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Chronic Mesenteric Ischemia as a pre-procedural risk factor
Jordan Knepper, MD, MSc, Nicholas Osborne, MD, MSc, Peter Henke, MD, Tina Chen, MD, Dawn Coleman, MD, Danielle Horne, MD, MS, John Rectenwald, MD, Katherine Gallagher, MD.
University of Michigan, Ann Arbor, MI, USA.
SCVC Abstract
Introduction: The recognition of chronic mesenteric ischemia (CMI) is increasing in clinical practice. Although this diagnosis has long been associated with high mortality rates, surprisingly little is known about the influence of CMI on outcomes following treatment of other common vascular disease processes (i.e., PAD,CAS, UE disease). This study examines the outcomes following endovascular therapy for non-mesenteric vascular disease in CMI patients previously treated with endovascular therapy.
Methods: A prospective Blue Cross Blue Shield Registry for patients in the State of Michigan was queried for all patients with CMI who underwent endovascular therapy (PTA or stent) from 2005 to 2011. Patients with acute or acute on chronic mesenteric ischemia were excluded from the study. Demographics, perioperative data and morbidity/mortality data were extracted and statistically evaluated using modeling and multivariable analyses.
Results: 15974 patient’s records were evaluated and analyzed. Of those, 474 patients underwent endovascular intervention for CMI. Endovascular therapy for these patients included stents in 60% and PTA alone in 40%. The average age was 67 +/- 10 years, with 67% of the patients being female. Comorbidities were assessed and were adequately matched, including CAD, smoking and PAD. 30-day mortality rates for patients with CMI/endovascular intervention who were undergoing non-mesenteric endovascular interventions were 3.85% compared to 1.15% in those patients without endovascular treated CMI undergoing non-mesenteric endovascular interventions. (P<.001) At 6 months, these differences between the groups remain significantly different (4.17% vs. 3.4%; P<.001).
Conclusions: As CMI has been diagnosed with increased frequency and commonly occurs with vascular disease in other vascular territories, it appears that CMI, is an independent pre-operative risk factor for endovascular treatment of all non-mesenteric vascular disease and should be considered, based on our results, as a CAD equivalent in terms of risk stratification.
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