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Surgical Porcine Model of Chronic Myocardial Ischemia Treated by Exosome-laden Collagen Patch and Off-pump Coronary Artery Bypass Graft
Published on: September 15, 2023
Surgical versus endovascular reconstruction for chronic mesenteric ischemia: a contemporary UK series
Robert S M Davies1, Michael L Wall, Stanley H Silverman
1University Department of Vascular Surgery, Heart of England NHS Foundation Trust, Birmingham, United Kingdom. RSMDavies@hotmail.com
Insights
Surgical reconstruction for chronic mesenteric ischemia offers superior long-term patency but longer hospital stays compared to endovascular repair. Endovascular repair shows shorter hospital stays but lower long-term patency rates.
Area of Science:
- Vascular Surgery
- Interventional Radiology
- Gastroenterology
Background:
- Chronic mesenteric ischemia (CMI) is a debilitating condition affecting blood supply to the intestines.
- Surgical reconstruction (SR) and endovascular reconstruction (ER) are treatment options for CMI.
- Assessing the comparative outcomes of SR and ER is crucial for clinical decision-making.
Purpose of the Study:
- To compare the early and late outcomes of surgical reconstruction (SR) versus endovascular reconstruction (ER) for chronic mesenteric ischemia (CMI).
Main Methods:
- Retrospective review of patients undergoing SR or ER for CMI between 1996 and 2006 in three UK vascular surgery units.
- Assessment of early outcomes including technical success, morbidity, mortality, and length of hospital stay.
- Evaluation of late outcomes such as symptom recurrence, vessel/graft patency, reintervention, and mortality.
Main Results:
- A total of 27 patients underwent 32 reconstructions (17 SR, 15 ER).
- Perioperative mortality was 6% for SR and 0% for ER (P > or = .99).
- Hospital stay was significantly shorter for ER (4.3 days) compared to SR (14.2 days) (P = .0003).
- At 2 years, SR showed superior secondary patency (100% vs. 65%) and clinical patency (100% vs. 73%) compared to ER.
Conclusions:
- Surgical mesenteric reconstruction is associated with a significantly longer hospital stay.
- However, surgical reconstruction demonstrates superior long-term patency and clinical outcomes compared to endovascular reconstruction.
- The choice between SR and ER for CMI should consider the trade-off between short-term resource utilization and long-term efficacy.
Objective:
To assess the outcome of surgical (SR) and endovascular (ER) reconstruction for chronic mesenteric ischemia (CMI).
Methods:
Retrospective review of consecutive patients who underwent SR or ER for CMI in 3 UK vascular surgery units between 1996 and 2006. Early (<30 days; technical success, morbidity, mortality, length of hospital stay) and late (>30 days) outcomes (symptom recurrence, vessel/graft patency, reintervention, mortality) were assessed.
Results:
A total of 27 patients underwent 32 reconstructions (SR = 17, ER = 15). A total of 44 of 56 (79%) diseased arteries underwent SR (n = 26; bypass = 24, reimplantation = 2; occlusion = 16, stenosis = 10) or ER (n = 18; stenosis = 16, occlusion = 2). Perioperative mortality for SR and ER was 6% and 0%, respectively (P > or = .99). Hospital stay was shorter following ER (mean, 4.3 vs. 14.2 days, P = .0003). Mean (range) follow-up for SR and ER was 34 (1-94) and 34 (0-135) months, respectively. At 2 years, SR demonstrated superior secondary patency (100% vs. 65%) and clinical patency (100% vs. 73%).
Conclusions:
Surgical mesenteric reconstruction is associated with significantly longer hospital stay, but superior long-term outcome compared to endovascular reconstruction.
