Open Mesenteric Interventions Are Equally Safe as Endovascular Interventions and Offer Better Midterm Patency for Chronic Mesenteric Ischemia.

BACKGROUND: Endovascular (EV) techniques are being advocated as the preferred method for mesenteric interventions because of their safety profile. However, midterm and long-term results are thought to be inferior to open interventions. We sought to compare our institutional experience with treatment of acute and chronic mesenteric ischemia (AMI and CMI, respectively) using EV and open techniques. METHODS: The medical records of open and EV mesenteric procedures performed at a single center were queried from 2002 to 2012. Demographic, perioperative, and follow-up data were extracted and analyzed. RESULTS: Thirty-eight patients underwent EV mesenteric interventions, whereas 77 patients underwent open revascularization. The demographic and perioperative characteristics for patients were similar. Most EV procedures (89.2%) comprised stenting, whereas open procedures included 25 (32.1%) antegrade bypasses, 38 (48.7%) retrograde bypasses, 8 (10.3%) thromboembolectomies, and 7 (9%) transaortic endarterectomies. Postoperative complications, overall 30-day morbidity and mortality were not significantly different in the open and EV groups for AMI or CMI. Thirty-day mortality in AMI (n = 34) was 38.2% (EV: 45.5% vs. open: 34.8%; P = nonsignificant). There was no mortality in either group for CMI patients. Mean follow-up was much longer for the open procedures (34.9 vs. 12.7 months, P = 0.004). Primary and secondary patency rates were better for open revascularization for CMI patients. CONCLUSIONS: Open revascularizations are equally safe as EV interventions for AMI and CMI. Patency of open revascularization for CMI is better than EV procedures at midterm follow-up.

Diagnosis, prevention, and treatment of claudication.

Lower extremity chronic ischemia due to atherosclerosis represents the continuum of peripheral arterial disease, encompassing intermittent claudication, rest pain, and tissue loss. Traditionally, the indication for invasive intervention has been critical limb ischemia as a means to prevent amputation. This article highlights claudication and reviews its diagnosis, available treatment modalities, and preventative measures.