Document Detail


Surgical or endovascular treatment for chronic mesenteric ischemia: a multicenter study.
MedLine Citation:
PMID:  20831994     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
Nihit Rawat; Christopher P Gibbons;
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Publication Detail:
Type:  Comparative Study; Journal Article; Multicenter Study    
Journal Detail:
Title:  Annals of vascular surgery     Volume:  24     ISSN:  1615-5947     ISO Abbreviation:  Ann Vasc Surg     Publication Date:  2010 Oct 
Date Detail:
Created Date:  2010-09-13     Completed Date:  2011-01-11     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8703941     Medline TA:  Ann Vasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  935-45     Citation Subset:  IM    
Copyright Information:
Copyright © 2010 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved.
Affiliation:
Morriston Hospital, Morriston, Swansea, United Kingdom.
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Angioplasty, Balloon* / adverse effects,  instrumentation,  mortality
Chronic Disease
Comorbidity
Endovascular Procedures* / adverse effects,  instrumentation,  mortality
Female
Great Britain
Humans
Ischemia / mortality,  physiopathology,  surgery,  therapy*
Kaplan-Meier Estimate
Male
Mesenteric Vascular Occlusion / mortality,  physiopathology,  surgery,  therapy*
Middle Aged
Patient Selection
Proportional Hazards Models
Recurrence
Reoperation
Retrospective Studies
Risk Assessment
Risk Factors
Stents
Treatment Outcome
Vascular Patency
Vascular Surgical Procedures* / adverse effects,  mortality

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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