Outcomes of reoperative open or endovascular interventions to treat patients with failing open mesenteric reconstructions for mesenteric ischemia

Abstract

Objective: Outcomes of reinterventions for failing mesenteric open reconstructions (ORs) have not been described. Mesenteric reoperative ORs (R-ORs) are challenging because of excessive scar and more advanced mesenteric disease. The purpose of this study was to evaluate outcomes of R-ORs and endovascular revascularization (ER) in patients with stenosis or occlusion of mesenteric grafts.

Methods: We reviewed 701 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. A 1:2 case-control matching was used to analyze outcomes of R-ORs compared with 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 reintervention.

Results: There were 47 patients (five men, 42 women; mean age, 58 ± 13 years) with failing ORs who were treated by R-ORs. Clinical presentation was CMI in 38 patients (81%) or acute mesenteric ischemia (AMI) in nine (19%). Reinterventions included R-ORs in 28 patients (19 CMI and nine 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 R-OR or ER. Early morbidity was 78% for R-ORs in patients treated for AMI. Morbidity was significantly higher for R-ORs than for ERs in patients with CMI (63% vs 16%; P < .05). Mean follow-up was 50 ± 60 months. Patient survival at 5 years was 60% ± 8% for the entire cohort. Primary and secondary patency at 1 year were 61% ± 10% and 92% ± 8% for R-ORs (P = .34) and 77% ± 10% and 100% for ERs (P = .41). Freedom from symptom recurrence and reinterventions at 1 year was 88% ± 6% and 87% ± 7% for R-ORs and 83% ± 8% and 71% ± 10% for ERs. Case case-control (1:2) matching showed R-OR was associated with similar early mortality and morbidity and also similar freedom from recurrence and reintervention but with lower primary patency rates at 1 year compared with first time ORs (66% ± 11% and 94% ± 5%; P < .05).

Conclusions: R-OR or ER interventions for failing mesenteric ORs carry similar mortality, recurrence, and reintervention rates. Early morbidity is lower with ER compared with R-OR. R-ORs are associated with similar morbidity and mortality and lower primary patency compared with first-time OR for CMI.