Chronic mesenteric ischemia: critical review and guidelines for management

Area of Science:

• Vascular Surgery
• Gastroenterology
• Interventional Radiology

Background:

• Chronic mesenteric ischemia (CMI) stems from occlusive disease of mesenteric arteries, a rare condition lacking clear treatment guidelines.
• Current treatment options for symptomatic CMI are debated, highlighting the need for evidence-based recommendations.

Purpose of the Study:

• To systematically review and compare the efficacy and safety of endovascular treatment (ET) versus open treatment (OT) for chronic mesenteric ischemia (CMI).
• To analyze treatment outcomes based on historical data to inform clinical decision-making and guideline development.

Main Methods:

• A systematic literature review of studies published over 25 years, focusing on CMI treatments in over 10 patients.
• Comparative analysis of perioperative mortality/morbidity, survival rates, patency, recurrence, technical success, and length of stay between ET and OT groups.
• Subgroup analysis based on publication year (1986-2000 vs. 2001-2010) to assess temporal trends in treatment outcomes.

Main Results:

• Endovascular treatment (ET) showed lower perioperative mortality and morbidity rates compared to open treatment (OT).
• Open treatment (OT) demonstrated superior primary and secondary patency rates, higher revascularization of vessels, and longer follow-up durations.
• Endovascular treatment (ET) had a shorter in-hospital length of stay but a higher CMI recurrence rate; technical success was superior in OT.

Conclusions:

• Endovascular treatment (ET) should be considered the primary option for most CMI patients, particularly those with severe malnutrition, due to lower periprocedural risks.
• Open treatment (OT) is recommended for patients unsuitable for ET or those with a long life expectancy, owing to better long-term results.
• ET may serve as a bridge therapy to OT in select cases requiring reintervention, provided it does not compromise subsequent surgical options.