Author (year)
n
Vessels
Mortality
Morbidity
Recurrence
Re-intervention
Primary patency
Follow-up (months)
%
Leke (2002)
17
25
6
41
0
0
100 at 34 months
34
Cho (2002)
25
41
4
–
32
20
57 at 5 years
64
Brown (2005)
33
51
9
30
9
7
100 at 6 months
34
Sivamurthy (2006)
46
66
15
46
32
12
83 at 6 months
9
Biebl (2007)
26
48
8
42
11
8
–
25
Kruger (2007)
39
67
2.5
12
5
3
92 at 5 years
39
Atkins (2007)
49
88
2
4
22
22
90
42
Mell (2008)
80
120
3.8
26
11
11
90
46
Oderich (2009)
146
265
2.7
36
6
5
88 at 5 years
36
Low risk
101
–
0.9
37
6
6
94 at 5 years
–
High risk
45
–
6.7
38
11
11
90 at 5 years
–
Concomitant aortic reconstruction
23
–
8.4
–
–
–
–
–
Rawat (2010)
52
75
13
32
15
13
81
41
Ryer (2012)
116
203
2.5
50
14
16
86 at 5 years
43
Total
629
1049
6.3
32
14
11
–
38
Postoperative medical therapy should include smoking cessation and antiplatelets and cholesterol-lowering agents. Patients may develop diarrhea after surgery because the absorptive capacity of the gut changes, and for some individuals, the diarrhea lasts weeks and can be problematic. Surveillance imaging with duplex ultrasound is done every six months during the first year and annually thereafter [4].
Symptom Relief, Recurrent Symptoms, and Re-intervention
Outcomes of mesenteric revascularization should include analysis of mortality, morbidity, symptom relief, and freedom from restenosis, recurrence, and re-intervention. There needs to be reporting standards, stratification of patient risk, and methods to compare anatomic severity of disease if comparisons of open and endovascular treatment are to have meaning. Currently, interpretation of data and comparison of outcomes between published reports is difficult for several reasons [6]. Studies often mix patients with acute and chronic presentations, including median arcuate ligament syndrome, and cover a long period of time; reports vary in the definition of technical success; analyses lack time-dependent outcomes such as patency rates, symptom recurrence, restenosis, and re-intervention; patient follow up is limited; and there is no consistent objective determination of patency.
Open revascularization provides excellent symptom relief and better durability than endovascular treatment. In a systematic review, symptom improvement averaged 93 % with open and 88 % with endovascular revascularization [18]. Most single-center reports and a systematic review suggest that bypass is associated with lower rates of restenosis, better patency, and higher freedom from recurrent symptoms or re-interventions compared to mesenteric angioplasty and stenting. Primary patency of open bypass averaged 89 % at 5 years in a recent review of the pooled literature (57 % to 92 %), with freedom from re-intervention in 93 % [20]. The systematic review by van Petersen et al. [19] showed open surgery to have better primary (86 % versus 51 %) and secondary patency rates (87 % versus 83 %), lower restenosis (15 % versus 37 %), less symptom recurrence (13 % versus 30 %), and fewer re-interventions (9 % versus 20 %) than endovascular intervention., respectively. Nonetheless, endovascular therapy is now the first option for treatment of atherosclerotic mesenteric artery stenoses at most centers, with stenting preferred because of its better patency. A contemporary report by Ryer and colleagues [15] indicated that open bypass is increasingly performed in patients with more comorbidities and worse anatomy than those treated with endovascular techniques. Despite this evolution toward more difficult reconstructions, open surgery had a respectable primary patency rate of 76 % at 5 years.
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