title: Chronic mesenteric ischemia: critical review and guidelines for management.
abstract: BACKGROUND
  CMI is caused by chronic occlusive disease of mesenteric arteries. In such an uncommon disease, clear recommendations are strongly needed. Unfortunately, treatment options for symptomatic CMI are still controversial and no guidelines exist.
  
  
  METHODS
  A systematic literature review of the last 25-years was conducted through MEDLINE, Embase, and Cochrane Review/Trials register to identify studies reporting on CMI treatment with more than 10 patients. Primary outcomes were perioperative mortality and morbidity rates. Secondary outcomes were survival rates, primary and secondary patency rates, vessels treated, CMI recurrence, follow-up (FU), technical success (TS), and in-hospital length of stay (InH-LOS). Patients were divided into endovascular treatment (ET) or open treatment (OT) groups. Subsequently, primary and secondary outcomes were analyzed by study publication year for the interval periods 1986-2000 ("A") and 2001-2010 ("B"). Differences were assessed using the t-test and the χ(2) test.
  
  
  RESULTS
  Forty-three articles with 1,795 patients were included. Perioperative mortality and morbidity rates were lower in the ET group. No difference in survival rate was observed. Primary and secondary patencies were superior in the OT group. A greater number of vessels were revascularized in the OT group. CMI recurrence was more frequent in the ET group. FU was longer in the OT group. TS was superior in the OT group and InH-LOS was shorter in the ET group. A higher number of patients were treated by ET in the period "A." No differences in mortality and morbidity were observed between period "A" and "B" in ET and OT groups.
  
  
  CONCLUSIONS
  Considering the lower periprocedural mortality and morbidity after ET, this approach should be considered as the first treatment option in most CMI patients, especially in those with severe malnutrition. Primary OT should be restricted to cases that do not qualify for ET or good surgical risk patients with long life expectancy. Considering better long-term results of OT, ET treatment should be considered as a bridge therapy to OT in some patients requiring retreatment if ET does not preclude subsequent OT.
authors.affiliation: Clinic for Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland; Vascluar Surgery Unit, University Hospital P. Giaccone, Via L.Giuffrè 5, Palermo, Italy. felicepecoraro@libero.it
authors.forename: Felice
authors.initials: F
authors.lastname: Pecoraro
authors.forename: Zoran
authors.initials: Z
authors.lastname: Rancic
authors.forename: Mario
authors.initials: M
authors.lastname: Lachat
authors.forename: Dieter
authors.initials: D
authors.lastname: Mayer
authors.forename: Beatrice
authors.initials: B
authors.lastname: Amann-Vesti
authors.forename: Thomas
authors.initials: T
authors.lastname: Pfammatter
authors.forename: Guido
authors.initials: G
authors.lastname: Bajardi
authors.forename: Frank J
authors.initials: FJ
authors.lastname: Veith
mesh_terms: D000465:Algorithms; D016009:Chi-Square Distribution; D057510:Endovascular Procedures / Q000009:adverse effects / Q000401:mortality / Q000592:standards*; D006801:Humans; D007511:Ischemia / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D007902:Length of Stay; D065666:Mesenteric Ischemia; D008641:Mesenteric Vascular Occlusion / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D012008:Recurrence; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014652:Vascular Diseases / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D014654:Vascular Patency; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality / Q000592:standards*