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Multimodality Diagnosis of Mesenteric Ischemia
Published on: July 21, 2023
Outcomes after endarterectomy for chronic mesenteric ischemia
Matthew W Mell1, Charles W Acher, John R Hoch
1Section of Vascular Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA.
Insights
Endarterectomy offers the most durable symptom relief for chronic mesenteric ischemia (CMI) patients undergoing open surgery. This surgical approach for CMI significantly reduces the risk of recurrent symptoms compared to other revascularization methods.
Area of Science:
- Vascular Surgery
- Gastroenterology
- Surgical Outcomes
Background:
- Chronic mesenteric ischemia (CMI) is a condition caused by reduced blood flow to the intestines.
- Open surgical revascularization is a treatment option for CMI.
- Identifying optimal surgical factors is crucial for improving patient outcomes.
Purpose of the Study:
- To identify factors influencing outcomes in patients undergoing open revascularization for CMI.
- To compare the effectiveness of different revascularization techniques.
Main Methods:
- Retrospective review of 80 patients who underwent open surgery for CMI between 1987 and 2006.
- Exclusion of patients with acute mesenteric ischemia or median arcuate ligament syndrome.
- Analysis of mortality, recurrent stenosis, and symptomatic recurrence using logistic regression and univariate/multivariate analysis.
Main Results:
- Endarterectomy was associated with significantly better freedom from recurrent symptoms (5.2% vs. 27.6% for other methods; HR 0.20; P = .02).
- Hospital mortality was 3.8%, associated with older age and renal insufficiency.
- One- and 5-year survival rates were 92.2% and 64.5%, respectively.
- One- and 5-year symptom-free survival rates were 89.7% and 82.1%.
Conclusions:
- Endarterectomy provides the most durable long-term symptom relief for open surgical candidates with CMI.
- Patient age and renal function are significant factors affecting mortality.
- Multivessel disease was common, with 50% of patients requiring multivessel reconstruction.
Objectives:
A retrospective study was performed to identify optimal factors affecting outcomes after open revascularization for chronic mesenteric ischemia.
Methods:
All patients who underwent open surgery for chronic mesenteric ischemia from 1987 to 2006 were reviewed. Patients with acute mesenteric ischemia or median arcuate ligament syndrome were excluded. Mortality, recurrent stenosis, and symptomatic recurrence were analyzed using logistic regression, and univariate and multivariate analysis.
Results:
We identified 80 patients (69% women, 31% men). Mean age was 64 years (range, 31-86 years). Acute-on-chronic symptoms were present in 26%. Presenting symptoms included postprandial pain (91%), weight loss (69%), and food fear and diarrhea (25%). Preoperative imaging demonstrated severe (>70%) stenosis of the superior mesenteric artery in 75 patients (24 occluded), the celiac axis in 63 (20 occluded), and the inferior mesenteric artery in 53 (20 occluded). Multivessel disease was present in 72 patients (90%), and 40 (50%) underwent multivessel reconstruction. Revascularization was achieved by endarterectomy in 37 patients, mesenteric bypass in 29, and combined procedures in 14. Concurrent aortic reconstruction was required in 13 patients (16%). Three hospital deaths occurred (3.8%). Mean follow-up was 3.8 years (range, 0-17.2 years). One- and 5-year survival was 92.2% and 64.5%. Mortality was associated with age (P = .019) and renal insufficiency (P = .007), but not by clinical presentation. Symptom-free survival was 89.7% and 82.1% at 1 and 5 years, respectively. Symptoms requiring reintervention occurred in nine patients (11%) at a mean of 29 months (range, 5-127 months). Multivariate analysis showed that freedom from recurrent symptoms correlated with endarterectomy for revascularization (5.2% vs 27.6%; hazard ratio, 0.20; 95% confidence interval, 0.04-0.92; P = .02).
Conclusion:
For open surgical candidates, endarterectomy appears to provide the most durable long-term symptom relief in patients with chronic mesenteric ischemia.
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