A systematic review and meta-analysis of endovascular versus open surgical revascularization for chronic mesenteric ischemia - Journal of Vascular Surgery

Despite the enthusiasm for endovascular revascularization for chronic mesenteric ischemia (CMI), it is not clear if early benefits offset long-term patency rates. This systematic review aimed to provide an up-to-date comprehensive evidence synthesis evaluating the two approaches. We searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Scopus through July 15, 2016, for studies that compared the endovascular with the open surgical approach for revascularization in CMI patients. We conducted a random-effects meta-analysis to pool outcomes of interest across studies. We included 100 observational studies (22 comparative, 78 noncomparative; 18,726 patients; mean age, 69 years). Open surgery was associated with a statistically significant increase in the risk of in-hospital complications (relative risk [RR], 2.2; 95% confidence interval [CI], 1.8-2.6) and a nonsignificant increase in mortality at 30 days (RR, 1.57; 95% CI, 0.84-2.93). Open surgery was associated with lower risk of 3-year recurrence rates (RR, 0.47; 95% CI, 0.34-0.66) and a similar 3-year survival. Data from noncomparative studies provided similar inferences. The quality of evidence was low. Observational evidence suggests that the endovascular approach for revascularization in patients with CMI may offer better early outcomes than open surgery, although this effect may not be durable. Long-term mortality appears to be similar. The treatment of chronic mesenteric ischemia (CMI) has evolved during the past few decades with the advances in diagnostic imaging and endovascular therapy. Mesenteric duplex ultrasound is currently an effective screening tool for visceral artery occlusive disease,1x1Moneta, G.L., Lee, R.W., Yeager, R.A., Taylor, L.M. Jr., and Porter, J.M. Mesenteric duplex scanning: a blinded prospective study. J Vasc Surg. 1993; 17: 79–84 (discussion: 85-6) Abstract | Full Text | Full Text PDF | PubMed | Scopus (190) | Google ScholarSee all References whereas computed tomography arteriography has emerged as the definitive diagnostic study and allows the assessment of the bowel and other intra-abdominal contents in addition to a detailed evaluation of the vessels themselves.2x2Oliva, I.B., Davarpanah, A.H., Rybicki, F.J., Desjardins, B., Flamm, S.D., Francois, C.J. et al. ACR Appropriateness Criteria imaging of mesenteric ischemia. Abdom Imaging. 2013; 38: 714–719 Crossref | PubMed | Scopus (58) | Google ScholarSee all References Indeed, duplex ultrasound and computed tomography arteriography have largely replaced