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Outcomes after Endarterectomy for Chronic Mesenteric Ischemia

OBJECTIVES: A retrospective study was performed to identify optimal factors affecting outcomes after open revascularization for chronic mesenteric ischemia (CMI).
METHODS: All patients who underwent open surgery for CMI from 1987 to 2006 were reviewed. Patients with acute mesenteric ischemia or median arcuate ligament syndrome were excluded. Mortality, recurrent stenosis and symptomatic recurrence were analyzed using logistic regression, univariate and multivariate analysis.
RESULTS: Eighty patients (69% female, 31% male) were identified. Mean age was 64 years (range 31-86). Acute-on-chronic symptoms were present in 26% patients. Presenting symptoms included post-prandial pain (91%), weight loss (69%), food fear and diarrhea (25%). Preoperative imaging demonstrated severe (>70%) stenosis of the superior mesenteric artery in 75 patients (24 occluded), the celiac axis in 63 (20 occluded), and the inferior mesenteric artery in 53 (20 occluded). Multi-vessel disease was present in 72 (90%) patients, and 40 (50%) underwent multi-vessel reconstruction. Revascularization was achieved by endarterectomy in 37 patients, mesenteric bypass in 29 patients, and combined procedures in 13. Concurrent aortic reconstruction was required in 13 (16%) patients. Three hospital deaths occurred (3.8%). Mean follow-up was 3.8 years (range, 0-17.2). One- and 5-year survival was 92.2% and 64.5%; mortality was predicted by age (p=.019) and renal insufficiency (p=.007), but not by clinical presentation. Symptom-free survival was 89.7% and 82.1% at 1 and 5 years respectively. Symptoms requiring reintervention occurred in 9 (11%) patients at a mean of 29 months (range: 5-127). Multivariate analysis showed that freedom from recurrent symptoms correlated with endarterectomy for revascularization (p=.02, hazard ratio [HR]: 0.185).
CONCLUSION: For open surgical candidates, endarterectomy appears to provide the most durable long-term symptom relief in patients with CMI.