CHRONIC MESENTERIC ISCHEMIA (CMI) - DIFFERENTIAL VASCULARSURGICAL THERAPY AND ITS OUTCOME IN A SINGLE-CENTER OBSERVATIONAL STUDY
Mohamed Essa3, Frank Meyer*1, Zuhir Halloul2
1Dept. of General, Abdominal, Vascular and Transplant Surgery; Otto-von-Guericke University with University Hospital, Magdeburg, Germany; 2Division of Vascular Surgery; Dept. of General, Abdominal, Vascular and Transplant Surgery; Otto-von-Guericke University with University Hospital, Magdeburg, Germany; 3Division of Vascular and Endovascular Surgery; Dept. of Abdominal, Thoracic and Vascular Surgery; University Hospital at Gießen and Marburg, Marburg, Germany
Chronic mesenteric ischemia (CMI) belongs to the most challenging diseases in visceral medicine requiring a combined and interdisciplinary approach of vascular and abdominal surgery as well as interventional radiology.
Aim: To investigate short-/long-term vascularsurgical patency and outcome in 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
one- versus (vs.) two-vessel as well as antegrade vs. retrograde reconstructions.
Results: In total, 38 patients were enrolled (mean [±SD] age, 64±13 [range, 32-83] years; sex ratio [m:f], 18:20[43:57]) over 12 years.
While 52.6 % of patients underwent one-vessel reconstruction, 47.4 % the two-vessel reconstruction. There was a trend of i) more perioperative complications in the two-vessel-group (83.3 % vs. 55 %, p=0.086), and ii) higher morbidity at one year in the two-vessel vs. one-vessel group (57.1 % and 41.2 %, respectively; p=0.470) while the morbidity of the two-vessel vs. one-vessel group at five years (100 % vs. 30 %) was significantly different (p=0.004). The mortality was greater in the two-vessel vs. one-vessel group: as a trend in the early postoperative period (27.8 % vs. 0, p=0.17) but significantly at one (38.5 % vs. 0, p=0.011) and five year(s) (100 % vs. 2 %, p=0.007). Regarding overall survival, the one-vessel group showed a significant superiority above the two-vessel group (p=0.001).
Actually, there was no significant difference of early postoperative morbidity comparing retrograde and antegrade group (p=0.161) as well as at one year and five years (p=0.479 and p=0.367, respectively). In addition, there was no significantly different postoperative mortality in antegrade vs. retrograde group at each time.
There was no significant difference regarding the survival of patients who had undergone antegrade vs. retrograde reconstruction whereas there was a significantly longer survival in one-vessel group vs. two-vessel group (p=0.001).
Specific and general complication rates were 60.5 % and 55.3 %, respectively, resulting in an overall morbidity of 73.3 % (mortality, 18.4 %).
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.
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