Surgical and interventional visceral revascularization for the treatment of chronic mesenteric ischemia--when to prefer which?
BACKGROUND
The purpose of the present study was to compare surgical and endovascular revascularization for chronic mesenteric ischemia (CMI).


METHODS
Forty-nine patients underwent surgical (SG) or endovascular (EG) treatment. Relief of symptoms was considered the primary endpoint; patency, morbidity, and mortality were secondary endpoints. For statistical analysis, significance was assumed if P values < or = 0.05.


RESULTS
Twenty-six patients (53%) underwent surgical revascularization; 23 patients (47%), endovascular repair. Mean follow-up was 25 +/- 21 months (SG) versus 10 +/- 10 (EG) months (P = 0.07). Except for body mass indices (SG 18.9 +/- 2.7 versus EG 23.6 +/- 4.8; P = 0.001), preoperative data were comparable. Freedom from symptoms was 100% (SG) versus 90% (EG) after intervention (P = 0.194), and 89% (SG) versus 75% (EG) at the end of follow-up. Reocclusion or re-stenosis occurred in 8% (SG) versus 25% (EG) (log-rank test: P = 0.003), and mesenteric ischemia developed in 0% (SG) versus 9% (EG) (P = 0.04). Reintervention for CMI was required in 0% (SG) versus 13% (EG) (P = 0.01). Surgical patients experienced more early complications (42% versus EG 4%; P = 0.02) and longer hospital stays (11.6 +/- 10.9 days versus EG 1.3 +/- 0.5 days; P < 0.001). Overall mortality at the end of follow-up was 31% (SG) versus 4% (EG) (log-rank test: P = 0.08), including all patients with combined open mesenteric and aortic reconstruction (P = 0.001).


CONCLUSIONS
Surgical treatment has superior long-term patency and requires fewer reinterventions, but it is also more invasive with greater morbidity and mortality compared to endovascular treatment. Endovascular techniques may be preferable in patients with significant co-morbidities, concomitant aortic disease, or indeterminate symptoms.
Biebl
Matthias
M
Section of Vascular Surgery, Department of Surgery, Mayo Clinic, Jacksonville, Florida 32224, USA.
Oldenburg
W Andrew
WA
Paz-Fumagalli
Ricardo
R
McKinney
J Mark
JM
Hakaim
Albert G
AG
D000368:Aged; D017130:Angioplasty; D019917:Blood Vessel Prosthesis Implantation; D016009:Chi-Square Distribution; D002908:Chronic Disease; D004691:Endarterectomy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007511:Ischemia / Q000175:diagnosis / Q000601:surgery* / Q000628:therapy*; D008297:Male; D008641:Mesenteric Vascular Occlusion / Q000175:diagnosis / Q000601:surgery* / Q000628:therapy*; D008643:Mesentery / Q000098:blood supply*; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures