title: Outcomes of reoperative open or endovascular interventions to treat patients with failing open mesenteric reconstructions for mesenteric ischemia.
abstract: OBJECTIVE
  Outcomes of reinterventions for failing mesenteric open reconstructions (ORs) have not been described. Mesenteric reoperative ORs (R-ORs) are challenging because of excessive scar and more advanced mesenteric disease. The purpose of this study was to evaluate outcomes of R-ORs and endovascular revascularization (ER) in patients with stenosis or occlusion of mesenteric grafts.
  
  
  METHODS
  We reviewed 701 patients treated for chronic mesenteric ischemia (CMI) in two academic centers from 1991 to 2013. Clinical data and outcomes of patients treated for failing ORs with R-ORs or ERs were included in the analysis. A 1:2 case-control matching was used to analyze outcomes of R-ORs compared with patients who underwent their first-time ORs for CMI. End points were early and late mortality, morbidity, patency rates, and freedom from symptom recurrence and reintervention.
  
  
  RESULTS
  There were 47 patients (five men, 42 women; mean age, 58 ± 13 years) with failing ORs who were treated by R-ORs. Clinical presentation was CMI in 38 patients (81%) or acute mesenteric ischemia (AMI) in nine (19%). Reinterventions included R-ORs in 28 patients (19 CMI and nine AMI) and ERs in 19, all for CMI. Early mortality was 22% in patients treated by R-ORs for AMI. There were no early deaths among patients treated for CMI with R-OR or ER. Early morbidity was 78% for R-ORs in patients treated for AMI. Morbidity was significantly higher for R-ORs than for ERs in patients with CMI (63% vs 16%; P < .05). Mean follow-up was 50 ± 60 months. Patient survival at 5 years was 60% ± 8% for the entire cohort. Primary and secondary patency at 1 year were 61% ± 10% and 92% ± 8% for R-ORs (P = .34) and 77% ± 10% and 100% for ERs (P = .41). Freedom from symptom recurrence and reinterventions at 1 year was 88% ± 6% and 87% ± 7% for R-ORs and 83% ± 8% and 71% ± 10% for ERs. Case case-control (1:2) matching showed R-OR was associated with similar early mortality and morbidity and also similar freedom from recurrence and reintervention but with lower primary patency rates at 1 year compared with first time ORs (66% ± 11% and 94% ± 5%; P < .05).
  
  
  CONCLUSIONS
  R-OR or ER interventions for failing mesenteric ORs carry similar mortality, recurrence, and reintervention rates. Early morbidity is lower with ER compared with R-OR. R-ORs are associated with similar morbidity and mortality and lower primary patency compared with first-time OR for CMI.
authors.affiliation: Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minn.
authors.forename: Karina S
authors.initials: KS
authors.lastname: Kanamori
authors.affiliation: Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minn. Electronic address: oderich.gustavo@mayo.edu.
authors.forename: Gustavo S
authors.initials: GS
authors.lastname: Oderich
authors.affiliation: Department of Vascular Surgery, Cleveland Clinic Foundation, Cleveland, Ohio.
authors.forename: Javairiah
authors.initials: J
authors.lastname: Fatima
authors.affiliation: Department of Vascular Surgery, Cleveland Clinic Foundation, Cleveland, Ohio.
authors.forename: Timur
authors.initials: T
authors.lastname: Sarac
authors.affiliation: Department of Epidemiology and Biostatistics, Mayo Clinic, Rochester, Minn.
authors.forename: Stephen
authors.initials: S
authors.lastname: Cha
authors.affiliation: Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minn.
authors.forename: Manju
authors.initials: M
authors.lastname: Kalra
authors.affiliation: Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minn.
authors.forename: Randall
authors.initials: R
authors.lastname: De Martino
authors.affiliation: Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minn.
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Bower
mesh_terms: D000328:Adult; D000368:Aged; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000401:mortality; D018572:Disease-Free Survival; D057510:Endovascular Procedures / Q000009:adverse effects / Q000401:mortality; D005260:Female; D006083:Graft Occlusion, Vascular / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D065666:Mesenteric Ischemia / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D008875:Middle Aged; D008910:Minnesota; D009820:Ohio; D019651:Plastic Surgery Procedures / Q000009:adverse effects* / Q000401:mortality; D012086:Reoperation; D012307:Risk Factors; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D017211:Treatment Failure; D014654:Vascular Patency