Author(s): Fidalgo, Helena ; Ribeiro, Tiago ; Pais, Fábio ; Cardoso, Joana ; Tavares, Carolina ; Correia, Ricardo ; Gonçalves, Daniela ; Ferreira, Maria Emília
Date: 2025
Origin: Angiologia e Cirurgia Vascular
Subject(s): Chronic intestinal ischemia; superior mesenteric artery; open mesenteric revascularization; endovascular mesenteric revascularization
INTRODUCTION: Chronic mesenteric ischemia (CMI) is a rare but life-threatening disease. This study aimed to analyze the safety and effectiveness of open (OR) and endovascular (ER) revascularization and respective outcomes in a consecutive series of CMI patients. METHODS: From 2013 to 2023, all CMI patients treated with OR and ER were retrospectively identified. Demographics, comorbidities, clinical presentation, preoperative imaging, and revascularization modalities were analyzed. Patients were grouped according to the type of revascularization (OR and ER) and compared for the study’s endpoints. The primary endpoint was the reintervention rate, and the secondary endpoints were overall survival and reintervention-free survival. RESULTS: Thirty-three patients with CMI (60% male, mean age 67, range 45-88 years) were treated by ER (27 patients) or OR (6 patients). The median follow-up was 38 (9-72) months. The ER of the superior mesenteric artery (SMA) included the deployment of covered balloon-expandable stents in 85 % (n=23) of the patients. The OR included SMA bypass using prosthetic conduit and iliac artery inflow in 83 % (n=5) of the patients. Long SMA lesions (>20mm) were present in 100 % of the OR group patients and 44 % of the patients in the ER group (p=.027). Reintervention due to symptom recurrence and target artery restenosis or re-occlusion was performed in four patients in the ER group, of which one patient underwent open surgery and three underwent endovascular surgery. The three-year reintervention rate was 18% in the ER and 0% in the OR group (p=.374). Thirty-day and 3-year overall survival in the OR and ER groups were 67% vs. 93% and 44% vs. 87%, respectively (p=.015). Three-year reintervention-free survival in the OR and ER groups was 50 % vs. 70%, respectively (p=.103). CONCLUSIONS: According to this study, we should expect lower survival in CMI patients who undergo OR, probably related to the higher burden of atherosclerotic disease observed in this group. However, the improved survival observed after ER is offset by a trend towards higher reintervention rates.
