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Open Access 01-08-2020 | Visceral Ischemia | Original Scientific Report

Early and Midterm Outcomes of Open and Endovascular Revascularization of Chronic Mesenteric Ischemia

Authors: Anna-Leonie Menges, Benedikt Reutersberg, Albert Busch, Michael Salvermoser, Marcus Feith, Matthias Trenner, Michael Kallmayer, Alexander Zimmermann, Hans-Henning Eckstein

Published in: World Journal of Surgery | Issue 8/2020

Abstract

Background

Revascularization strategies for chronic mesenteric ischemia (CMI) include open (OR) and endovascular (ER) modalities. The primary objective of this study was to analyze the safety and effectiveness of OR and ER and the impact of clinical and morphological variables on early and midterm outcomes in a consecutive series of CMI patients in a tertiary referral center.

Patients and methods

From 2004 to 2017, all CMI patients treated with OR and ER were retrospectively identified. Patient records, preoperative imaging, as well as peri- and postoperative outcomes were analyzed. Univariable and multivariable analysis was performed to identify clinical or morphological variables affecting reintervention rates within 2 years.

Results

In total, 63 patients (33% male; mean age 71, range 60–76 years) were treated by ER (41 patients) or OR (22 patients) for CMI. Mean follow-up was 26 (10–71) months. 30-day mortality was 0.0% after ER and 4.5% after OR (p = 0.069); 30-day morbidity was 9.8% vs. 31.8%, respectively (p = 0.030). Length of stay was significantly longer after OR (14 vs. 4 days; p < 0.001). Freedom from reintervention rate after 2 years was 82% after OR and 73% after ER (p = 0.14). Overall survival did not differ after 2 years (OR 85% vs. ER 86%; p = 0.35). Multivariable analysis revealed that smoking was associated with higher risk of reintervention (hazard ratio, HR: 4.14; 95% confidence interval, CI 1.11–15.53; p = 0.03). Additionally, a nonsignificant trend of lower reintervention rates after OR was detected (HR 0.23 95% CI 0.05–1.08; p = 0.06).

Conclusion

Due to a lower invasiveness, despite the higher reintervention rate, an “endovascular first” strategy is justified and recommended.

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Title: Early and Midterm Outcomes of Open and Endovascular Revascularization of Chronic Mesenteric Ischemia
Authors: Anna-Leonie Menges
Benedikt Reutersberg
Albert Busch
Michael Salvermoser
Marcus Feith
Matthias Trenner
Michael Kallmayer
Alexander Zimmermann
Hans-Henning Eckstein
Publication date: 01-08-2020
Publisher: Springer International Publishing
Keyword: Visceral Ischemia
Published in: World Journal of Surgery / Issue 8/2020
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-020-05513-2

At a glance: The STEP trials

Springer Medicine

Early and Midterm Outcomes of Open and Endovascular Revascularization of Chronic Mesenteric Ischemia

Abstract

Background

Patients and methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Patients and methods

Results

Conclusion

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