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Chronic mesenteric ischemia can be managed by open surgical repair (OS) or alternatively, by endovascular repair. It is still be determined what the best approach is. We sought to evaluate the clinical and procedural outcomes between the two treatment modalities through a meta-analysis of current clinical studies.
Systematic review of PubMed, Cochrane and Embase database was performed for all clinical studies that directly compared OS and endovascular therapy for chronic mesenteric ischemia. Primary outcome was post-procedure mortality. Secondary outcomes included long-term survival and primary and secondary lesion patency. We used random effects analysis according to the Cochrane-Handbook of Systematic Reviews and RevMan 5.2 for statistical analysis.
A total of 14 studies (13 retrospective and one prospective) provided a total of 7463 patients, 4289 in the endovascular group and 3174 in the OS. There was no significant difference in the post-procedural death between the endovascular and OS groups (3.4% vs. 11.3%, p = 0.60). There also was no significant difference in long-term survival between the endovascular and OS groups (77% vs. 73%, p=0.52). Primary and secondary patency were significantly better in the OS group compared to the endovascular group (p<0.001) (Figure 1).
Our analysis was based mainly on retrospective studies and suggested that endovascular therapy has comparable mortality and morbidity, although OS is associated with superior patency over time. Endovascular therapy might be indicated for the patients who are not good surgical candidates. Newer-generation stents can help to improve lesion patency. Further randomized studies are warranted.