REVASCULARIZATION FOR CHRONIC MESENTERIC ISCHEMIA - COMPARISON OF OPERATIVE ARTERIAL BYPASS-GRAFTING AND PERCUTANEOUS TRANSLUMINAL ANGIOPLASTY

PURPOSE: To compare the relative safety and efficacy of the two primary techniques for treatment of chronic mesenteric ischemia (CIM): operative bypass grafting (OBG) and percutaneous transluminal angioplasty (PTA). PATIENTS AND METHODS: Retrospective analysis of hospital charts and angiograms, and supplemental telephone follow-up were performed for 17 patients treated for CMI between January 1985 and September 1993. Nine patients underwent OBG; eight patients underwent PTA (one patient underwent two PTA procedures). RESULTS: Technical success was 100% for OBG versus 30% according to angiographic criteria for PTA (although 80% had improved luminal diameter). Procedure-related mortality was 11% (one of nine patients) for OBG and 13% (one of eight) for PTA. The nonfatal major complication rate was 33% (three of nine) for OBG; and 25% (two of eight) for PTA. Initial pain relief occurred in seven of nine (78%) successful OBGs and all of seven (100%) PTA procedures with lumen improvement. Long-term pain relief among OBG survivors was complete in seven of eight (88%) and four of six (67%) of PTA survivors with CMI (mean follow up, 34.5 and 9.2 months, respectively). CONCLUSIONS: Due to the greater durability of results, OBG is indicated in patients with low operative risk and classic symptoms and angiographic findings of CMI ischemia. PTA is best reserved for patients with prohibitive operative risks, classic symptoms, and atherosclerotic stenoses.