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Comparative Study
. 2020 Aug;44(8):2804-2812.
doi: 10.1007/s00268-020-05513-2.

Early and Midterm Outcomes of Open and Endovascular Revascularization of Chronic Mesenteric Ischemia

Anna-Leonie Menges  1 , Benedikt Reutersberg  2 , Albert Busch  1 , Michael Salvermoser  1 , Marcus Feith  3 , Matthias Trenner  1 , Michael Kallmayer  1 , Alexander Zimmermann  2 , Hans-Henning Eckstein  4
Affiliations
Comparative Study

Early and Midterm Outcomes of Open and Endovascular Revascularization of Chronic Mesenteric Ischemia

Anna-Leonie Menges et al. World J Surg. 2020 Aug.

Abstract

Background: Revascularization strategies for chronic mesenteric ischemia (CMI) include open (OR) and endovascular (ER) modalities. The primary objective of this study was to analyze the safety and effectiveness of OR and ER and the impact of clinical and morphological variables on early and midterm outcomes in a consecutive series of CMI patients in a tertiary referral center.

Patients and methods: From 2004 to 2017, all CMI patients treated with OR and ER were retrospectively identified. Patient records, preoperative imaging, as well as peri- and postoperative outcomes were analyzed. Univariable and multivariable analysis was performed to identify clinical or morphological variables affecting reintervention rates within 2 years.

Results: In total, 63 patients (33% male; mean age 71, range 60-76 years) were treated by ER (41 patients) or OR (22 patients) for CMI. Mean follow-up was 26 (10-71) months. 30-day mortality was 0.0% after ER and 4.5% after OR (p = 0.069); 30-day morbidity was 9.8% vs. 31.8%, respectively (p = 0.030). Length of stay was significantly longer after OR (14 vs. 4 days; p < 0.001). Freedom from reintervention rate after 2 years was 82% after OR and 73% after ER (p = 0.14). Overall survival did not differ after 2 years (OR 85% vs. ER 86%; p = 0.35). Multivariable analysis revealed that smoking was associated with higher risk of reintervention (hazard ratio, HR: 4.14; 95% confidence interval, CI 1.11-15.53; p = 0.03). Additionally, a nonsignificant trend of lower reintervention rates after OR was detected (HR 0.23 95% CI 0.05-1.08; p = 0.06).

Conclusion: Due to a lower invasiveness, despite the higher reintervention rate, an "endovascular first" strategy is justified and recommended.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Clinical, morphological parameters and mode of revascularization were adjusted for age and sex. HR, hazard ratio; CI, confidence interval; OR, open revascularization; ER, endovascular revascularization, CHD, coronary heart disease, ESRD, end-stage renal disease
See this image and copyright information in PMC

Comment in

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