Significance of Prior Endovascular Intervention on Contemporary Outcomes of Open Mesenteric Revascularization

Abstract

Endovascular treatment has emerged as the primary modality of revascularization in patients with chronic mesenteric ischemia (CMI). The purpose of this study was to determine whether patients undergoing open mesenteric revascularization in the setting of failed prior endovascular intervention had worse outcomes compared to those without prior endovascular intervention. A single-center retrospective review of patients with CMI treated with open mesenteric bypass from 2000 to 2019 was conducted. Demographic, comorbidities, perioperative variables, and outcomes were collected. Patients were categorized into those with prior endovascular intervention and those without. Categorical factors were compared with Pearson χ2 tests or Fisher exact tests, and the life-table method for survival analysis was used to estimate event rates at predefined time frame. From 2000 to 2019, there were 236 patients who underwent open mesenteric bypasses, of which 92 were performed for CMI. Antegrade aortomesenteric bypasses constituted 95% (87/92) of cases. Total of 145 vessels were revascularized: celiac artery (33 vessels), hepatic artery (25 vessels), and superior mesenteric artery (87 vessels). Seventy-six percent (70/92) of patients had undergone a prior endovascular intervention, which subsequently failed. In 91% (84/92) of patients, one or more visceral vessel was chronically occluded on imaging prior to bypass procedure. Patients with prior endovascular intervention were older (64 ± 15 years vs 54 ± 11 years; P = .006). Demographics and comorbidities were otherwise similar between the groups. Primary patency for celiac artery bypass was 93% and 89% at 1 and 3 years, respectively. Primary patency for superior mesenteric artery bypass was 92% and 84% at 1 and 3 years, respectively. There was no statistically significant difference in primary bypass patency rates of those with or without prior endovascular intervention (P > .05). Patients with prior endovascular intervention had a higher all-cause mortality trend at 30 days, 1 year, and 3 years (5.8% vs 0%; 13.7% vs 5.4%; and 30% vs 5.4%; P = .1); however, this did not reach statistical significance. Open mesenteric bypass remains a durable revascularization procedure in patients with CMI. Failed endovascular intervention does not significantly impact open mesenteric revascularization outcomes; however, it likely signifies an overall higher atherosclerotic disease burden.