Differences in Anatomy and Outcomes in Patients Treated with Open Mesenteric Revascularization before and after the Endovascular Era

OBJECTIVES: Endovascular revascularization (ER) is currently the preferred treatment method in patients with chronic mesenteric ischemia (CMI). The aim of this study was to compare differences in clinical characteristics, anatomy and outcomes in patients treated with open mesenteric revascularization (OR) before and after the endovascular era.
METHODS: 241 patients treated for CMI (51.8% ER and 48.2% OR) between 1998 and 2009 were entered into a prospective database. Since 2002, ER was used in 102 patients (63.8%) and OR in 58 (36.3%) because ER was not possible, failed or the patient had unfavorable lesions. We reviewed the clinical data and outcomes of patients treated with OR before (Group A) and after (Group B) the preferential use of ER in 2002. Computed tomography angiography with centerline measurement and conventional angiography were used to assess differences in anatomy.
RESULTS: There were 58 patients treated with OR in Group A and 58 in Group B. Both groups has similar demographics, risk factors and clinical presentation, with the exception of more (p<0.05) cardiac interventions, dysrhythmias, abdominal pain and food fear in Group B. Patients in Group B had more extensive disease, including more superior mesenteric artery (SMA) occlusions (45% vs 67%, p=0.02). There were no differences in operative mortality (1.7% vs 3.4%), complications (43% vs 53%) and length of stay (12±1 vs 12±1 days) for Group A and B, respectively (p=NS). Symptom improvement was noted in 88% of Group A patients and in 86% of Group B patients (p=NS). Mean follow up was 56±7 months in Group A and 22±3 months in Group B (p<0.01). At 1-year, there were no differences in patency and recurrence rates between groups.
CONCLUSIONS: Open mesenteric revascularization is currently indicated in ~36% of patients with CMI. Despite the presence of more extensive mesenteric disease in patients currently treated with OR, outcomes have not changed in comparison to those achieved prior to the preferential use of mesenteric stents.