Clinical outcomes of mesenteric artery stenting versus surgical revascularization in chronic mesenteric ischemia.
OBJECTIVE
Endovascular stenting of atherosclerotic lesions has become a common practice and widely accepted treatment strategy in the treatment of arterial occlusive disease. This study examines the clinical outcome of mesenteric stenting and open mesenteric revascularization for chronic mesenteric ischemia (CMI).


METHODS
Hospital records and clinical data of all patients undergoing surgical or endovascular interventions for CMI were reviewed during a recent 10-year period. Clinical outcomes were analyzed between the two groups.


RESULTS
Endovascular treatment was performed in 48 patients (58 vessels), and open repair was performed in 96 patients (157 vessels) during the study period. The mean age in the endovascular group was greater than the open group (74+/-9 vs 62+/-7 years, P<0.05). There was no difference in comorbidities, symptom duration, or treatment indications between the two groups. Among patients treated with surgical revascularization, operative strategies included bypass grafting (N.=72, 75%); transaortic endarterectomy (N.=19, 20%), or patch angioplasty (N.=5, 5%). In the open group, one-vessel and two-vessel revascularization was performed in 36% and 64% of patients, respectively. In the endovascular cohorts, one-vessel and two-vessel balloon angioplasty and/or stenting were performed in 79% and 21% of patients, respectively. The hospital length of stay was shorter in the endovascular group (3 vs 12 days, P<0.03). There was no difference in 30-day mortality, in-hospital complication, or three-year cumulative survival rate. Cumulative freedom from recurrent symptoms at three years were significantly greater in the open group (66%) compared to the endovascular group (27%, P<0.02).


CONCLUSIONS
Endovascular treatment offers a benefit of shorter hospitalization compared to the open revascularization, while both groups had similar morbidity and mortality rates. Patients treated with surgical reconstruction were more likely to experience long-term symptomatic relief compared to endovascular cohorts, possibly due to higher incidence of two-vessel surgical revascularization. Long term durability of endovascular intervention may be improved with two-vessel revascularization.
Kougias
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Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX 77030, USA. pkougias@bcm.tmc.edu
Huynh
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Lin
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D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D016009:Chi-Square Distribution; D002908:Chronic Disease; D005260:Female; 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; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents; D013781:Texas; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality