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Cited by 35Abdominal vascular conditions and treatmentsPeripheral Artery Disease ManagementVascular anomalies and interventions

Chronic mesenteric ischemia outcome analysis and predictors of endovascular failure

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Zacharias, Nikolaos, Eghbalieh, Sammy D., Chang, Benjamin B., Kreienberg, Paul B., Roddy, Sean P., Taggert, John B., Sternbach, Yaron, Darling, R. Clement·2016·Journal of Vascular Surgery
DOI 10.1016/j.jvs.2016.02.051
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Abstract

Objective Outcomes of open revascularization (OR) and endovascular revascularization (ER) for chronic mesenteric ischemia (CMI) were analyzed to identify predictors of endovascular failure.Methods A retrospective study was performed of all consecutive patients with CMI (161 patients, 215 vessels) treated from 2008 to 2012. Demographics, comorbidities, clinical presentation, etiology, and treatment modalities were compared. Outcomes included technical success, restenosis requiring reintervention, complications, mortality, and hospital length of stay.Results There were 116 patients who were first treated with ER (72%) and 45 patients with OR (28%). Overall mortality was 6.8% (11/161). Among the ER patients, 27 developed restenosis and required OR (23%). Patients treated with ER were older (73 vs 66 years; P = .014), had similar comorbidities, and had higher rate of short lesions (≤2 cm) on preoperative angiograms (23% vs 47%; P = .004). Primary patency at 3 years was higher in the OR group compared with the ER group (91% vs 74%; P = .018). Long-term survival rates were higher in the ER group (95% vs 78%; P = .003). Hospital length of stay and intensive care unit length of stay were shorter in the ER group (<.001). Perioperative mortality (30-day) was not statistically significant between the groups (5.2% vs 11%; P = .165). A subgroup analysis was performed between the patients with successful ER and failure of ER requiring OR. Patients with failure of ER had significantly higher rates of aortic occlusive disease (86% vs 49%; P = .005) and long lesions ≥2 cm on angiography (57% vs 12%; P < .001) that were close to the mesenteric takeoff. Perioperative mortality was higher in the ER failure group (15% vs 2%; P = .009).Conclusions ER has similar perioperative mortality and shorter hospitalization but higher rate of restenosis requiring reintervention compared with OR. Patients with ER who required reintervention appear to have longer lesions as well as higher rates of aortic occlusive disease on preoperative angiography. Patients who crossed over from ER to OR had higher perioperative mortality than either primary open or endovascular patients. These findings may guide treatment selection in patients with CMI undergoing ER or OR.

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Authors
Zacharias, N., Eghbalieh, S. D., Chang, B. B., Kreienberg, P. B., Roddy, S. P., Taggert, J. B., Sternbach, Y., & Darling, R. C.
Affiliations
Albany Medical College (US)
Corresponding author
Darling, R. Clement
ORCID
Venue
Journal of Vascular Surgery
Publisher
Elsevier BV
Published
2016-06
Volume
63
Issue
6
Pages
1582-1587
ISSN
0741-5214 (ISSN-L)
DOI
10.1016/j.jvs.2016.02.051
OpenAlex
W2035045305
Cited by
35
References
20
Citations by year
2025: 5 · 2023: 5 · 2022: 4 · 2021: 4 · 2020: 3 · 2019: 2 · 2018: 5 · 2017: 5 · 2015: 1 · 2013: 1
FWCI
4.44
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, endovascular revascularization, open surgical revascularization, restenosis, reintervention, aortic occlusive disease, perioperative mortality, primary patency, predictors of failure, length of hospital stay, mesenteric artery stenosis, mesenteric artery occlusion, mesenteric artery thrombosis
MeSH terms
Aged, Aged, 80 and over, Angiography, Chronic Disease, Female, Humans, Length of Stay, Male, Mesenteric Vascular Occlusion, Middle Aged, Postoperative Complications, Recurrence, Reoperation, Retrospective Studies, Risk Factors, Splanchnic Circulation, Time Factors, Vascular Patency, Vascular Surgical Procedures, Proportional Hazards Models, Hospital Mortality, Treatment Failure, Kaplan-Meier Estimate, Endovascular Procedures, Mesenteric Ischemia

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