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Clinical Outcomes Of Mesenteric Artery Stenting Versus Mesenteric Surgical Revascularization In Chronic Mesenteric Ischemia

Panagiotis Kougias, William Kauffman, Wei Zhou, Hosam F. El Sayed, Joseph J. Naoum, Peter H. Lin.
Baylor College of Medicine, Houston, TX.

OBJECTIVES: Endovascular stenting of atherosclerotic lesion has become a common practice and widely accepted treatment strategy in a variety of arterial occlusive diseases. This study examines the clinical outcome of mesenteric stenting and open mesenteric revascularization for chronic mesenteric ischemia (CMI).

METHODS: Hospital records and clinical data of all patients undergoing surgical or endovascular interventions for CMI were reviewed during a recent 10-year period. Clinical outcomes were analyzed between the two groups.

RESULTS: Endovascular treatment was performed in 48 patients (58 vessels), and open repair was performed in 96 patients (157 vessels) during the study period. The mean age in the endovascular group was greater than the open group (74 ± 9 vs. 62 ± 7 years, p < 0.05). There was no difference in comorbidities, symptom duration, or treatment indications between the two groups. Among patients treated with surgical revascularization, operative strategies included bypass grafting (n=72, 75%); transaortic endarterectomy (n=19, 20%), or patch angioplasty (n=5, 5%). In the open group, one-vessel and two-vessel revascularization was performed in 36% and 64% of patients, respectively. In the endovascular cohorts, one-vessel and two-vessel balloon angioplasty and/or stenting was performed in 79% and 21% of patients, respectively. The hospital length of stay was shorter in the endovascular group compared to the open group (3 vs. 12 days, p<0.03). There was no difference in 30-day mortality, in-hospital complication, or three-year cumulative survival rate. Cumulative freedom from recurrent symptoms at three years were significantly greater in the open group (66%) compared to the endovascular group (27%, p<0.02).

CONCLUSIONS: Endovascular treatment offers a benefit of shorter hospitalization compared to the open revascularization, while both groups had similar morbidity and mortality rates. Patients treated with surgical reconstruction were more likely to experience long-term symptomatic relief compared to endovascular cohorts, possibly due to higher incidence of two-vessel surgical revascularization. Long term durability of endovascular intervention may be improved with two-vessel revascularization.