Outcomes In Open And Endovascular Revascularization Techniques For Acute Mesenteric Ischemia
James M. Chang, MD, Samuel Broida, BS, Yazan Duwayri, MD, Luke P. Brewster, MD, Christopher R. Ramos, MD, Olamide Alabi, MD, Thomas F. Dodson, MD, William D. Jordan, Jr., MD, Guillermo A. Escobar, MD.
Emory University, Atlanta, GA, USA.
OBJECTIVES: Acute mesenteric ischemia is a rare but deadly condition, with an average mortality over 50%. Minimal data exists comparing open versus endovascular revascularization.
METHODS: Retrospective review of a multihospital, prospectively collected database from 2008 to 2018 identifying patients treated for acute mesenteric ischemia. We analyzed the patient's demographics, operative approaches, and outcomes. Patients were divided into OPEN and STENT groups based upon the initial treatment modality.
RESULTS: Of 102 patients with mesenteric ischemia who underwent revascularization, 49 had chronic mesenteric ischemia and were excluded. 53 had acute mesenteric ischemia (AMI). 29 patients were female (55%) and the average age was 66 years. Seventeen patients had evidence of embolus, 29 mesenteric thrombosis and 5 had malperfusion secondary to dissection. Seventeen patients (32%) had an initial endovascular attempt at revascularization (STENT). Eleven patients (21%) underwent stenting, while 6 of the 17 patients (35%) had failure of endovascular therapy with conversion to an open procedure. In the primarily OPEN group (n=36), 15 patients (42%) had thrombectomy alone and 20 (56%) had a bypass. Seventeen total patients (32%) required bowel resection, including 16 patients who had open treatment (10 of the bypasses and 5 of the thrombectomy alone patients, 1 patient underwent resection due to infarction but no revascularization) required bowel resections, as opposed to only one patient in the endovascular group. The average number of operations required was 1.8, range 1-10. Twelve patients died during the index hospitalization (23%): 9 of the 36 OPEN patients (25%) and 3 of the 17 STENT patients (18%) (p=0.599).
CONCLUSIONS: Open and endovascular revascularization has similar mortality, despite previous reports that open is higher. We correlate that 1/3 require bowel resection regardless of technique, however, this series demonstrated a lower (23%) overall mortality than previous reports. Our findings differ from other series for which a larger, multi-institutional study is needed to define optimal management.
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