title: Chronic mesenteric ischemia: when and how to intervene on patients with celiac/SMA stenosis.
abstract: BACKGROUND
  Studies that compared open surgical mesenteric artery repair (OSMAR) with percutaneous mesenteric artery stenting (PMAS) in patients with chronic mesenteric ischemia (CMI) are based on merely older studies in which only a minority of patients received PMAS. This does not reflect the current PMAS-first choice treatment paradigm. This article focused on the present opinions and changes in outcomes of OSMAR for CMI in the era of preferred use of PMAS.
  
  
  METHODS
  Patients who received OSMAR for CMI from 1997 until 2014 in a tertiary referral centre for chronic mesenteric ischemia were included in this report. Patients were divided into two groups, the historical OSMAR preferred group and present PMAS preferred group.
  
  
  RESULTS
  Patient characteristics, SVS comorbidity severity score, clinical presentation and number of diseased mesenteric arteries were not significantly changed after the widespread introduction of PMAS. In the present PMAS first era there were trends of less open surgical mesenteric artery multivessel repair, less antegrade situated bypasses, decreased clinical success but improved survival after OSMAR.
  
  
  CONCLUSIONS
  Elective OSMAR should only be used in patients with substantial physiologic reserve and who have unfavourable mesenteric lesions, failed PMAS or multiple recurrences of in-stent stenosis/occlusion. PMAS in CMI patients is evolved from "bridge to surgery" to nowadays first choice treatment and "bridge to repeated PMAS" in almost all patients with CMI.
authors.affiliation: Division of Vascular Surgery, Department of Surgery, Medical Spectrum Twente, Enschede, The Netherlands.|Department of Surgery, Isala Clinics, Zwolle, The Netherlands.
authors.forename: Juliëtte
authors.initials: J
authors.lastname: Blauw
authors.affiliation: Department of Radiology, Medical Spectrum Twente, Enschede, The Netherlands.
authors.forename: Tomas
authors.initials: T
authors.lastname: Bulut
authors.affiliation: Division of Vascular Surgery, Department of Surgery, Medical Spectrum Twente, Enschede, The Netherlands.
authors.forename: Paul
authors.initials: P
authors.lastname: Eenhoorn
authors.affiliation: Division of Vascular Surgery, Department of Surgery, Medical Spectrum Twente, Enschede, The Netherlands.
authors.forename: Roland J
authors.initials: RJ
authors.lastname: Beuk
authors.affiliation: Department of Epidemiology, Medical Spectrum Twente, Enschede, The Netherlands.
authors.forename: Marjolein
authors.initials: M
authors.lastname: Brusse-Keizer
authors.affiliation: Department of Gastroenterology, Medical Spectrum Twente, Enschede, The Netherlands.|Department of Gastroenterology, University Medical Center Groningen, University of Groningen, Groningen, Belgium.
authors.forename: Jeroen J
authors.initials: JJ
authors.lastname: Kolkman
authors.affiliation: Division of Vascular Surgery, Department of Surgery, Medical Spectrum Twente, Enschede, The Netherlands - r.geelkerken@mst.nl.|Experimental Center of Technical Medicine, Faculty of Science and Technology, University Twente, Enschede, The Netherlands.
authors.forename: Robert H
authors.initials: RH
authors.lastname: Geelkerken
mesh_terms: D000328:Adult; D000368:Aged; D017130:Angioplasty / Q000295:instrumentation; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D002445:Celiac Artery / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D002908:Chronic Disease; D003251:Constriction, Pathologic; D016208:Databases, Factual; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D017538:Mesenteric Artery, Superior / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D065666:Mesenteric Ischemia / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D008641:Mesenteric Vascular Occlusion / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D008875:Middle Aged; D009426:Netherlands; D018579:Patient Selection; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents; D062606:Tertiary Care Centers; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality