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Cited by 275Abdominal vascular conditions and treatmentsPeripheral Artery Disease ManagementRenal and Vascular Pathologies

Chronic mesenteric ischemia: open surgery versus percutaneous angioplasty and stenting

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Kasirajan, Karthikeshwar, O'Hara, Patrick J., Gray, Bruce H., Hertzer, Norman R., Clair, Daniel G., Greenberg, Roy K., Krajewski, Leonard P., Beven, Edwin G. +1 more·2001·Journal of Vascular Surgery
DOI 10.1067/mva.2001.111808
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Abstract

Objective The aim of the study was to evaluate the safety and efficacy of percutaneous angioplasty and stenting (PAS) in comparison with traditional open surgical (OS) revascularization for the treatment of chronic mesenteric ischemia.Methods Over a 3.5-year period, 28 patients (32 vessels) underwent PAS (balloon angioplasty alone, 5 [18%] of 28; angioplasty and stenting, 23 [82%] of 28) for symptoms of chronic mesenteric ischemia. These patients were compared with a previously published series of 85 patients (130 vessels) treated with OS (bypass grafting, 60 [71%] of 85; transaortic endarterectomy, 19 [22%] of 85; or patch angioplasty, 6 [7%] of 85).Results The PAS and OS groups were similar with respect to baseline comorbidities, duration of symptoms (median: 6.7 vs 10.5 months, P =.52), and the number of vessels involved, but the patients differed in their age at presentation (median: 72 vs 65 years, P =.005). Fewer vessels were revascularized per patient in the PAS group (1.1 +/- 0.4) compared with the OS group (1.5 +/- 0.6, P =.001). Overall, 85.7% (24/28) had one vessel and 14.3% (4/28) had two vessels revascularized in the PAS group versus 48.2% (41/85) with one-vessel and 47.1% (40/85) with two-vessel revascularization in the OS group. No difference was noted in the early in-hospital complications (median: 17.9% [PAS] vs 32.9% [OS], P =.12) or mortality rate (10.7% [PAS] vs 8.2% [OS], P =.71). A reduced length of hospital stay in the PAS patients did not attain statistical significance (median: 5 days [PAS] vs 13 days [OS], P =.08). Although the 3-year cumulative recurrent stenosis (P =.62) and mortality rate (P =.99) did not differ, the PAS treatment group had a higher incidence of recurrent symptoms (P =.001).Conclusion Although the results of PAS and OS were similar with respect to morbidity, death, and recurrent stenosis, PAS was associated with a significantly higher incidence of recurrent symptoms. These findings suggest that OS should be preferentially offered to patients deemed fit for open revascularization.

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  • Experience at the Cleveland Clinic Foundation and Mayo Clinic showed that long-term restenosis and recurrence of symptoms were higher in the PEVT group compared to the open surgical revascularization group.

    “Experience at the Cleveland Clinic Foundation and Mayo Clinic showed that long term restenosis and recurrence of symptoms were higher in the PEVT group compared to open surgical revascularization group[120,121].”

    From Ischemic bowel disease in 2021. (2021) · cites this paper as [120]

    The late-follow-up results (p. 65) report more recurrent symptoms at three years after percutaneous treatment than after open surgery (34% versus 13%, P = .001). Recurrent stenosis or occlusion was numerically higher (27% versus 24%), but that difference was not statistically significant (P = .62), so the claim overstates the restenosis finding. (LLM, conf=0.88)

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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 [14]

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Research works printed but not linked: 3

  1. Christen MG, Lorentzen JE, Schroeder TV. Revascularization of ath- erosclerotic mesenteric arteries: experience in 90 consecutive patients. Eur J Vasc Surg 1994;8:297-302.
  2. Taylor LM, Porter JM. Treatment of chronic intestinal ischemia. Semin Vasc Surg 1990;3:186-99.
  3. Hallisey MJ, Deschaine J, Illescas FF, Sussman SK, Vine HS, Ohki SK, et al. Angioplasty for the treatment of visceral ischemia. J Vasc Interv Radiol 1995;6:785-91.

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Authors
Kasirajan, K., O'Hara, P. J., Gray, B. H., Hertzer, N. R., Clair, D. G., Greenberg, R. K., Krajewski, L. P., Beven, E. G., & Ouriel, K.
Affiliations
Cleveland Clinic (US)
ORCID
Venue
Journal of Vascular Surgery
Publisher
Elsevier BV
Published
2001-01
Volume
33
Issue
1
Pages
63-71
ISSN
0741-5214 (ISSN-L)
DOI
10.1067/mva.2001.111808
OpenAlex
W2134114330
Cited by
275
References
34
Citations by year
2026: 1 · 2025: 3 · 2024: 1 · 2023: 3 · 2022: 2 · 2021: 6 · 2020: 6 · 2019: 3 · 2018: 5 · 2017: 14 · 2016: 12 · 2015: 10 · 2014: 14 · 2013: 15 · 2012: 21
FWCI
9.57
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 › Pulmonary and Respiratory Medicine › Renal and Vascular Pathologies
Keywords
chronic mesenteric ischemia, open surgical revascularization, mesenteric artery stenosis, balloon angioplasty, bypass grafting, patch angioplasty, stenosis recurrence, mortality, length of hospital stay, in-hospital complications, mesenteric ischemia
MeSH terms
Aged, Angioplasty, Balloon, Chronic Disease, Endarterectomy, Female, Humans, Intestines, Ischemia, Male, Mesenteric Vascular Occlusion, Middle Aged, Postoperative Complications, Recurrence, Vascular Surgical Procedures, Stents, Treatment Outcome, Blood Vessel Prosthesis Implantation

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