Short-Term Outcomes for Open Revascularization of Chronic Mesenteric Ischemia

Davenport, Daniel L.; Shivazad, Armin; Endean, Eric D.

doi:10.1016/j.avsg.2011.11.006

Cited by 18 publications

(10 citation statements)

References 19 publications

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“…[3] The absence of the archetypal body habitus of patients with CMI cannot be used to exclude the diagnosis of CMI because, as previously reported, 1/3 of these patients are now overweight or obese, which was also observed in this study with 35% of the cohort having a BMI ≥25. [2] This highlights the need for maintaining a high index of suspicion for CMI as the traditional clinical picture may be confounded by this shifting patient population. This also necessitates evaluation and clarification of the role patient BMI plays in clinical decision making for mesenteric revascularization.…”

Section: Discussionmentioning

confidence: 99%

“…However, with the obesity epidemic there is a significant proportion of patients with an elevated body mass index (BMI) who require mesenteric revascularization for CMI. [1, 2] This is counterintuitive to the disease pathophysiology. Recent studies have shown worse outcomes in patients at the extremes of BMI undergoing vascular surgery.…”

Section: Introductionmentioning

confidence: 99%

“…[3] The studies that have examined CMI in obese patients have only evaluated open revascularizations or only looked at short-term outcomes. [2, 3]…”

Section: Introductionmentioning

confidence: 99%

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Impact of Body Mass Index on Outcomes after Mesenteric Revascularization for Chronic Mesenteric Ischemia

Mansukhani

Hekman

Yoon

et al. 2018

Annals of Vascular Surgery

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BMI needs to be considered in assessing and counseling patients on outcomes of mesenteric revascularization for CMI, as a BMI over 25 is associated with poorer long-term survival after open revascularization. Smoking, hypertensive chronic kidney disease, PAD, and open repair with the use of venous conduit are independent predictors of long-term mortality after mesenteric revascularization independent of BMI.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Impact of Body Mass Index on Outcomes after Mesenteric Revascularization for Chronic Mesenteric Ischemia

Mansukhani

Hekman

Yoon

et al. 2018

Annals of Vascular Surgery

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“…Table I shows the probabilities for OR and EV. 11,[14][15][16][17][18][19][20][21][22][23] To differentiate the impact of interventions in low-and high-risk patients, perioperative mortality rates were multiplied by relative risks (range, 0.5-5).…”

Section: Loss Of Patency Of the Treated Vessel During Follow-upmentioning

confidence: 99%

A comparison of open and endovascular revascularization for chronic mesenteric ischemia in a clinical decision model

Hogendoorn

Hunink

Schlösser

et al. 2014

Journal of Vascular Surgery

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“…Interestingly, however, the authors did not mention a natural alternative in this situation, which would be ante-or retrograde stenting of the superior mesenteric artery (SMA). 5 Of greater practical interest (than single-center series) is the analysis of population-based outcomes, which generally avoid the problem of publication bias. Swedvasc, the Swedish vascular registry, was founded in 1987 and captures >90% of all vascular surgical procedures in a country with 9.5 million inhabitants.…”

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confidence: 99%

Part One: For the Motion. An Endovascular First Strategy is the Optimal Approach for Treating Acute Mesenteric Ischemia

Björck

2015

European Journal of Vascular and Endovascular Surgery

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Acute mesenteric ischemia continues to be a lifethreatening insult in often elderly patients with many comorbidities. Recognition and correct diagnosis can be an issue, leading to delays in therapy resulting in loss of bowel and/or life. The basic surgical principals in treating acute mesenteric ischemia have long been early recognition, resuscitation, urgent revascularization, resection of necrotic bowel, and reassessment with second-look laparatomies. Endovascular techniques now offer a less invasive alternative but it is unclear whether an endovascular first or open surgery first approach is preferred in the majority of patients. Our discussants will attempt to clarify these issues.This debate is to be as evidence based as possible. The first point to establish, however, is that there have been no randomized controlled trials (RCTs) comparing an endovascular first versus an open surgery first strategy for the treatment of acute mesenteric ischemia (AMI), as there have been for ruptured aortic aneurysm repair. 1 Given that AMI is relatively uncommon and usually presents as an emergency, there probably never will be an RCT to study this issue. However, according to the GRADE guidelines, 2 data from observational studies can be valuable, provided certain criteria are met, including that the risk of bias must be minimized, data should be consistent, and confounding factors need to be controlled for.Most published reports are single-center series, with all the methodological problems related to that type of study design, in particular publication bias. A recent example is from Kuopio University Hospital, Finland, which reported a 5-year consecutive series of patients with AMI, during which time an endovascular first strategy was applied, which was feasible in 88% of cases. 3 Mortality was a commendable 32% and in half of the cases where endovascular therapy (EVT) failed, surgical bypass was ultimately successful. These survival rates compare favorably with the experience of the opponents of this debate (in another single-center series), who reported 30-day mortality rates of 62% after the treatment of acute arterial thrombosis and 59% after arterial embolism, where a policy of open surgery first was the primary treatment strategy. 4 One important group of patients with AMI are those who develop acute upon chronic ischemia. In another publication from Endean's group on the treatment of patients with chronic mesenteric ischemia, high mortality rates are reported in patients in whom a vein graft was used as the bypass conduit (16% vs. 5% amongst those who had a prosthetic graft; p ¼ .039). 4 Patients in whom a vein graft was used underwent emergency surgery more often (16% vs. 4%; p ¼ .012) and more often had a contaminated surgical site (30% vs. 7%; p ¼ .001). The authors concluded that the inferior results after venous bypass might have been prevented had the revascularization taken place more Eur J Vasc Endovasc Surg (2015) 50, 273e280

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Short-Term Outcomes for Open Revascularization of Chronic Mesenteric Ischemia

Cited by 18 publications

References 19 publications

Impact of Body Mass Index on Outcomes after Mesenteric Revascularization for Chronic Mesenteric Ischemia

Impact of Body Mass Index on Outcomes after Mesenteric Revascularization for Chronic Mesenteric Ischemia

A comparison of open and endovascular revascularization for chronic mesenteric ischemia in a clinical decision model

Part One: For the Motion. An Endovascular First Strategy is the Optimal Approach for Treating Acute Mesenteric Ischemia

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