Chronic Visceral Ischemia: Symptom-Free Survival After Open Surgical Repair
A retrospective review of patients treated with a history of chronic visceral ischemia (CVI) was made to determine primary patency of open surgical repair and estimated symptom-free survival. Patients with CVI between 1990 and 2003 were reviewed. Included were those with chronic symptoms alone (C-CV...
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| Veröffentlicht in: | Vascular and endovascular surgery 2004-11, Vol.38 (6), p.493-503 |
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| creator | English, William P. Pearce, Jeffrey D. Craven, Timothy E. Edwards, Matthew S. Geary, Randolph L. Plonk, George W. Hansen, Kimberley J. |
| description | A retrospective review of patients treated with a history of chronic visceral ischemia (CVI) was made to determine primary patency of open surgical repair and estimated symptom-free survival. Patients with CVI between 1990 and 2003 were reviewed. Included were those with chronic symptoms alone (C-CVI) and acute-on-chronic symptoms (A-CVI). Data were obtained from a vascular database. Symptom-free survival and graft patency were estimated by using product limit estimates. Fifty-eight patients (13 men, 45 women; mean age: 63 years) were treated surgically for C-CVI (34 patients) and A-CVI (24 patients). All patients had postprandial abdominal pain and weight loss (mean: 17 kg). One fourth reported food fear. Preoperative imaging demonstrated disease of the superior mesenteric artery (SMA) (100%; 64% occluded), celiac axis (89%; 37% occluded), and inferior mesenteric artery (IMA) (54%; 60% occluded). Multiple vessels were involved in 95% of patients (mean: 2.3 vessels/patient). Operative management included antegrade revascularization of 80 vessels. Combined aortic and/or renal procedures were performed in 7 patients. Patient demographics and visceral disease did not differ for C-CVI and A-CVI; however, perioperative mortality differed significantly (10% for C-CVI vs 54% for A-CVI [p |
| doi_str_mv | 10.1177/153857440403800602 |
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Patients with CVI between 1990 and 2003 were reviewed. Included were those with chronic symptoms alone (C-CVI) and acute-on-chronic symptoms (A-CVI). Data were obtained from a vascular database. Symptom-free survival and graft patency were estimated by using product limit estimates. Fifty-eight patients (13 men, 45 women; mean age: 63 years) were treated surgically for C-CVI (34 patients) and A-CVI (24 patients). All patients had postprandial abdominal pain and weight loss (mean: 17 kg). One fourth reported food fear. Preoperative imaging demonstrated disease of the superior mesenteric artery (SMA) (100%; 64% occluded), celiac axis (89%; 37% occluded), and inferior mesenteric artery (IMA) (54%; 60% occluded). Multiple vessels were involved in 95% of patients (mean: 2.3 vessels/patient). Operative management included antegrade revascularization of 80 vessels. Combined aortic and/or renal procedures were performed in 7 patients. Patient demographics and visceral disease did not differ for C-CVI and A-CVI; however, perioperative mortality differed significantly (10% for C-CVI vs 54% for A-CVI [p<0.001]). Intestinal gangrene at presentation was associated with perioperative (hazard ratio [HR]: 7.6; 95% CI: 2.7–21.6; p=0.0002) and follow-up death (HR: 7.8; CI 2.8–21.9; p< 0.0001). Follow-up (mean: 34 months) was complete for 54/68 vessels (79%). Estimated primary and primary assisted patency at 5 years were 81% and 89% respectively. Estimated symptom-free survival for hospital survivors was 57% at 70 months. Open antegrade methods of visceral artery repair for CVI were durable and associated with 57% symptom-free survival at 70 months. Patient demographics and distribution of visceral artery anatomy were similar; however, perioperative mortality for C-CVI and A-CVI differed dramatically. Improved outcomes for A-CVI require recognition and treatment of CVI before onset of intestinal gangrene.</description><identifier>ISSN: 1538-5744</identifier><identifier>EISSN: 1938-9116</identifier><identifier>DOI: 10.1177/153857440403800602</identifier><identifier>PMID: 15592629</identifier><language>eng</language><publisher>708 Glen Cove Avenue, Glen Head, NY 11545, USA: SAGE Publications</publisher><subject>Aged ; Arterial Occlusive Diseases - epidemiology ; Arterial Occlusive Diseases - surgery ; Biological and medical sciences ; Chronic Disease ; Comorbidity ; Female ; General and cellular metabolism. Vitamins ; Humans ; Ischemia - epidemiology ; Ischemia - mortality ; Ischemia - surgery ; Male ; Medical sciences ; Mesenteric Artery, Inferior ; Mesenteric Artery, Superior ; Middle Aged ; Multivariate Analysis ; Pharmacology. Drug treatments ; Retrospective Studies ; Risk Factors ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Survival Analysis ; Tobacco, tobacco smoking ; Toxicology ; Vascular Patency ; Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels ; Viscera - blood supply</subject><ispartof>Vascular and endovascular surgery, 2004-11, Vol.38 (6), p.493-503</ispartof><rights>2005 INIST-CNRS</rights><rights>Copyright Westminster Publications, Inc. Nov/Dec 2004</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c313t-bf40b8ae7098270a1fbe4abe9b8b405f93f5071c3e47666fe6d188941740f19f3</citedby><cites>FETCH-LOGICAL-c313t-bf40b8ae7098270a1fbe4abe9b8b405f93f5071c3e47666fe6d188941740f19f3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://journals.sagepub.com/doi/pdf/10.1177/153857440403800602$$EPDF$$P50$$Gsage$$H</linktopdf><linktohtml>$$Uhttps://journals.sagepub.com/doi/10.1177/153857440403800602$$EHTML$$P50$$Gsage$$H</linktohtml><link.rule.ids>314,776,780,21798,27901,27902,43597,43598</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=16324137$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/15592629$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>English, William P.</creatorcontrib><creatorcontrib>Pearce, Jeffrey D.</creatorcontrib><creatorcontrib>Craven, Timothy E.</creatorcontrib><creatorcontrib>Edwards, Matthew S.</creatorcontrib><creatorcontrib>Geary, Randolph L.</creatorcontrib><creatorcontrib>Plonk, George W.</creatorcontrib><creatorcontrib>Hansen, Kimberley J.</creatorcontrib><title>Chronic Visceral Ischemia: Symptom-Free Survival After Open Surgical Repair</title><title>Vascular and endovascular surgery</title><addtitle>Vasc Endovascular Surg</addtitle><description>A retrospective review of patients treated with a history of chronic visceral ischemia (CVI) was made to determine primary patency of open surgical repair and estimated symptom-free survival. Patients with CVI between 1990 and 2003 were reviewed. Included were those with chronic symptoms alone (C-CVI) and acute-on-chronic symptoms (A-CVI). Data were obtained from a vascular database. Symptom-free survival and graft patency were estimated by using product limit estimates. Fifty-eight patients (13 men, 45 women; mean age: 63 years) were treated surgically for C-CVI (34 patients) and A-CVI (24 patients). All patients had postprandial abdominal pain and weight loss (mean: 17 kg). One fourth reported food fear. Preoperative imaging demonstrated disease of the superior mesenteric artery (SMA) (100%; 64% occluded), celiac axis (89%; 37% occluded), and inferior mesenteric artery (IMA) (54%; 60% occluded). Multiple vessels were involved in 95% of patients (mean: 2.3 vessels/patient). Operative management included antegrade revascularization of 80 vessels. Combined aortic and/or renal procedures were performed in 7 patients. Patient demographics and visceral disease did not differ for C-CVI and A-CVI; however, perioperative mortality differed significantly (10% for C-CVI vs 54% for A-CVI [p<0.001]). Intestinal gangrene at presentation was associated with perioperative (hazard ratio [HR]: 7.6; 95% CI: 2.7–21.6; p=0.0002) and follow-up death (HR: 7.8; CI 2.8–21.9; p< 0.0001). Follow-up (mean: 34 months) was complete for 54/68 vessels (79%). Estimated primary and primary assisted patency at 5 years were 81% and 89% respectively. Estimated symptom-free survival for hospital survivors was 57% at 70 months. Open antegrade methods of visceral artery repair for CVI were durable and associated with 57% symptom-free survival at 70 months. Patient demographics and distribution of visceral artery anatomy were similar; however, perioperative mortality for C-CVI and A-CVI differed dramatically. Improved outcomes for A-CVI require recognition and treatment of CVI before onset of intestinal gangrene.</description><subject>Aged</subject><subject>Arterial Occlusive Diseases - epidemiology</subject><subject>Arterial Occlusive Diseases - surgery</subject><subject>Biological and medical sciences</subject><subject>Chronic Disease</subject><subject>Comorbidity</subject><subject>Female</subject><subject>General and cellular metabolism. Vitamins</subject><subject>Humans</subject><subject>Ischemia - epidemiology</subject><subject>Ischemia - mortality</subject><subject>Ischemia - surgery</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Mesenteric Artery, Inferior</subject><subject>Mesenteric Artery, Superior</subject><subject>Middle Aged</subject><subject>Multivariate Analysis</subject><subject>Pharmacology. Drug treatments</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><subject>Survival Analysis</subject><subject>Tobacco, tobacco smoking</subject><subject>Toxicology</subject><subject>Vascular Patency</subject><subject>Vascular surgery: aorta, extremities, vena cava. 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Vitamins</topic><topic>Humans</topic><topic>Ischemia - epidemiology</topic><topic>Ischemia - mortality</topic><topic>Ischemia - surgery</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Mesenteric Artery, Inferior</topic><topic>Mesenteric Artery, Superior</topic><topic>Middle Aged</topic><topic>Multivariate Analysis</topic><topic>Pharmacology. Drug treatments</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</topic><topic>Survival Analysis</topic><topic>Tobacco, tobacco smoking</topic><topic>Toxicology</topic><topic>Vascular Patency</topic><topic>Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels</topic><topic>Viscera - blood supply</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>English, William P.</creatorcontrib><creatorcontrib>Pearce, Jeffrey D.</creatorcontrib><creatorcontrib>Craven, Timothy E.</creatorcontrib><creatorcontrib>Edwards, Matthew S.</creatorcontrib><creatorcontrib>Geary, Randolph L.</creatorcontrib><creatorcontrib>Plonk, George W.</creatorcontrib><creatorcontrib>Hansen, Kimberley J.</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection (Proquest)</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Science Database (Alumni Edition)</collection><collection>STEM Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>AUTh Library subscriptions: ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest Research Library</collection><collection>ProQuest Science Journals</collection><collection>Research Library (Corporate)</collection><collection>Research Library China</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>Vascular and endovascular surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>English, William P.</au><au>Pearce, Jeffrey D.</au><au>Craven, Timothy E.</au><au>Edwards, Matthew S.</au><au>Geary, Randolph L.</au><au>Plonk, George W.</au><au>Hansen, Kimberley J.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Chronic Visceral Ischemia: Symptom-Free Survival After Open Surgical Repair</atitle><jtitle>Vascular and endovascular surgery</jtitle><addtitle>Vasc Endovascular Surg</addtitle><date>2004-11</date><risdate>2004</risdate><volume>38</volume><issue>6</issue><spage>493</spage><epage>503</epage><pages>493-503</pages><issn>1538-5744</issn><eissn>1938-9116</eissn><abstract>A retrospective review of patients treated with a history of chronic visceral ischemia (CVI) was made to determine primary patency of open surgical repair and estimated symptom-free survival. Patients with CVI between 1990 and 2003 were reviewed. Included were those with chronic symptoms alone (C-CVI) and acute-on-chronic symptoms (A-CVI). Data were obtained from a vascular database. Symptom-free survival and graft patency were estimated by using product limit estimates. Fifty-eight patients (13 men, 45 women; mean age: 63 years) were treated surgically for C-CVI (34 patients) and A-CVI (24 patients). All patients had postprandial abdominal pain and weight loss (mean: 17 kg). One fourth reported food fear. Preoperative imaging demonstrated disease of the superior mesenteric artery (SMA) (100%; 64% occluded), celiac axis (89%; 37% occluded), and inferior mesenteric artery (IMA) (54%; 60% occluded). Multiple vessels were involved in 95% of patients (mean: 2.3 vessels/patient). Operative management included antegrade revascularization of 80 vessels. Combined aortic and/or renal procedures were performed in 7 patients. Patient demographics and visceral disease did not differ for C-CVI and A-CVI; however, perioperative mortality differed significantly (10% for C-CVI vs 54% for A-CVI [p<0.001]). Intestinal gangrene at presentation was associated with perioperative (hazard ratio [HR]: 7.6; 95% CI: 2.7–21.6; p=0.0002) and follow-up death (HR: 7.8; CI 2.8–21.9; p< 0.0001). Follow-up (mean: 34 months) was complete for 54/68 vessels (79%). Estimated primary and primary assisted patency at 5 years were 81% and 89% respectively. Estimated symptom-free survival for hospital survivors was 57% at 70 months. Open antegrade methods of visceral artery repair for CVI were durable and associated with 57% symptom-free survival at 70 months. Patient demographics and distribution of visceral artery anatomy were similar; however, perioperative mortality for C-CVI and A-CVI differed dramatically. Improved outcomes for A-CVI require recognition and treatment of CVI before onset of intestinal gangrene.</abstract><cop>708 Glen Cove Avenue, Glen Head, NY 11545, USA</cop><pub>SAGE Publications</pub><pmid>15592629</pmid><doi>10.1177/153857440403800602</doi><tpages>11</tpages></addata></record> |
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| ispartof | Vascular and endovascular surgery, 2004-11, Vol.38 (6), p.493-503 |
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| subjects | Aged Arterial Occlusive Diseases - epidemiology Arterial Occlusive Diseases - surgery Biological and medical sciences Chronic Disease Comorbidity Female General and cellular metabolism. Vitamins Humans Ischemia - epidemiology Ischemia - mortality Ischemia - surgery Male Medical sciences Mesenteric Artery, Inferior Mesenteric Artery, Superior Middle Aged Multivariate Analysis Pharmacology. Drug treatments Retrospective Studies Risk Factors Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Survival Analysis Tobacco, tobacco smoking Toxicology Vascular Patency Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels Viscera - blood supply |
| title | Chronic Visceral Ischemia: Symptom-Free Survival After Open Surgical Repair |
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