Surgical and interventional visceral revascularization for the treatment of chronic XXXX --when to prefer which?

@entity1 @entity850 @entity5327 @entity2333
BACKGROUND: The purpose of the present study was to compare surgical and endovascular revascularization for chronic @entity5327 (CMI). METHODS: Forty-nine @entity1 underwent surgical (SG) or endovascular (EG) treatment. Relief of symptoms was considered the primary endpoint; patency, morbidity, and mortality were secondary endpoints. For statistical analysis, significance was assumed if P values < or = 0.05. RESULTS: Twenty-six @entity1 (53%) underwent surgical revascularization; 23 @entity1 (47%), endovascular repair. Mean follow-up was 25 +/- 21 months (SG) versus 10 +/- 10 (EG) months (P = 0.07). Except for body mass indices (SG 18.9 +/- 2.7 versus EG 23.6 +/- 4.8; P = 0.001), preoperative data were comparable. Freedom from symptoms was 100% (SG) versus 90% (EG) after intervention (P = 0.194), and 89% (SG) versus 75% (EG) at the end of follow-up. Reocclusion or re- @entity850 occurred in 8% (SG) versus 25% (EG) (log-rank test: P = 0.003), and @entity5327 developed in 0% (SG) versus 9% (EG) (P = 0.04). Reintervention for CMI was required in 0% (SG) versus 13% (EG) (P = 0.01). Surgical @entity1 experienced more early complications (42% versus EG 4%; P = 0.02) and longer hospital stays (11.6 +/- 10.9 days versus EG 1.3 +/- 0.5 days; P < 0.001). Overall mortality at the end of follow-up was 31% (SG) versus 4% (EG) (log-rank test: P = 0.08), including all @entity1 with combined open mesenteric and aortic reconstruction (P = 0.001). CONCLUSIONS: Surgical treatment has superior long-term patency and requires fewer reinterventions, but it is also more invasive with greater morbidity and mortality compared to endovascular treatment. Endovascular techniques may be preferable in @entity1 with significant co-morbidities, concomitant @entity2333 , or indeterminate symptoms.
