A Systematic Review of Endovascular Repair Outcomes in Atherosclerotic Chronic Mesenteric Ischaemia.

Nana, Petroula; Koelemay, Mark J W; Leone, Nicola; Brodis, Alexandros; Van den Berg, Jos C; de Bruin, Jorg L; Geelkerken, Robert H; Spanos, Konstantinos (2023). A Systematic Review of Endovascular Repair Outcomes in Atherosclerotic Chronic Mesenteric Ischaemia. European journal of vascular and endovascular surgery, 66(5), pp. 632-643. Elsevier 10.1016/j.ejvs.2023.07.011

Preview

Text 1-s2.0-S1078588423005373-main.pdf - Accepted Version Available under License Creative Commons: Attribution-Noncommercial-No Derivative Works (CC-BY-NC-ND). Download (1MB) | Preview

OBJECTIVE

Chronic mesenteric ischaemia (CMI) treatment focuses on symptom relief and prevention of disease progression. Endovascular repair represents the main treatment modality, while data on the associated antiplatelet regimen are scarce. The aim of this meta-analysis was to assess the early and mid term outcomes of endovascular repair in patients with CMI.

DATA SOURCES

Randomised controlled trials and observational studies (1990 - 2022) reporting on early and mid term endovascular repair outcomes in patients with atherosclerotic CMI.

REVIEW METHODS

The PRISMA guidelines and PICO model were followed. The protocol was registered to PROSPERO (CRD42023401685). Medline, Embase (via Ovid), and Cochrane databases were searched (end date 21 February 2023). The Newcastle-Ottawa Scale was used for risk of bias assessment, and GRADE for evidence quality assessment. Primary outcomes were technical success, 30 day mortality, and symptom relief, assessed using prevalence meta-analysis. The role dual antiplatelet therapy (DAPT) was investigated using meta-regression analysis.

RESULTS

Sixteen retrospective studies (1 224 patients; mean age 69.8 ± 10.6 years; 60.3% female) reporting on 1 368 target vessels (57.8% superior mesenteric arteries) were included. Technical success was 95.0% (95% CI 93 - 97%, p = .28, I2 19%, low certainty), 30 day mortality was 2.0% (95% CI 2 - 4%, p = .93, I2 36%, low certainty), and immediate symptom relief was 87.0% (95% CI 80 - 92%, p < .010, I2 85%, very low certainty). At mean follow up of 28 months, mortality was 15.0% (95% CI 9 - 25%, p = .010, I2 86%, very low certainty), symptom recurrence 25.0% (95% CI 21 - 31%, p < .010, I2 68%, very low certainty) and re-intervention rate 26.0% (95% CI 17 - 37%, p < .010, I2 92%, very low certainty). Single antiplatelet therapy (SAPT) and DAPT performed similarly in the investigated outcomes.

CONCLUSION

Endovascular repair for CMI appears to be safe as first line treatment, with low peri-operative mortality and acceptable immediate symptom relief. During mid term follow up, symptom recurrence and need for re-intervention are not uncommon. SAPT appears to be equal to DAPT in post-operative outcomes.

Interest & Impact

Downloads

10 since deposited on 17 Jul 2023
10 in the past 12 months

Citations

5 Citations in Web of Science ®
6 Citations in Scopus

Search

in Google Scholar™

Services

Actions (login required)

Edit item

Actions (login required)

Edit item