French Nationwide Outcomes after Revascularisation for Acute and Chronic Mesenteric Ischaemia

Area of Science:

• Vascular Surgery
• Gastroenterology
• Interventional Cardiology

Background:

• Acute and chronic mesenteric ischemia (AMI/CMI) are severe conditions with high morbidity and mortality.
• Revascularization is crucial for managing AMI and CMI.
• Comparing endovascular and open surgical approaches is essential for optimizing patient outcomes.

Purpose of the Study:

• To evaluate short- and mid-term outcomes of revascularization for AMI and CMI.
• To compare the effectiveness of endovascular versus open surgical repair for mesenteric ischemia.
• To identify factors influencing mortality and re-intervention rates.

Main Methods:

• Nationwide retrospective observational study using the French National Health Data System (SNDS).
• Included adults undergoing first revascularization for AMI or CMI (2014-2024).
• Analyzed 30-day, 1-year, and 2-year mortality, and re-intervention rates using multivariable Cox models.

Main Results:

• For AMI (6,228 patients), endovascular repair showed significantly lower 30-day (16.5% vs 36.7%), 1-year, and 2-year mortality compared to open repair.
• For CMI (5,016 patients), endovascular repair was associated with lower 30-day mortality but a higher risk of re-intervention.
• Advanced age (>64 years) was linked to increased mortality in both AMI and CMI.

Conclusions:

• Endovascular revascularization is associated with reduced mortality for AMI and lower early mortality for CMI compared to open surgery.
• Findings support the use of endovascular strategies for mesenteric ischemia, particularly in high-risk individuals.
• Further prospective studies are needed to fully assess long-term outcomes.