Chronic mesenteric ischemia: Open surgery versus percutaneous angioplasty and stenting

Objective: The aim of the study was to evaluate the safety and efficacy of percutaneous angioplasty and stenting (PAS) in comparison with traditional open surgical (OS) revascularization for the treatment of chronic mesenteri c ischemia. Methods: Over a 3.5-year period, 28 patients (32 vessels) underwent PAS (ba lloon angioplasty alone, 5 [18%] of 28; angioplasty and stenting, 23 [82%] of 28) for symptoms of chronic mesenteric ischemia. These patients were com pared with a previously published series of 85 patients (130 vessels) treat ed with OS (bypass grafting, 60 [71%] of 85; transaortic endarterectomy, 19 [22%] of 85; or patch angioplasty 6 [7%] of 85). Results: The PAS and OS groups were similar with respect to baseline comorb idities, duration of symptoms (median: 6.7 vs 10.5 months, P = .52), and th e number of vessels involved, but the patients differed in their age at pre sentation (median: 72 vs 65 years, P = .005). Fewer vessel were revasculari zed per patient in the PAS group (1.1 +/- 0.4) compared with the OS group ( 1.5 +/- 0.6, P = .001). Overall, 85.7% (24/28) had one vessel and 14.3% (4/ 28) had two vessels revascularized in the PAS group versus 48.2% (41/85) wi th one-vessel and 47.1% (40/85) with two-vessel revascularization in the OS group. No difference was noted in the early in-hospital complications (med ian: 17.9% [PAS] vs 32.9% [OS], P = .12) or mortality rate (10.7% [PAS] vs 8.2% [OS], P = .71). A reduced length of hospital stay in the PAS patients did not attain statistical significance (median: 5 days [PAS] vs 13 days [O S], P = .08). Although the a-year cumulative recurrent stenosis (P = .62) a nd mortality rate(P = .99) did not differ, the PAS treatment group had a hi gher incidence of recurrent symptoms (P = .001). Conclusion: Although the results of PAS and OS were similar with respect to morbidity, death, and recurrent stenosis, PAS was associated with a signif icantly higher incidence of recurrent symptoms. These findings suggest that OS should be preferentially offered to patients deemed fit for open revasc ularization.