Outcomes Following Open and Endovascular Revascularization for Chronic Mesenteric Ischemia

Abstract

Objectives: Endovascular therapy for chronic mesenteric ischemia (CMI) has been used increasingly as firstline therapy; however concerns over durability remain. This study was performed to compare outcomes following open and endovascular revascularization in CMI patients. Methods: Retrospective analysis was performed of all patients treated for CMI at one medical center from 2002-2012. Survival and reintervention were estimated with Kaplan Meier methodology. Propensity scores to estimate likelihood of open vs endovascular revascularization were determined with logistic regression. Results: 111 patients underwent treatment for CMI with equal open (55) and endovascular (56) revascularization. Median follow-up was 12.8 months (range, 0.1-105). Open patients were younger (65 vs 72 years; P 1⁄4 .001), had less coronary artery disease (42 vs 64%; P 1⁄4 .02), and more prior interventions (29 vs 11%; P 1⁄4 .02). Open patients had higher perioperative morbidity (60 vs 11%; P < .001) and mortality (13 vs 4%; P 1⁄4 .08), but overall survival was not different between groups (P 1⁄4 .2; Fig). Within all matched propensity quartiles, there was no significant difference in survival between open and endovascular groups. Symptom recurrence (65 vs 18%; P 1⁄4 .02) and rate of reintervention (44 vs 2%; P 1⁄4 .003) at 3 years were higher in endovascular compared to open patients. Conclusions: Endovascular therapy for CMI is associated with lower perioperative morbidity and mortality but also greater symptom recurrence and reintervention. Open mesenteric revascularization may be the best option for patients with reasonable perioperative risk.