A systematic review and meta-analysis of endovascular versus open surgical revascularization for chronic mesenteric ischemia

Fares Alahdab, Remy Arwani, Ahmed Khurshid Pasha, Zayd A. Razouki, Larry J. Prokop, Thomas S. Huber, Mohammad H Murad

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background: Despite the enthusiasm for endovascular revascularization for chronic mesenteric ischemia (CMI), it is not clear if early benefits offset long-term patency rates. This systematic review aimed to provide an up-to-date comprehensive evidence synthesis evaluating the two approaches. Methods: We searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Scopus through July 15, 2016, for studies that compared the endovascular with the open surgical approach for revascularization in CMI patients. We conducted a random-effects meta-analysis to pool outcomes of interest across studies. Results: We included 100 observational studies (22 comparative, 78 noncomparative; 18,726 patients; mean age, 69 years). Open surgery was associated with a statistically significant increase in the risk of in-hospital complications (relative risk [RR], 2.2; 95% confidence interval [CI], 1.8-2.6) and a nonsignificant increase in mortality at 30 days (RR, 1.57; 95% CI, 0.84-2.93). Open surgery was associated with lower risk of 3-year recurrence rates (RR, 0.47; 95% CI, 0.34-0.66) and a similar 3-year survival. Data from noncomparative studies provided similar inferences. The quality of evidence was low. Conclusions: Observational evidence suggests that the endovascular approach for revascularization in patients with CMI may offer better early outcomes than open surgery, although this effect may not be durable. Long-term mortality appears to be similar.

Original languageEnglish (US)
JournalJournal of Vascular Surgery
DOIs
StateAccepted/In press - Jan 1 2018

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Meta-Analysis
Confidence Intervals
Mortality
MEDLINE
Observational Studies
Mesenteric Ischemia
Databases
Recurrence
Survival

ASJC Scopus subject areas

  • Surgery
  • Cardiology and Cardiovascular Medicine

Cite this

A systematic review and meta-analysis of endovascular versus open surgical revascularization for chronic mesenteric ischemia. / Alahdab, Fares; Arwani, Remy; Pasha, Ahmed Khurshid; Razouki, Zayd A.; Prokop, Larry J.; Huber, Thomas S.; Murad, Mohammad H.

In: Journal of Vascular Surgery, 01.01.2018.

Research output: Contribution to journalArticle

Alahdab, Fares ; Arwani, Remy ; Pasha, Ahmed Khurshid ; Razouki, Zayd A. ; Prokop, Larry J. ; Huber, Thomas S. ; Murad, Mohammad H. / A systematic review and meta-analysis of endovascular versus open surgical revascularization for chronic mesenteric ischemia. In: Journal of Vascular Surgery. 2018.
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abstract = "Background: Despite the enthusiasm for endovascular revascularization for chronic mesenteric ischemia (CMI), it is not clear if early benefits offset long-term patency rates. This systematic review aimed to provide an up-to-date comprehensive evidence synthesis evaluating the two approaches. Methods: We searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Scopus through July 15, 2016, for studies that compared the endovascular with the open surgical approach for revascularization in CMI patients. We conducted a random-effects meta-analysis to pool outcomes of interest across studies. Results: We included 100 observational studies (22 comparative, 78 noncomparative; 18,726 patients; mean age, 69 years). Open surgery was associated with a statistically significant increase in the risk of in-hospital complications (relative risk [RR], 2.2; 95{\%} confidence interval [CI], 1.8-2.6) and a nonsignificant increase in mortality at 30 days (RR, 1.57; 95{\%} CI, 0.84-2.93). Open surgery was associated with lower risk of 3-year recurrence rates (RR, 0.47; 95{\%} CI, 0.34-0.66) and a similar 3-year survival. Data from noncomparative studies provided similar inferences. The quality of evidence was low. Conclusions: Observational evidence suggests that the endovascular approach for revascularization in patients with CMI may offer better early outcomes than open surgery, although this effect may not be durable. Long-term mortality appears to be similar.",
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