Outcomes of endovascular and open treatment for chronic mesenteric ischemia.
OBJECTIVE
To measure contemporary practice patterns and compare outcomes of open and endovascular repair for chronic mesenteric ischemia (CMI).


METHODS
The New York State Health Department Statewide Planning and Research Cooperative System database was queried for the ICD-9-CM codes for CMI for the years 2000 to 2006. In this time period, 6549 patients were evaluated for CMI in New York State. Of these patients, 666 received an intervention and underwent either open (n = 280) or endovascular (n = 347) repair; 39 patients underwent both treatments and were excluded. Trends in operative management and short-term outcomes were analyzed.


RESULTS
Over the 7-year study period, there was a steady increase in the number of endovascular procedures from 28% in 2000 to 75% in 2006. The overall mortality rate for the 7-year period was significantly lower for endovascular versus open repair (11.0% versus 20.4%, respectively; p = 0.0011). Endovascular repair was associated with a significantly lower rate of mesenteric ischemic complications compared to open repair (6.92% versus 17.1%, respectively; p<0.0001). Moreover, compared with open surgery, endovascular repair resulted in significantly lower rates of cardiac, pulmonary, and infectious complications (p<0.05). Only 37% of patients having open repair were discharged home compared to 55% of patients treated with endovascular procedures (p<0.0001).


CONCLUSIONS
The number of patients treated for CMI continues to increase and correlates with the increasing utilization of endovascular procedures. The patients undergoing endovascular treatment had fewer complications, lower in-hospital mortality, and a greater likelihood of being discharged home.
Section of Vascular Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut 06520, USA. jeffrey.indes@yale.edu
Jeffrey E
JE
Indes
Jeannine K
JK
Giacovelli
Bart E
BE
Muhs
Julie Ann
JA
Sosa
Alan
A
Dardik
D000368:Aged; D002908:Chronic Disease; D019992:Databases as Topic; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007511:Ischemia / Q000401:mortality / Q000601:surgery*; D016015:Logistic Models; D008297:Male; D008641:Mesenteric Vascular Occlusion / Q000401:mortality / Q000601:surgery*; D008643:Mesentery / Q000098:blood supply*; D009518:New York; D016017:Odds Ratio; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data; D010351:Patient Discharge; D011183:Postoperative Complications / Q000401:mortality; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality / Q000706:statistics & numerical data