Outcomes after endarterectomy for chronic mesenteric ischemia

Abstract

For open surgical candidates, endarterectomy appears to provide the most durable long-term symptom relief in patients with chronic mesenteric ischemia.

Patients with chronic gastrointestinal ischemia have a higher cardiovascular disease risk and mortality

“…A remarkable predominance of female gender in patients with atherosclerotic CGI was observed. This is in line with earlier reports of larger cohorts of CGI patients [1,12,14,18]. Earlier case series reveal high prevalence CACS in women [30e32], however we excluded patients with CACS in our study.…”

Outcomes of Endovascular and Open Treatment for Chronic Mesenteric Ischemia

“…12 Recent published series with relatively large numbers of patients receiving open treatment for CMI report mortality rates ranging from 0% to 11%, with the incidence of a major complication as high as 66%. [11][12][13][14][15][16][17][18][19][20] Although improvements in outcomes were observed in more recent open series, the vascular community has increasingly adopted the use of endovascular techniques to treat CMI. 10 Many recent endovascular series have emerged; however, these studies have been small (9-39 cases) and lacked statistical power.…”

“…10 Open treatment for CMI in the form of endarterectomy, bypass, or a combination of both offers durable long-term results, although there is significant procedural morbidity and mortality. [11][12][13][14][15][16][17][18][19][20] The optimal open treatment for CMI, the number of vessels to treat, and whether open surgery should preclude an endovascular approach in patients is controversial.…”

Efficacy of combined renal and mesenteric revascularization

“…In addition, renal and mesenteric reinterventions were required in Ͻ10% of patients after COR, consistent with reported results for isolated open revascularization of each bed reported by other authors. 2,10,14,15 The progression to renal failure in the long-term is the most concerning sequelae. Associated severe aortoiliac occlusive disease was a predictor for eventual renal failure in a large group of 500 patients undergoing open renal artery repair by Cherr et al 12 Although only one patient had documented graft occlusion, 6 of 68 COR patients (9%) ultimately progressed to end-stage renal disease over a median of 5.7 years, highlighting the multifactorial nature of renal deterioration in this patient population and the need for close follow-up.…”