Surgical versus endovascular reconstruction for chronic mesenteric ischemia: a contemporary UK series.
OBJECTIVE
To assess the outcome of surgical (SR) and endovascular (ER) reconstruction for chronic mesenteric ischemia (CMI).


METHODS
Retrospective review of consecutive patients who underwent SR or ER for CMI in 3 UK vascular surgery units between 1996 and 2006. Early (<30 days; technical success, morbidity, mortality, length of hospital stay) and late (>30 days) outcomes (symptom recurrence, vessel/graft patency, reintervention, mortality) were assessed.


RESULTS
A total of 27 patients underwent 32 reconstructions (SR = 17, ER = 15). A total of 44 of 56 (79%) diseased arteries underwent SR (n = 26; bypass = 24, reimplantation = 2; occlusion = 16, stenosis = 10) or ER (n = 18; stenosis = 16, occlusion = 2). Perioperative mortality for SR and ER was 6% and 0%, respectively (P > or = .99). Hospital stay was shorter following ER (mean, 4.3 vs. 14.2 days, P = .0003). Mean (range) follow-up for SR and ER was 34 (1-94) and 34 (0-135) months, respectively. At 2 years, SR demonstrated superior secondary patency (100% vs. 65%) and clinical patency (100% vs. 73%).


CONCLUSIONS
Surgical mesenteric reconstruction is associated with significantly longer hospital stay, but superior long-term outcome compared to endovascular reconstruction.
Davies
Robert S M
RS
University Department of Vascular Surgery, Heart of England NHS Foundation Trust, Birmingham, United Kingdom. RSMDavies@hotmail.com
Wall
Michael L
ML
Silverman
Stanley H
SH
Simms
Malcolm H
MH
Vohra
Rajiv K
RK
Bradbury
Andrew W
AW
Adam
Donald J
DJ
D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000401:mortality; D002908:Chronic Disease; D003251:Constriction, Pathologic; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007511:Ischemia / Q000209:etiology / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008297:Male; D008641:Mesenteric Vascular Occlusion / Q000150:complications / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D008875:Middle Aged; D012092:Replantation; D012189:Retrospective Studies; D018570:Risk Assessment; D013997:Time Factors; D016896:Treatment Outcome; D006113:United Kingdom; D014654:Vascular Patency; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality