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Outcomes of reoperative open or endovascular interventions to treat patients with failing open mesenteric reconstructions for mesenteric ischemia
Karina S. Kanamori, MD1, Gustavo S. Oderich, MD1, Javairiah Fatima, MBBS2, Timur Sarac, MD2, Daniel Clair, MD2, Stephen Cha, MS1, Audra A. Duncan, MD1, Manju Kalra, MBBS1, Mark Fleming, MD1, Randall R. De Martino, MD1, Peter Gloviczki, MD1, Thomas C. Bower, MD1.
1Mayo Clinic, Rochester, MN, USA, 2Cleveland Clinic, Cleveland, OH, USA.

Objectives: Outcomes of re-interventions for failing open mesenteric reconstructions (ORs) have not been described. Reoperative open mesenteric reconstructions (R-ORs) can be challenging because of excessive scar and more advanced mesenteric disease. The purpose of this study was to evaluate outcomes of R-ORs and endovascular revascularizations (ERs) in patients with stenosis or occlusion of ORs.
Methods: We reviewed a cohort of 593 patients treated for chronic mesenteric ischemia (CMI) in two academic centers from 1991 to 2013. Clinical data and outcomes of patients treated for failing ORs with R-ORs or ERs were included in the analysis. Case-control propensity-score matching was used to analyze outcomes of R-ORs as compared to patients who underwent their first time ORs for CMI. End-points were early and late mortality, morbidity, patency rates and freedom from symptom recurrence and re-intervention.
Results: There were 47 patients (5 male, 42 female; mean age, 58±13 years) treated by re-interventions for failing ORs. Clinical presentation was CMI in 38 patients (81%) or acute mesenteric ischemia (AMI) in 9 (19%). Re-interventions included R-ORs in 28 patients (19 CMI and 9 AMI) and ERs in 19, all for CMI. Early mortality was 22% in patients treated by R-ORs for AMI. There were no early deaths among patients treated for CMI with either R-OR or ER. Early morbidity was 78% for R-ORs in patients treated for AMI. Morbidity was significantly higher for R-ORs as compared to ERs in patients with CMI (68% vs 16%; P<.001). Mean follow up was 50±60 months. Patient survival at 5-years was 60±8% for entire cohort. Primary and secondary patency at 1-year was 61±10% and 92±8% for R-ORs, and 77±10% and 100% for ERs (P=NS). Freedom from symptom recurrence and re-interventions at 1-year was 88±6% and 87±7% for R-ORs, and 83±8% and 71±10% for ERs. Using propensity-score matched comparison R-ORs were associated with similar mortality, morbidity, patency, recurrence and reintervention rates as compared to first time ORs.
Conclusions: Re-interventions for failing open mesenteric reconstructions using reoperative open or endovascular interventions carry similar mortality, patency, recurrence and re-intervention rates. Early morbidity is significantly lower with endovascular as compared to reoperative open reconstructions performed for CMI. Outcomes of reoperative open reconstructions are similar to those obtained with the first time open reconstructions in patients with CMI.


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