title: Open Mesenteric Interventions Are Equally Safe as Endovascular Interventions and Offer Better Midterm Patency for Chronic Mesenteric Ischemia.
abstract: BACKGROUND
  Endovascular (EV) techniques are being advocated as the preferred method for mesenteric interventions because of their safety profile. However, midterm and long-term results are thought to be inferior to open interventions. We sought to compare our institutional experience with treatment of acute and chronic mesenteric ischemia (AMI and CMI, respectively) using EV and open techniques.
  
  
  METHODS
  The medical records of open and EV mesenteric procedures performed at a single center were queried from 2002 to 2012. Demographic, perioperative, and follow-up data were extracted and analyzed.
  
  
  RESULTS
  Thirty-eight patients underwent EV mesenteric interventions, whereas 77 patients underwent open revascularization. The demographic and perioperative characteristics for patients were similar. Most EV procedures (89.2%) comprised stenting, whereas open procedures included 25 (32.1%) antegrade bypasses, 38 (48.7%) retrograde bypasses, 8 (10.3%) thromboembolectomies, and 7 (9%) transaortic endarterectomies. Postoperative complications, overall 30-day morbidity and mortality were not significantly different in the open and EV groups for AMI or CMI. Thirty-day mortality in AMI (n = 34) was 38.2% (EV: 45.5% vs. open: 34.8%; P = nonsignificant). There was no mortality in either group for CMI patients. Mean follow-up was much longer for the open procedures (34.9 vs. 12.7 months, P = 0.004). Primary and secondary patency rates were better for open revascularization for CMI patients.
  
  
  CONCLUSIONS
  Open revascularizations are equally safe as EV interventions for AMI and CMI. Patency of open revascularization for CMI is better than EV procedures at midterm follow-up.
authors.affiliation: Division of Vascular Surgery, Emory University, Atlanta, GA; Surgical Service Line, Atlanta Veterans Affairs Medical Center, Decatur, GA.
authors.forename: Shipra
authors.initials: S
authors.lastname: Arya
authors.affiliation: Department of Surgery, University of California Los Angeles, Los Angeles, CA.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Kingman
authors.affiliation: Section of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI.
authors.forename: Jordan P
authors.initials: JP
authors.lastname: Knepper
authors.affiliation: Section of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI.
authors.forename: Jonathan L
authors.initials: JL
authors.lastname: Eliason
authors.affiliation: Section of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI.
authors.forename: Peter K
authors.initials: PK
authors.lastname: Henke
authors.affiliation: Section of Vascular & Endovascular Surgery, UT Southwestern Medical Center, Dallas, TX. Electronic address: john.rectenwald@utsouthwestern.edu.
authors.forename: John E
authors.initials: JE
authors.lastname: Rectenwald
mesh_terms: D000208:Acute Disease; D000368:Aged; D019917:Blood Vessel Prosthesis Implantation; D002908:Chronic Disease; D057510:Endovascular Procedures; D005260:Female; D006801:Humans; D008297:Male; D065666:Mesenteric Ischemia / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D008875:Middle Aged; D012189:Retrospective Studies; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency