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Published on: January 18, 2018
Open Revascularization for Acute Mesenteric Ischemia is Associated with Increased Morbidity and Mortality when
Andrew S Warren1, Blake Murphy2, Nallely Saldana-Ruiz2
1Division of Vascular Surgery, University of Washington, Seattle, WA; Pacific Northwest University of Health Sciences, Yakima, WA.
Objectives:
Historically, open approaches have been considered the primary treatment for acute mesenteric ischemia (AMI) due to the potential for bowel resection. However, the use of endovascular therapy is increasing. Given the paucity of current data, this study aims to compare outcomes between open and endovascular interventions for AMI.
Methods:
Patients treated for AMI between 2011 and 2022 were identified in the National Surgical Quality Improvement Program (NSQIP) by ICD-9 and ICD-10 codes. Intervention type (open vs. endovascular) was obtained from CPT codes. Demographics, comorbidities, pre-operative laboratory values, and 30-day outcomes were compared between intervention types. Multivariable analysis was utilized to adjust for differences between groups with a patient's need for bowel resection included to account for disease severity.
Results:
A total of 1,172 patients underwent revascularization for AMI (1,023 open, 149 endovascular). Among those treated with open revascularization, 577 (56%) underwent thrombectomies/embolectomy, 125 (12%) underwent thromboendarterectomy, and 321 (31%) received bypasses. Of the patients who underwent endovascular revascularizations, 101 (68%) received a stent, 23 (15%) underwent angioplasty without stenting, and 25 (17%) underwent lysis/thrombectomy. Patients who underwent endovascular revascularization had higher rates of smoking (36% open vs. 47% endovascular; P < 0.01), were more likely to have an eGFR less than 30 (6% open vs. 15% endovascular; P < 0.01), and underwent more bowel resections at the time of the initial operation (33% open vs. 48% endovascular; P < 0.01). For outcomes, patients who underwent open repair had longer median hospital stays (10 days vs. 7 days; P < 0.01). All other outcomes including 30-day mortality were similar on univariate analysis. Following adjustment for the need for bowel resection and comorbidities, 30-day-mortality (OR 1.96, 95% CI: 1.28-3.02), failure to wean from ventilator (OR 1.56 95% CI: 1.05-2.34), and length of hospital stay (β 3.7 days, 95% CI: 1.8-5.6) were higher among patients treated with open surgery.
Conclusions:
After accounting for the need for bowel resection and comorbidities, open revascularization for AMI is associated with higher peri-operative morbidity and mortality compared to endovascular intervention. Thus, the need for bowel resection should not preclude endovascular treatment for AMI.
Insights
Endovascular intervention for acute mesenteric ischemia (AMI) shows lower peri-operative morbidity and mortality compared to open surgery. The need for bowel resection does not exclude endovascular treatment for AMI.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Gastroenterology
Background:
- Open surgical approaches have traditionally dominated acute mesenteric ischemia (AMI) treatment due to the necessity of bowel resection.
- Endovascular therapies are increasingly utilized for AMI, yet comparative outcome data remain limited.
Purpose of the Study:
- To compare the outcomes of open versus endovascular interventions for acute mesenteric ischemia (AMI).
- To evaluate the impact of intervention type on peri-operative morbidity and mortality, considering the need for bowel resection.
Main Methods:
- A retrospective analysis of 1,172 patients with AMI treated between 2011 and 2022 from the National Surgical Quality Improvement Program (NSQIP) database.
- Intervention types (open vs. endovascular) were identified using CPT codes.
- Multivariable analysis was performed to adjust for patient demographics, comorbidities, and the critical factor of bowel resection necessity.
Main Results:
- Patients undergoing endovascular repair had higher rates of smoking and reduced eGFR, and a greater likelihood of requiring bowel resection.
- Open repair was associated with longer hospital stays (10 vs. 7 days).
- After adjusting for bowel resection and comorbidities, open surgery correlated with significantly higher 30-day mortality (OR 1.96) and ventilator weaning failure (OR 1.56), along with extended hospital stays (3.7 days longer).
Conclusions:
- Open revascularization for AMI is linked to increased peri-operative morbidity and mortality when compared to endovascular intervention, even after accounting for disease severity and comorbidities.
- The necessity for bowel resection should not be a contraindication for considering endovascular treatment in AMI patients.
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