A systematic review and meta-analysis of endovascular versus open surgical revascularization for chronic mesenteric ischemia

Published on May 1, 2018in Journal of Vascular Surgery3.405
· DOI :10.1016/J.JVS.2017.12.046
Fares Alahdab46
Estimated H-index: 46
(Mayo Clinic),
Remy Arwani1
Estimated H-index: 1
(Ain Shams University)
+ 4 AuthorsM. Hassan Murad88
Estimated H-index: 88
(Mayo Clinic)
Sources
Abstract
Abstract Background Despite the enthusiasm for endovascular revascularization for chronic mesenteric ischemia (CMI), it is not clear if early benefits offset long-term patency rates. This systematic review aimed to provide an up-to-date comprehensive evidence synthesis evaluating the two approaches. Methods We searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Scopus through July 15, 2016, for studies that compared the endovascular with the open surgical approach for revascularization in CMI patients. We conducted a random-effects meta-analysis to pool outcomes of interest across studies. Results We included 100 observational studies (22 comparative, 78 noncomparative; 18,726 patients; mean age, 69 years). Open surgery was associated with a statistically significant increase in the risk of in-hospital complications (relative risk [RR], 2.2; 95% confidence interval [CI], 1.8-2.6) and a nonsignificant increase in mortality at 30 days (RR, 1.57; 95% CI, 0.84-2.93). Open surgery was associated with lower risk of 3-year recurrence rates (RR, 0.47; 95% CI, 0.34-0.66) and a similar 3-year survival. Data from noncomparative studies provided similar inferences. The quality of evidence was low. Conclusions Observational evidence suggests that the endovascular approach for revascularization in patients with CMI may offer better early outcomes than open surgery, although this effect may not be durable. Long-term mortality appears to be similar.
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