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Surgical Versus Endovascular Reconstruction for Chronic Mesenteric Ischemia: A Contemporary UK Series

University Department of Vascular Surgery, Heart of England NHS Foundation Trust, Birmingham, United Kingdom, RSMDavies{at}hotmail.com, Department of Vascular Surgery, University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom

Michael L. Wall, MRCS

Department of Vascular Surgery, University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom

Stanley H. Silverman, FRCSEng

Department of Vascular Surgery, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, United Kingdom

Malcolm H. Simms, FRCS

Department of Vascular Surgery, University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom

Rajiv K. Vohra, PhD, FRCSEd, FRCSEng

Department of Vascular Surgery, University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom

Andrew W. Bradbury, BSc, MBA, MD, FRCSEd

University Department of Vascular Surgery, Heart of England NHS Foundation Trust, Birmingham, United Kingdom

Donald J. Adam, MD, FRCSEd

University Department of Vascular Surgery, Heart of England NHS Foundation Trust, Birmingham, United Kingdom

Objective: To assess the outcome of surgical (SR) and endovascular (ER) reconstruction for chronic mesenteric ischemia (CMI). Methods: Retrospective review of consecutive patients who underwent SR or ER for CMI in 3 UK vascular surgery units between 1996 and 2006. Early (<30 days; technical success, morbidity, mortality, length of hospital stay) and late (>30 days) outcomes (symptom recurrence, vessel/graft patency, reintervention, mortality) were assessed. Results: A total of 27 patients underwent 32 reconstructions (SR = 17, ER = 15). A total of 44 of 56 (79%) diseased arteries underwent SR (n = 26; bypass = 24, reimplantation = 2; occlusion = 16, stenosis = 10) or ER (n = 18; stenosis = 16, occlusion = 2). Perioperative mortality for SR and ER was 6% and 0%, respectively (P .99). Hospital stay was shorter following ER (mean, 4.3 vs. 14.2 days, P = .0003). Mean (range) follow-up for SR and ER was 34 (1-94) and 34 (0-135) months, respectively. At 2 years, SR demonstrated superior secondary patency (100% vs. 65%) and clinical patency (100% vs. 73%). Conclusions: Surgical mesenteric reconstruction is associated with significantly longer hospital stay, but superior long-term outcome compared to endovascular reconstruction.

Key Words: chronic mesenteric ischemia • endovascular • surgical

This version was published on April 1, 2009

Vascular and Endovascular Surgery, Vol. 43, No. 2, 157-164 (2009)
DOI: 10.1177/1538574408328665


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