title: Is open surgery or endovascular therapy best to treat acute mesenteric occlusive disease?
abstract: A best evidence topic in vascular surgery was written according to a structured protocol. The question addressed whether endovascular treatment improved peri-operative outcomes when compared to an open approach to restore arterial perfusion in acute mesenteric occlusive disease. Four hundred and ninety seven papers were identified using the reported search; of which 4 represented the best evidence to answer the question and are discussed. The evidence on this subject is limited, comprising largely of non-randomised retrospective cohort studies. The evidence suggests that endovascular treatment is associated with reduced mortality and has better short-term peri-operative outcomes, as well as longer-term survival - however many endovascular cases require subsequent open surgery. There is also conflicting evidence to suggest endovascular therapy is associated with longer ICU stays. Aside from procedural complications, factors such as patient status, time delay to diagnosis and treatment may play a greater role in determining mortality rates. In summary, endovascular therapy appears to be a feasible treatment option with post-operative complications and inpatient mortality rates lower than those seen in open surgery.
authors.affiliation: School of Clinical Medicine, University of Cambridge, UK.
authors.forename: S F
authors.initials: SF
authors.lastname: Smith
authors.forename: N D
authors.initials: ND
authors.lastname: Gollop
authors.forename: S G
authors.initials: SG
authors.lastname: Klimach
authors.forename: P J
authors.initials: PJ
authors.lastname: Murray
mesh_terms: D000208:Acute Disease; D000368:Aged; D057510:Endovascular Procedures / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008641:Mesenteric Vascular Occlusion / Q000601:surgery*; D008875:Middle Aged; D012189:Retrospective Studies; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data
keywords: Acute mesenteric ischaemia; Acute mesenteric occlusive disease; Endovascular surgery; Open surgery