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

Publikation: Beitrag in FachzeitschriftForschungsartikelBeigetragenBegutachtung

Beitragende

  • Anna-Leonie Menges - , Technische Universität München (Autor:in)
  • Benedikt Reutersberg - , Universitätsspital Zürich (Autor:in)
  • Albert Busch - , Klinikum Rechts der Isar (MRI TUM), Technische Universität München (Autor:in)
  • Michael Salvermoser - , Technische Universität München (Autor:in)
  • Marcus Feith - , Technische Universität München (Autor:in)
  • Matthias Trenner - , Technische Universität München (Autor:in)
  • Michael Kallmayer - , Technische Universität München (Autor:in)
  • Alexander Zimmermann - , Universitätsspital Zürich (Autor:in)
  • Hans-Henning Eckstein - , Technische Universität München (Autor:in)

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.

Details

OriginalspracheEnglisch
Seiten (von - bis)2804-2812
Seitenumfang9
FachzeitschriftWorld journal of surgery
Jahrgang44
Ausgabenummer8
PublikationsstatusVeröffentlicht - Aug. 2020
Peer-Review-StatusJa
Extern publiziertJa

Externe IDs

PubMedCentral PMC7326829
Scopus 85084124767

Schlagworte

Schlagwörter

  • Aged, Angioplasty, Blood Vessel Prosthesis Implantation, Chronic Disease, Female, Humans, Male, Mesenteric Arteries/surgery, Mesenteric Ischemia/etiology, Middle Aged, Retrospective Studies, Stents, Treatment Outcome, Vascular Surgical Procedures/adverse effects