Surgical or Endovascular Treatment for Chronic Mesenteric Ischemia: A Multicenter Study

Background: To evaluate treatment options for patients with chronic mesenteric ischemia in the United Kingdom. Methods: Early and late outcomes of patients with chronic mesenteric ischemia who underwent bypass or percutaneous angioplasty (PTA) in 12 centers were compared on an intention-to-treat basis. Results: A total of 76 patients underwent 101 procedures (PTA 49; bypass 52). Of these, 36 had a PTA first, and 40 had a bypass first. Among those who underwent a primary PTA, nine required a subsequent bypass. Three patients who underwent a primary bypass also required a graft PTA, and three patients required further surgery. Patients who underwent a primary PTA were found to be significantly older and tended to have greater comorbidities. As compared with PTA, primary bypasses were more frequently undertaken in an urgent manner or as an emergency (43% vs. 8%). Perioperative morbidity for bypass was significantly greater than that for PTA (32% vs. 6%). Overall, 30-day mortality for bypass tended to be greater than that for PTA (13% vs. 4%; n.s.), but was similar for patients treated electively in the two groups (4% vs. 3%). Cumulative 1- and 5-year survival (bypass: 85%, 63%; PTA: 67%, 31%) and primary patency (bypass: 81%, 69%; PTA: 54%, 32%) rates were found to be significantly better after primary bypass. Conclusions: Treatment preferences were center-dependent. Symptomatic recurrence was found to be less frequent and patency rates were better after a primary bypass. PTA may be a viable alternative in patients with significant comorbidities.