Chronic mesenteric ischemia outcome analysis and predictors of endovascular failure

Abstract

Objective: Outcomes of open revascularization (OR) and endovascular revascularization (ER) for chronic mesenteric ischemia (CMI) were analyzed to identify predictors of endovascular failure. Methods: A retrospective study was performed of all consecutive patients with CMI (161 patients, 215 vessels) treated from 2008 to 2012. Demographics, comorbidities, clinical presentation, etiology, and treatment modalities were compared. Outcomes included technical success, restenosis requiring reintervention, complications, mortality, and hospital length of stay. Results: There were 116 patients who were first treated with ER (72%) and 45 patients with OR (28%). Overall mortality was 6.8% (11/161). Among the ER patients, 27 developed restenosis and required OR (23%). Patients treated with ER were older (73 vs 66 years; P [ .014), had similar comorbidities, and had higher rate of short lesions (#2 cm) on preoperative angiograms (23% vs 47%; P [ .004). Primary patency at 3 years was higher in the OR group compared with the ER group (91% vs 74%; P [ .018). Long-term survival rates were higher in the ER group (95% vs 78%; P [ .003). Hospital length of stay and intensive care unit length of stay were shorter in the ER group (<.001). Perioperative mortality (30-day) was not statistically significant between the groups (5.2% vs 11%; P [ .165). A subgroup analysis was performed between the patients with successful ER and failure of ER requiring OR. Patients with failure of ER had significantly higher rates of aortic occlusive disease (86% vs 49%; P [ .005) and long lesions $2 cm on angiography (57% vs 12%; P < .001) that were close to the mesenteric takeoff. Perioperative mortality was higher in the ER failure group (15% vs 2%; P [ .009). Conclusions: ER has similar perioperative mortality and shorter hospitalization but higher rate of restenosis requiring reintervention compared with OR. Patients with ER who required reintervention appear to have longer lesions as well as higher rates of aortic occlusive disease on preoperative angiography. Patients who crossed over from ER to OR had higher perioperative mortality than either primary open or endovascular patients. These findings may guide treatment selection in patients with CMI undergoing ER or OR.

Endovascular Management for Symptomatic Chronic Mesenteric Ischemia: A Single-Center Experience

“…13 Recent studies have demonstrated that patients after ET who presented with clinical recurrence or required reintervention appeared to have longer lesions (!2 cm), nominal stent diameter 5 mm, residual stenosis !40%, and higher rates of aortic occlusive disease. 14,15 Oderich et al 16 reported a nonrandomized comparison of covered versus bare metal stents in 225 patients treated for CMI. In their study, covered stents outperformed bare metal stents, with lower rates of restenosis, symptom recurrence, and reintervention and improved patency rates.…”

“…22 Because of differences in the comorbidities and the difficulty in comparing the outcomes in patients treated with OSR versus ET, the establishment of treatment guidelines is particularly difficult. 14 Lejay et al reported that the complete OSR of visceral arteries for CMI provided lasting results, despite high morbidity. The 30-day mortality and morbidity rates were 3.5% and 13.9%, respectively, with a median follow-up of 6.9 years, while the primary patency rate was not statistically different between the complete revascularization group (84%) and the incomplete revascularization group (87%) at 10 years.…”

Isquemia mesentérica crónica en una anciana con demencia: un reto diagnóstico

“…La cirugía ofrece mayor probabilidad de permeabilidad vascular a cinco años [20][21][22][23] . Con el tratamiento endovascular, se reducen las complicaciones posquirúrgicas, la estancia hospitalaria, el costo, la invasión para el paciente y las complicaciones anestésicas 24,25 .…”

“…En comparación con la cirugía, se encontró que, en los casos de tratamiento endovascular los pacientes eran más ancianos (73 Vs. 66 años; p=0,014) y había mayor tasa de lesiones cortas (≤2 cm) en el angiograma (23 Vs. 47 %; p=0,004), menor tasa de permeabilidad vascular a los tres años (91 Vs. 74 %; p=0,018), mayor supervivencia (95 Vs. 78 %; p=0,003), y estancia más corta en la unidad de cuidados intensivos (p<0,001); no hubo diferencia en la mortalidad entre ambos grupos (5,2 Vs. 11 %; p=0,165). Al analizar los casos de fracaso terapéutico, se encontró que, con el tratamiento endovascular, había mayor tasa de enfermedad aórtica oclusiva (86 Vs. 49 %, p=0,005), lesiones más largas (57 Vs. 12 %; p<0,001) y mayor mortalidad perioperatoria (15 Vs. 2 %; p=0,009) 24 .…”

Surgical and endovascular revascularization of chronic mesenteric ischemia

“…Chronic mesenteric ischemia (CMI) is a severe disease characterized by postprandial pain and weight loss and occurs when visceral vessels develop high-grade stenosis or occlusion [ 1 , 2 ]. Early therapy for the symptomatic disease is important to prevent cachexia and end-organ ischemia, associated with high mortality of 50–69% [ 3 , 4 ].…”