Related Experiment Video
Updated: Feb 17, 2026
Multimodality Diagnosis of Mesenteric Ischemia
Published on: July 21, 2023
Endovascular Versus Surgical Revascularization for Chronic Mesenteric Ischemia: Insights From the National Inpatient
Fabio V Lima1, Dhaval Kolte1, Kevin F Kennedy2
1Cardiovascular Institute, Warren Alpert Medical School of Brown University, Providence, Rhode Island.
Insights
Endovascular therapy for chronic mesenteric ischemia (CMI) is linked to fewer major adverse cardiac and cerebrovascular events (MACCE) and complications compared to open surgery. This approach also results in lower costs and shorter hospital stays for CMI patients.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Gastroenterology
Background:
- Limited contemporary data exists on cardiovascular outcomes for chronic mesenteric ischemia (CMI) patients undergoing endovascular therapy versus open surgery in the US.
- CMI revascularization strategies significantly impact patient outcomes and healthcare resource utilization.
Purpose of the Study:
- To compare in-hospital major adverse cardiac and cerebrovascular events (MACCE) following endovascular therapy versus open surgery for CMI.
- To evaluate differences in composite in-hospital complications, costs, and length of stay between the two revascularization methods.
Main Methods:
- Retrospective analysis of 4,150 patients with CMI from the National Inpatient Sample (2007-2014).
- Comparison of endovascular therapy versus open surgery (mesenteric bypass or endarterectomy).
- Propensity score matching created a balanced cohort of 880 patients in each group for outcome analysis.
Main Results:
- Endovascular therapy was performed in 77.2% of patients, while 22.8% underwent surgery.
- Propensity-matched analysis showed significantly lower MACCE (8.6% vs. 15.9%) and composite in-hospital complications (15.3% vs. 20.3%) with endovascular therapy.
- Endovascular therapy was associated with lower hospital costs and shorter length of stay compared to open surgery (p < 0.001 for all).
Conclusions:
- Endovascular therapy is the dominant revascularization modality for CMI.
- Endovascular therapy is associated with superior in-hospital outcomes, including reduced MACCE and complications.
- The findings support endovascular therapy as a cost-effective and efficient treatment for CMI.
Objectives:
This study sought to compare in-hospital major adverse cardiac and cerebrovascular events (MACCE) following endovascular therapy with open surgery for chronic mesenteric ischemia (CMI).
Background:
There are limited contemporary data on in-hospital cardiovascular outcomes among patients with CMI undergoing revascularization via endovascular therapy versus open surgery in the United States.
Methods:
Patients with CMI undergoing endovascular or surgical (mesenteric bypass or endarterectomy) revascularization between 2007 and 2014 were identified from the National Inpatient Sample. Weighted national estimates were obtained. Primary and secondary endpoints were MACCE (death, myocardial infarction, stroke, cardiac post-operative complications) and composite in-hospital complications (MACCE + post-operative peripheral vascular complications, gastrointestinal hemorrhage, major bleeding, and bowel resection), respectively. Propensity score matching was used to obtain a balanced cohort of 880 unweighted patients in each group.
Results:
Of 4,150 patients with CMI, 3,206 (77.2%) underwent endovascular therapy and 944 (22.8%) underwent surgery (weighted national estimates of 15,850 and 4,687, respectively). In the propensity-matched cohort, MACCE and composite in-hospital complications occurred significantly less often after endovascular therapy than surgery (8.6% vs. 15.9%; p < 0.001; and 15.3% vs. 20.3%; p < 0.006). Endovascular therapy was also associated with lower median hospital costs ($20,807.00 [interquartile range: $13,640.20 to $32.754.50] vs. $31,137.00 [interquartile range: $21,680.40 to $52,152.20]; p < 0.001, respectively) and shorter length of stay (5 [interquartile range: 2 to 10] vs. 10 [interquartile range: 7 to 17] days, respectively; p < 0.001) compared with open surgery.
Conclusions:
In a large, retrospective analysis of patients with CMI, endovascular therapy remained the dominant revascularization modality, and was associated with lower rates of MACCE, composite in-hospital complications, lower costs, and shorter length of stay compared with surgery.
