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Percutaneous Endovascular versus Open Non-Endovascular Treatment for Chronic Mesenteric Ischemia-A Meta-Analysis
George Galyfos1, Alexandros Chamzin1, Ioannis Moisidis1
1Vascular Surgery Unit, First Department of Propedeutic Surgery, National and Kapodistrian University of Athens, Hippocration Hospital, Athens, Greece.
Purpose:
Aim of this review is to compare pooled data on early and late outcomes between endovascular and open treatment for chronic mesenteric ischemia (CMI).
Materials And Methods:
The present systematic review and meta-analysis was conducted under the PRISMA guidelines. The following databases were utilized: Pubmed, Embase, Scopus, and Cochrane Library. All eligible studies published online up to April 2024 were investigated. Eligible studies should compare early and/or late outcomes between endovascular repair (ER) and open surgery (OS) for CMI. Early outcomes included 30-day mortality, myocardial infarction (MI), pulmonary, gastrointestinal, and renal complications. Late outcomes included all-cause survival, symptom recurrence, and re-intervention.
Results:
In total, 15 studies (published from 1995 to 2024) were evaluated (12,326 patients under ER versus 6008 patients under OS). Regarding 30-day outcomes, ER was associated with a lower 30-day mortality risk (pooled OR = 0.58; 95% CI [0.347-0.975]; p = 0.039), a lower 30-day MI risk (pooled OR = 0.59; 95% CI [0.351-0.989]; p=0.045), a lower pulmonary complications risk (pooled OR = 0.18; 95% CI [0.075-0.426]; p=0.0001), and a lower 30-day renal complications risk (pooled OR = 0.28; 95% CI [0.146-0.553]; p=.00002). Regarding late outcomes, ER was associated with a lower overall 5-year survival (pooled OR = 0.414; 95% CI [0.291-0.591]; p < 0.0001). ER was also associated with a higher 3-year symptom recurrence risk (pooled OR = 3.77; 95% CI [2.314-6.142]; p < 0.0001) and a higher 5-year re-intervention risk (pooled OR = 2.40; 95% CI [1.538-3.739]; p=0.0001).
Conclusions:
ER is associated with superior early outcomes and worse late outcomes compared to OS among patients treated for CMI.Clinical ImpactThis is the most updated meta-analysis comparing pooled data between percutaneous endovascular repair (ER) and open surgery (OS) for patients with chronic mesenteric ischemia. This review verifies the advantage of endovascular treatment regarding early outcomes. However, this benefit is lost in the long-term as far as mortality and re-interventions are concerned. These findings seem to further support the current endovascular-first approach. One should take into consideration that ER is probably selected for patients of worse clinical status. OS may be more suitable for fitter patients who are not candidates for ER.
Insights
Endovascular repair (ER) for chronic mesenteric ischemia (CMI) shows better early outcomes, including lower mortality and complications. However, open surgery (OS) may offer better long-term survival and fewer re-interventions for CMI patients.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Gastroenterology
Background:
- Chronic mesenteric ischemia (CMI) is a debilitating condition affecting blood supply to the intestines.
- Treatment options for CMI include endovascular repair (ER) and open surgery (OS).
- Comparative data on early and late outcomes between ER and OS for CMI are crucial for clinical decision-making.
Purpose of the Study:
- To conduct a systematic review and meta-analysis comparing early and late outcomes of endovascular repair (ER) versus open surgery (OS) for chronic mesenteric ischemia (CMI).
- To pool data from eligible studies to provide a comprehensive comparison of treatment efficacy and safety.
Main Methods:
- Systematic review and meta-analysis conducted following PRISMA guidelines.
- Searched databases: Pubmed, Embase, Scopus, and Cochrane Library for studies up to April 2024.
- Included studies comparing ER and OS for CMI, analyzing early (30-day mortality, MI, complications) and late outcomes (survival, recurrence, re-intervention).
Main Results:
- Endovascular repair (ER) was associated with significantly lower 30-day mortality, myocardial infarction, pulmonary, and renal complications compared to open surgery (OS).
- However, ER demonstrated lower overall 5-year survival rates.
- ER also showed a higher risk of symptom recurrence and re-intervention within 3-5 years compared to OS.
Conclusions:
- Endovascular repair (ER) offers superior early outcomes for chronic mesenteric ischemia (CMI) patients.
- Open surgery (OS) may provide better long-term survival and reduced need for re-interventions.
- Findings support an endovascular-first approach, considering patient selection based on clinical status, with OS potentially better for fitter patients.
