Surgical and interventional visceral revascularization for the treatment of chronic mesenteric ischemia - When to prefer which?

Background: The purpose of the present study was to compare surgical and endovascular revascularization for chronic mesenteric ischemia (CMI). Methods: Forty-nine patients underwent surgical (SG) or endovascular (EG) treatment. Relief of symptoms was considered the primary endpoint; patency, morbidity, and mortality were secondary endpoints. For statistical analysis, significance was assumed if P values <= 0.05. Results: Twenty-six patients (53%) underwent surgical revascularization; 23 patients (47%), endovascular repair. Mean follow-up was 25 +/- 21 months (SG) versus 10 +/- 10 (EG) months ( P = 0.07). Except for body mass indices ( SG 18.9 +/- 2.7 versus EG 23.6 +/- 4.8; P = 0.001), preoperative data were comparable. Freedom from symptoms was 100% ( SG) versus 90% ( EG) after intervention ( P = 0.194), and 89% ( SG) versus 75% ( EG) at the end of follow-up. Reocclusion or re-stenosis occurred in 8% ( SG) versus 25% ( EG) ( log-rank test: P = 0.003), and mesenteric ischemia developed in 0% ( SG) versus 9% ( EG) ( P = 0.04). Reintervention for CMI was required in 0% ( SG) versus 13% ( EG) ( P = 0.01). Surgical patients experienced more early complications (42% versus EG 4%; P = 0.02) and longer hospital stays (11.6 +/- 10.9 days versus EG 1.3 +/- 0.5 days; P < 0.001). Overall mortality at the end of follow-up was 31% ( SG) versus 4% ( EG) ( log-rank test: P = 0.08), including all patients with combined open mesenteric and aortic reconstruction ( P = 0.001). Conclusions: Surgical treatment has superior long-term patency and requires fewer reinterventions, but it is also more invasive with greater morbidity and mortality compared to endovascular treatment. Endovascular techniques may be preferable in patients with significant co-morbidities, concomitant aortic disease, or indeterminate symptoms.