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Updated: Mar 22, 2026
Multimodality Diagnosis of Mesenteric Ischemia
Published on: July 21, 2023
Chronic mesenteric ischemia outcome analysis and predictors of endovascular failure
Nikolaos Zacharias1, Sammy D Eghbalieh1, Benjamin B Chang1
1Institute for Vascular Health and Disease, Albany Medical College/Albany Medical Center Hospital, Albany, NY.
Insights
Endovascular revascularization (ER) for chronic mesenteric ischemia (CMI) offers shorter hospital stays but higher restenosis rates than open revascularization (OR). Predictors of ER failure include aortic occlusive disease and long lesions.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Gastroenterology
Background:
- Chronic mesenteric ischemia (CMI) management involves open revascularization (OR) and endovascular revascularization (ER).
- Predicting endovascular failure is crucial for optimizing treatment strategies in CMI patients.
Purpose of the Study:
- To analyze outcomes of OR versus ER for CMI.
- To identify predictors of endovascular failure in CMI patients.
Main Methods:
- Retrospective study of 161 CMI patients (2008-2012).
- Comparison of demographics, comorbidities, clinical presentation, etiology, and treatment outcomes.
- Outcomes included technical success, restenosis, complications, mortality, and length of stay.
Main Results:
- ER (72%) had shorter hospital stays but higher restenosis rates (23%) requiring OR compared to OR (28%).
- Primary patency at 3 years was higher with OR (91%) vs ER (74%).
- Long-term survival was higher with ER (95%) vs OR (78%).
- Endovascular failure was associated with aortic occlusive disease and long lesions (≥2 cm).
Conclusions:
- ER offers comparable perioperative mortality and shorter hospitalization to OR, but with higher restenosis rates.
- Longer lesions and aortic occlusive disease predict ER failure.
- Patients requiring crossover from ER to OR had increased perioperative mortality.
Objective:
Outcomes of open revascularization (OR) and endovascular revascularization (ER) for chronic mesenteric ischemia (CMI) were analyzed to identify predictors of endovascular failure.
Methods:
A retrospective study was performed of all consecutive patients with CMI (161 patients, 215 vessels) treated from 2008 to 2012. Demographics, comorbidities, clinical presentation, etiology, and treatment modalities were compared. Outcomes included technical success, restenosis requiring reintervention, complications, mortality, and hospital length of stay.
Results:
There were 116 patients who were first treated with ER (72%) and 45 patients with OR (28%). Overall mortality was 6.8% (11/161). Among the ER patients, 27 developed restenosis and required OR (23%). Patients treated with ER were older (73 vs 66 years; P = .014), had similar comorbidities, and had higher rate of short lesions (≤2 cm) on preoperative angiograms (23% vs 47%; P = .004). Primary patency at 3 years was higher in the OR group compared with the ER group (91% vs 74%; P = .018). Long-term survival rates were higher in the ER group (95% vs 78%; P = .003). Hospital length of stay and intensive care unit length of stay were shorter in the ER group (<.001). Perioperative mortality (30-day) was not statistically significant between the groups (5.2% vs 11%; P = .165). A subgroup analysis was performed between the patients with successful ER and failure of ER requiring OR. Patients with failure of ER had significantly higher rates of aortic occlusive disease (86% vs 49%; P = .005) and long lesions ≥2 cm on angiography (57% vs 12%; P < .001) that were close to the mesenteric takeoff. Perioperative mortality was higher in the ER failure group (15% vs 2%; P = .009).
Conclusions:
ER has similar perioperative mortality and shorter hospitalization but higher rate of restenosis requiring reintervention compared with OR. Patients with ER who required reintervention appear to have longer lesions as well as higher rates of aortic occlusive disease on preoperative angiography. Patients who crossed over from ER to OR had higher perioperative mortality than either primary open or endovascular patients. These findings may guide treatment selection in patients with CMI undergoing ER or OR.
