Endovascular versus open revascularization for chronic mesenteric ischemia: a comparative study.

Area of Science:

• Vascular Surgery
• Interventional Cardiology
• Gastroenterology

Background:

• Chronic intestinal ischemia (CII) significantly impacts patient quality of life.
• Treatment options include endovascular procedures and open surgical revascularization.
• Comparative outcomes data for these approaches are crucial for clinical decision-making.

Purpose of the Study:

• To compare the short- and long-term clinical outcomes of percutaneous angioplasty (PA) versus open revascularization (OR) in patients with chronic intestinal ischemia.
• To evaluate the efficacy and safety of both revascularization strategies.

Main Methods:

• A prospective study of 29 consecutive patients with symptomatic CII (thrombosis or >=80% stenosis of the superior mesenteric artery) from 2000 to 2006.
• Patients were divided into two groups: PA (n=14) and OR (n=15).
• Outcomes assessed included complications, mortality, length of stay, restenosis, and survival rates.

Main Results:

• The PA group included older patients (p=0.0009).
• OR revascularized more vessels (1.4 vs. 1, p=0.01).
• No significant differences were observed in major complications, mortality, hospital stay, or symptomatic recurrence. Primary restenosis occurred in 21.4% of PA patients. Two-year survival was 58% for PA and 70% for OR (p=NS).

Conclusions:

• Percutaneous angioplasty is a viable option for older patients or those unsuitable for open surgery.
• Open revascularization may offer advantages in cases requiring multi-vessel revascularization.
• Both methods demonstrate comparable safety profiles regarding major complications and survival in this cohort.