ORIGINAL ARTICLE   

Italian Journal of Vascular and Endovascular Surgery 2024 December;31(4):208-13

DOI: 10.23736/S1824-4777.24.01680-2

Copyright © 2024 EDIZIONI MINERVA MEDICA

lingua: Inglese

Factors influencing long-term outcomes for endovascular revascularization in patients with chronic mesenteric ischemia

Mohammad MIAH ¹ ✉, Terri-Ann RUSSELL ², Sivaram PREMNATH ¹, Alaa GINAWI ³, James KIRK ³, Ganesh KUHAN ¹

¹ Department of Vascular and Endovascular Surgery, University Hospital of Derby and Burton NHS Trust, Derby, CT, USA; ² Department of Radiology, University Hospital of Derby and Burton NHS Trust, Derby, CT, USA; ³ Department of Vascular and Endovascular Surgery, University Hospital of Leicester, Leicester, UK

BACKGROUND: Endovascular revascularization (ER) for chronic mesenteric ischemia (CMI) has comparable outcomes with open revascularization, but it is associated with higher rates of restenosis and re-interventions.
METHODS: All patients treated with ER for CMI between 2012 and 2020 were analyzed. Twenty clinical, five anatomical, six procedure-related and seven outcome variables were collected. Kaplan-Meier survival analysis was carried out to identify variables influencing symptom recurrence, reinterventions, and survival. Predictors were determined using a log-rank test and Cox regression analysis.
RESULTS: Thirty-seven patients were included with a mean age of 72.9 (range 50-90) years and 64.9% were women. Smokers were 51.4%, 94.6% patients had single-vessel treatment and 81.1% were treated with covered-stent. Median follow-up was 59.7 (range 10.7-111.2) months. The 30-day-complications and mortality rates were 16.2% and 5.4% respectively. Symptoms recurred in 18.9% and 10.8% had re-interventions. Median survival was 86.4 (95% CI 29.0-143.8) months, median symptom free survival was 52.9 (95% CI 24.8-81.0) months and median intervention free survival was 86.4 (95% CI 26.4-146.4) months. Smoking was associated with recurrence of symptoms (P=0.028) and re interventions (P=0.033). Revascularization using covered stents reduced re-interventions (P=0.002).
CONCLUSIONS: The use of covered stent and cessation of smoking can improve the outcomes for ER in patients with CMI.

KEY WORDS: Endovascular procedures; Mesenteric ischemia; Drug-eluting stents