Open versus endovascular revascularization for chronic mesenteric ischemia: Risk-stratified outcomes

Gustavo Oderich, Thomas C. Bower, Timothy M. Sullivan, Haraldur Bjarnason, Stephen Cha, Peter Gloviczki

Research output: Contribution to journalArticle

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Abstract

Objective: Outcomes of open (OR) and endovascular revascularization (ER) for chronic mesenteric ischemia (CMI) were analyzed with respect to clinical risk stratification. Methods: The data of 229 consecutive patients treated for CMI with OR (146 patients/265 vessels) or ER (83 patients/105 vessels) between 1991 and 2005 were reviewed. Patients were classified as low-risk or high-risk using standard scoring systems. End points were mortality and morbidity, recurrence-free survival, and patency rates. A subset analysis compared 111 patients (208 vessels) who had OR with 58 patients (76 vessels) who had stenting. Results: The ER patients were significantly older (71 ± 15 vs 65 ± 11 years; P < .05), had higher risk (58% vs 31%), and fewer vessels revascularized (1.3 ± 0.5 vs 1.8 ± 0.4). Four (2.7%) procedurally related deaths occurred in the OR and two (2.4%) in the ER group (P = NS). Mortality was higher for high-risk patients (OR, 6.7% vs 0.9%; ER, 4.8% vs 0%; P < .05), but differences were not significant among low-risk or high-risk OR vs ER patients. OR patients had more complications (36% vs 18%; P < .001) and longer hospitalization (12 ± 8 vs 3 ± 5 days; P < .001). At 5 years, OR had improved (P < .05) recurrence-free survival (89% ± 4% vs 51% ± 9%), and primary (88% ± 3% vs 41% ± 9%) and secondary patency rates (97% ± 2% vs 88% ± 4%). More restenoses (hazard ratio [HR], 5.1; 95% confidence interval [CI], 2.4-10.2), recurrences (HR, 6.7; 95% CI, 3.3-13.8), and reinterventions occurred in the ER group (HR, 4.3; 95% CI, 1.9-9.7). At last follow-up, significant symptom improvement was noted in 137 OR (96%) and 72 ER patients (92%, P = NS). In the subset analysis of patients having first-time operations vs stenting, OR resulted in improved (P < .05) recurrence-free survival (91% ± 3% vs 56% ± 8% at 5 years) and better primary and secondary patency rates (93% ± 2% and 98% ± 1% vs 52% ± 8% and 93% ± 4% at 3 years). Conclusion: OR has similar mortality but higher morbidity and longer hospitalization than ER in low-risk or high-risk patients with CMI. Both treatments effectively improved symptoms, but restenosis, recurrent symptoms, and reinterventions were more likely in ER patients. These findings may guide treatment selection and counseling of low-risk and high-risk CMI patients undergoing OR or ER procedures.

Original languageEnglish (US)
JournalJournal of Vascular Surgery
Volume49
Issue number6
DOIs
StatePublished - Jun 1 2009

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Recurrence
Mesenteric Ischemia
Confidence Intervals
Mortality
Hospitalization
Morbidity
Endovascular Procedures
Survival
Counseling
Survival Rate
Therapeutics

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Open versus endovascular revascularization for chronic mesenteric ischemia : Risk-stratified outcomes. / Oderich, Gustavo; Bower, Thomas C.; Sullivan, Timothy M.; Bjarnason, Haraldur; Cha, Stephen; Gloviczki, Peter.

In: Journal of Vascular Surgery, Vol. 49, No. 6, 01.06.2009.

Research output: Contribution to journalArticle

Oderich, Gustavo ; Bower, Thomas C. ; Sullivan, Timothy M. ; Bjarnason, Haraldur ; Cha, Stephen ; Gloviczki, Peter. / Open versus endovascular revascularization for chronic mesenteric ischemia : Risk-stratified outcomes. In: Journal of Vascular Surgery. 2009 ; Vol. 49, No. 6.
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T1 - Open versus endovascular revascularization for chronic mesenteric ischemia

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AU - Oderich, Gustavo

AU - Bower, Thomas C.

AU - Sullivan, Timothy M.

AU - Bjarnason, Haraldur

AU - Cha, Stephen

AU - Gloviczki, Peter

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N2 - Objective: Outcomes of open (OR) and endovascular revascularization (ER) for chronic mesenteric ischemia (CMI) were analyzed with respect to clinical risk stratification. Methods: The data of 229 consecutive patients treated for CMI with OR (146 patients/265 vessels) or ER (83 patients/105 vessels) between 1991 and 2005 were reviewed. Patients were classified as low-risk or high-risk using standard scoring systems. End points were mortality and morbidity, recurrence-free survival, and patency rates. A subset analysis compared 111 patients (208 vessels) who had OR with 58 patients (76 vessels) who had stenting. Results: The ER patients were significantly older (71 ± 15 vs 65 ± 11 years; P < .05), had higher risk (58% vs 31%), and fewer vessels revascularized (1.3 ± 0.5 vs 1.8 ± 0.4). Four (2.7%) procedurally related deaths occurred in the OR and two (2.4%) in the ER group (P = NS). Mortality was higher for high-risk patients (OR, 6.7% vs 0.9%; ER, 4.8% vs 0%; P < .05), but differences were not significant among low-risk or high-risk OR vs ER patients. OR patients had more complications (36% vs 18%; P < .001) and longer hospitalization (12 ± 8 vs 3 ± 5 days; P < .001). At 5 years, OR had improved (P < .05) recurrence-free survival (89% ± 4% vs 51% ± 9%), and primary (88% ± 3% vs 41% ± 9%) and secondary patency rates (97% ± 2% vs 88% ± 4%). More restenoses (hazard ratio [HR], 5.1; 95% confidence interval [CI], 2.4-10.2), recurrences (HR, 6.7; 95% CI, 3.3-13.8), and reinterventions occurred in the ER group (HR, 4.3; 95% CI, 1.9-9.7). At last follow-up, significant symptom improvement was noted in 137 OR (96%) and 72 ER patients (92%, P = NS). In the subset analysis of patients having first-time operations vs stenting, OR resulted in improved (P < .05) recurrence-free survival (91% ± 3% vs 56% ± 8% at 5 years) and better primary and secondary patency rates (93% ± 2% and 98% ± 1% vs 52% ± 8% and 93% ± 4% at 3 years). Conclusion: OR has similar mortality but higher morbidity and longer hospitalization than ER in low-risk or high-risk patients with CMI. Both treatments effectively improved symptoms, but restenosis, recurrent symptoms, and reinterventions were more likely in ER patients. These findings may guide treatment selection and counseling of low-risk and high-risk CMI patients undergoing OR or ER procedures.

AB - Objective: Outcomes of open (OR) and endovascular revascularization (ER) for chronic mesenteric ischemia (CMI) were analyzed with respect to clinical risk stratification. Methods: The data of 229 consecutive patients treated for CMI with OR (146 patients/265 vessels) or ER (83 patients/105 vessels) between 1991 and 2005 were reviewed. Patients were classified as low-risk or high-risk using standard scoring systems. End points were mortality and morbidity, recurrence-free survival, and patency rates. A subset analysis compared 111 patients (208 vessels) who had OR with 58 patients (76 vessels) who had stenting. Results: The ER patients were significantly older (71 ± 15 vs 65 ± 11 years; P < .05), had higher risk (58% vs 31%), and fewer vessels revascularized (1.3 ± 0.5 vs 1.8 ± 0.4). Four (2.7%) procedurally related deaths occurred in the OR and two (2.4%) in the ER group (P = NS). Mortality was higher for high-risk patients (OR, 6.7% vs 0.9%; ER, 4.8% vs 0%; P < .05), but differences were not significant among low-risk or high-risk OR vs ER patients. OR patients had more complications (36% vs 18%; P < .001) and longer hospitalization (12 ± 8 vs 3 ± 5 days; P < .001). At 5 years, OR had improved (P < .05) recurrence-free survival (89% ± 4% vs 51% ± 9%), and primary (88% ± 3% vs 41% ± 9%) and secondary patency rates (97% ± 2% vs 88% ± 4%). More restenoses (hazard ratio [HR], 5.1; 95% confidence interval [CI], 2.4-10.2), recurrences (HR, 6.7; 95% CI, 3.3-13.8), and reinterventions occurred in the ER group (HR, 4.3; 95% CI, 1.9-9.7). At last follow-up, significant symptom improvement was noted in 137 OR (96%) and 72 ER patients (92%, P = NS). In the subset analysis of patients having first-time operations vs stenting, OR resulted in improved (P < .05) recurrence-free survival (91% ± 3% vs 56% ± 8% at 5 years) and better primary and secondary patency rates (93% ± 2% and 98% ± 1% vs 52% ± 8% and 93% ± 4% at 3 years). Conclusion: OR has similar mortality but higher morbidity and longer hospitalization than ER in low-risk or high-risk patients with CMI. Both treatments effectively improved symptoms, but restenosis, recurrent symptoms, and reinterventions were more likely in ER patients. These findings may guide treatment selection and counseling of low-risk and high-risk CMI patients undergoing OR or ER procedures.

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