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Title: Chronic mesenteric ischemia : differential vascularsurgical therapy and its outcome in a single-center observational study
Author(s): Essa, MohamedLook up in the Integrated Authority File of the German National Library
Meyer, FrankLook up in the Integrated Authority File of the German National Library
Damm, Robert FriedrichLook up in the Integrated Authority File of the German National Library
Halloul, ZuhirLook up in the Integrated Authority File of the German National Library
Issue Date: 2022
Type: Article
Language: English
URN: urn:nbn:de:gbv:ma9:1-1981185920-883071
Subjects: Chronic mesenteric ischemia
Open reconstruction
One-/ two-vessel reconstruction
Antegrade/retrograde reconstruction
Abstract: Aim: The aim of this study was to investigate short-/longterm vascularsurgical patency and the outcome in chronic mesenteric ischemia (CMI) depending on the mesenteric revascularization technique and reflecting real-world data. Methods: This retrospective single-center observational study registered all patients who had undergone open vascularsurgical reconstruction because of CMI at a tertiary German university hospital comparing 1-versus (vs.) 2-vessel as well as antegrade versus retrograde reconstructions. Results: In total, 35 patients were enrolled (mean [± SD] age, 64 ± 13 [range, 45–83] years; sex ratio [m:f], 16:19 [46:54]) over 12 years. Three patients with symptoms of mesenteric ischemia because of rare causes (radiation-induced and median arcuate ligament syndrome) have been excluded. While 51% of patients underwent 1-vessel reconstruction, 49% underwent 2-vessel reconstruction. There was a trend of (i) more perioperative complications in the 2-vessel group (88.2% vs. 55.6%, p = 0.06) and (ii) higher morbidity at 1 year in the 2-vessel versus 1-vessel group (57.1% and 42.9%, respectively; p = 0.466), while the morbidity of the 2-vessel versus 1-vessel group at 5 years (100% vs. 33.3%) was significantly different (p = 0.009). The mortality was greater in the 2-vessel versus 1-vessel group as it was significantly different in the early postoperative period (31.3% vs. 0, p = 0.016) and at 1 year (50% vs. 0, p = 0.005) and 5 years (100% vs. 11%, p = 0.003). Regarding overall survival, the 1-vessel group showed a significant superiority above the 2-vessel group (p = 0.004). Actually, there was no significant difference of early postoperative morbidity comparing the retrograde and antegrade group (p = 0.285) as well as at 1 year and 5 years (p = 0.715 and p = 0.620, respectively). In addition, there was no significantly different postoperative mortality in antegrade versus retrograde group at each time. Specific and general complication rates were 62.9% and 57.1%, respectively, resulting in an overall morbidity of 77.1% (mortality, 20%). Conclusion: The vascular surgeon should be prepared to perform various procedures of mesenteric reconstruction to tailor the operative strategy to the specific needs of the individual patient.
Open Access: Open access publication
License: (CC BY 4.0) Creative Commons Attribution 4.0(CC BY 4.0) Creative Commons Attribution 4.0
Journal Title: Visceral medicine
Publisher: Karger
Publisher Place: Basel
Volume: 38
Original Publication: 10.1159/000519423
Page Start: 1
Page End: 10
Appears in Collections:Medizinische Fakultät (OA)

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