years, diabetes, CKD stage IV or V, and home oxygen were independent predictors of any-cause mortality. Diabetes and CKD stage IV or V were independently associated with mesenteric-related death.
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Continued surveillance for stent or graft restenosis is important, as AMI after mesenteric revascularization accounts for 6-8% of late deaths.
“Continued surveillance for stent or graft restenosis is important, as AMI after mesenteric revascularization accounts for 6–8% of late deaths [153].”
From Acute mesenteric ischemia: updated guidelines of the World Society of Emergency Surgery. (2022) · cites this paper as [153]
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Erben, Y., Oderich, G. S., & Debus, E. S. (2019) · Springer Reference Medizin · doi:10.1007/978-3-662-45856-3_79-1
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Isquemia mesentérica. Estrategia actual
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- Authors
- Tallarita, T., Oderich, G. S., Gloviczki, P., Duncan, A. A., Kalra, M., Cha, S., Misra, S., & Bower, T. C.
- Affiliations
- Mayo Clinic (US)
- Corresponding author
- Oderich, Gustavo S.
- Venue
- Journal of Vascular Surgery
- Publisher
- Elsevier BV
- Published
- 2013-03
- Volume
- 57
- Issue
- 3
- Pages
- 747-755
- ISSN
- 0741-5214 (ISSN-L)
- PMC
- PMC3923307
- OpenAlex
- W1971769703
- Cited by
- 83
- References
- 15
- Citations by year
- 2026: 4 · 2025: 8 · 2024: 2 · 2023: 5 · 2022: 8 · 2021: 3 · 2020: 7 · 2019: 3 · 2018: 5 · 2017: 11 · 2016: 5 · 2015: 15 · 2014: 7
- FWCI
- 8.88
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of Vascular Surgery (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Heart, Lung, and Blood Institute (R01HL098967)
- Topics
- Health Sciences › Medicine › Surgery › Abdominal vascular conditions and treatments
- Health Sciences › Medicine › Surgery › Peripheral Artery Disease Management
- Health Sciences › Medicine › Gastroenterology › Gastrointestinal Bleeding Diagnosis and Treatment
- Keywords
- chronic mesenteric ischemia, mesenteric revascularization, open surgery, endovascular treatment, patient survival, mortality, diabetes mellitus, chronic kidney disease, home oxygen therapy, risk stratification, atherosclerosis, mortality risk factors, causes of death, pulmonary complications, cardiovascular mortality, cancer mortality
- MeSH terms
- Age Factors, Aged, Aged, 80 and over, Cause of Death, Diabetes Mellitus, Female, Humans, Ischemia, Male, Middle Aged, Oxygen Inhalation Therapy, Retrospective Studies, Risk Factors, Time Factors, Vascular Diseases, Vascular Surgical Procedures, Comorbidity, Multivariate Analysis, Chi-Square Distribution, Proportional Hazards Models, Odds Ratio, Treatment Outcome, Survivors, Risk Assessment, Renal Insufficiency, Chronic, Kaplan-Meier Estimate, Propensity Score, Endovascular Procedures, Mesenteric Ischemia
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