Contemporary management of acute and chronic mesenteric ischemia: 10-year experience from a multihospital healthcare system
Open accessAbstract
Objective Endovascular and hybrid methods have been increasingly used to treat mesenteric ischemia. However, the long-term outcomes and risk of symptom recurrence remain unknown. The objective of the present study was to define the predictors of postoperative morbidity, mortality, and patency loss for acute mesenteric ischemia (AMI) and chronic mesenteric ischemia (CMI).Methods The inpatient and follow-up records for all patients who had undergone revascularization for AMI and CMI from 2010 to 2020 at a multicenter hospital system were reviewed. Patency and mortality were evaluated with Cox regression, visualized with Kaplan-Meier curves, and compared using log-rank testing. Patency was further evaluated using Fine-Gray regression with death as a competing risk. The postoperative major adverse events (MAE) and 30-day mortality were evaluated with logistic regression.Results A total of 407 patients were included, 148 with AMI and 259 with CMI. For the AMI group, the 30-day mortality was 31%. Open surgery was associated with lower rates of bowel resection (odds ratio [OR], 0.23; 95% confidence interval [CI], 0.13-0.61). The etiology of AMI also did not change the outcomes (OR, 1.30; 95% CI, 0.77-2.19). Adjusted analyses indicated that a history of diabetes (OR, 2.77; 95% CI, 1.37-5.61) and sepsis on presentation (OR, 2.32; 95% CI, 1.18-4.58) were independently associated with an increased risk of 30-day MAE. In the CMI group, open surgery and chronic kidney disease were associated with a higher incidence of MAE (OR, 3.03; 95% CI, 1.14-8.05; OR, 2.37; 95% CI, 1.31-4.31). In contrast, chronic kidney disease (OR, 3.02; 95% CI, 1.10-8.37) and inpatient status before revascularization (OR, 2.78; 95% CI, 1.01-7.61) were associated with increased 30-day mortality. For the CMI group, the endovascular cohort had experienced greater rates of symptom recurrence (29% vs 13%) with a faster onset (endovascular, 64 days; vs bypass, 338 days).Conclusions AMI remains a morbid disease despite the evolving revascularization techniques. An open approach should remain the reference standard because it reduces the likelihood of bowel resection. For CMI, endovascular interventions have improved the postoperative morbidity but have also resulted in early symptom recurrence and reintervention. An endovascular-first approach should be the standard of care for CMI with close surveillance.
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Larger database analyses consistently show endovascular interventions are associated with improved postoperative morbidity and mortality, lower in-hospital mortality, lower bowel resection, decreased need for parenteral nutrition, shorter hospital stays, and lower cost compared to open surgery.
“larger database analyses have consistently shown that these interventions are associated with improved postoperative morbidity and mortality, lower rates of in-hospital mortality, lower rates of bowel resection, decreased need for parenteral nutrition, shorter hospital stays, and lower cost compared to open surgery [53,74,75,76].”
From Revascularization Strategies for Acute and Chronic Mesenteric Ischemia: A Narrative Review (2024) · cites this paper as [53]
The Discussion (Acute Mesenteric Ischemia; page unavailable) reports that larger database analyses found improved postoperative morbidity and mortality with endovascular treatment, including lower mortality in AMI. The Discussion (Chronic Mesenteric Ischemia; page unavailable) reports lower in-hospital complications and costs, but no mortality difference, in a database analysis of CMI; it also reports a shorter length of stay after endovascular treatment in this paper’s cohort. The source does not establish the claimed reductions in bowel resection or parenteral nutrition: its own AMI cohort found lower bowel-resection rates with open approaches and no effect of intervention type on TPN dependence. (LLM, conf=0.88)
Experimental — accuracy not yet measuredSome small cohort studies reported better outcomes for endovascular interventions.
“While some small cohort studies have reported better outcomes for endovascular interventions [53,56,58,74]”
From Revascularization Strategies for Acute and Chronic Mesenteric Ischemia: A Narrative Review (2024) · cites this paper as [53]
The Results (Chronic mesenteric ischemia; page unavailable) report fewer postoperative major adverse events with endovascular treatment than with open intervention (9% versus 27%). But the Discussion (Acute Mesenteric Ischemia; page unavailable) says intervention type did not affect major adverse events or mortality in that cohort, and the Conclusions describe this study as the largest mesenteric-ischemia experience to date. The claim therefore captures a favorable outcome for endovascular treatment in chronic disease, but overgeneralizes it and inaccurately characterizes this study as small. (LLM, conf=0.87)
Experimental — accuracy not yet measuredComparative studies show similar outcomes between open and endovascular approaches in patients with indications for laparotomy.
“Comparative studies between open and endovascular approaches have shown similar outcomes in patients with indications for laparotomy [53,65].”
From Revascularization Strategies for Acute and Chronic Mesenteric Ischemia: A Narrative Review (2024) · cites this paper as [53]
The Discussion’s Acute Mesenteric Ischemia section (page not provided) reports that intervention type did not affect overall major adverse events or mortality in the study cohort. It does not report equivalent outcomes specifically among patients with indications for laparotomy; it also reports lower bowel-resection rates after open interventions. (LLM, conf=0.86)
Experimental — accuracy not yet measuredDSA could not confirm DUS findings in 24% of the patients in this study.
“Of note, DSA could not confirm DUS findings in 24% of the patients in this study, which underscores the relevance of CTA as second level imaging if re-intervention is considered.”
From Editor's Choice - European Society for Vascular Surgery (ESVS) 2025 Clinical Practice Guidelines on the Management of Diseases of the Mesenteric and Renal Arteries and Veins. (2025) · cites this paper as [25]
The Results and Discussion (Chronic Mesenteric Ischemia; page unavailable) report that angiography found no significant stenosis in 9 of 37 stented patients evaluated for reintervention (24%) after duplex surveillance. The 24% applies to that subgroup, not all patients in the study, and the paper calls the test an angiogram without specifying DSA. (LLM, conf=0.87)
Experimental — accuracy not yet measuredIn a retrospective study, 65/259 patients (25%) treated for CMI had recurrent symptoms or weight loss within one year, more often after endovascular (29%) than open revascularisation (13%).
“In a retrospective study, 65/259 patients (25%) treated for CMI had recurrent symptoms or weight loss within one year, more often after endovascular (29%) than open revascularisation (13%).”
From Editor's Choice - European Society for Vascular Surgery (ESVS) 2025 Clinical Practice Guidelines on the Management of Diseases of the Mesenteric and Renal Arteries and Veins. (2025) · cites this paper as [25]
The Results (Chronic mesenteric ischemia; page not supplied) report recurrence of abdominal pain or unexplained weight loss in 65/259 patients (25%), with rates of 29% after endovascular treatment and 13% after bypass. The Methods define recurrence as occurring during follow-up, not necessarily within one year; the Results give average CMI follow-up as 1.5 years. Thus the one-year limit is not supported. (LLM, conf=0.90)
Experimental — accuracy not yet measured
Open approaches have resulted in quicker time to intervention.
“Logistically, open approaches have resulted in quicker time to intervention [53].”
From Revascularization Strategies for Acute and Chronic Mesenteric Ischemia: A Narrative Review (2024) · cites this paper as [53]
Most patients with recurrent symptoms present during the first year after revascularisation.
“Most patients with recurrent symptoms present during the first year after revascularisation.”
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- Authors
- Andraska, E. A., Tran, L. M., Haga, L. M., Mak, A. K., Madigan, M. C., Makaroun, M. S., Eslami, M. H., & Chaer, R. A.
- Affiliations
- University of Pittsburgh Medical Center (US)
- University of Pittsburgh (US)
- Corresponding author
- Andraska, Elizabeth A.
- Venue
- Journal of Vascular Surgery
- Publisher
- Elsevier BV
- Published
- 2022-05
- Volume
- 75
- Issue
- 5
- Pages
- 1624-1633.e8
- ISSN
- 0741-5214 (ISSN-L)
- PMC
- PMC9038632
- OpenAlex
- W3211591251
- Cited by
- 41
- References
- 26
- Citations by year
- 2026: 7 · 2025: 10 · 2024: 11 · 2023: 7 · 2022: 6
- FWCI
- 5.64
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of Vascular Surgery (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- NIH
- National Heart, Lung, and Blood Institute (T32HL098036)
- Burroughs Wellcome Fund
- University of Pittsburgh
- Topics
- Health Sciences › Medicine › Surgery › Abdominal vascular conditions and treatments
- Health Sciences › Medicine › Emergency Medicine › Appendicitis Diagnosis and Management
- Health Sciences › Medicine › Surgery › Intestinal and Peritoneal Adhesions
- Keywords
- acute mesenteric ischemia, chronic mesenteric ischemia, mesenteric revascularization, endovascular revascularization, hybrid revascularization, graft patency, postoperative complications, 30-day mortality, diabetes mellitus, sepsis, chronic kidney disease, predictors of poor outcome, symptom recurrence, bowel resection, long-term outcomes
- MeSH terms
- Chronic Disease, Delivery of Health Care, Female, Humans, Ischemia, Male, Mesenteric Vascular Occlusion, Retrospective Studies, Time Factors, Vascular Patency, Treatment Outcome, Renal Insufficiency, Chronic, Endovascular Procedures, Mesenteric Ischemia
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