Zettervall Sara L, Lo Ruby C, Soden Peter A, Deery Sarah E, Ultee Klaas H, Pinto Duane S, Wyers Mark C, Schermerhorn Marc L
Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, MA.
Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA.
Ann Vasc Surg. 2017 Jul;42:111-119. doi: 10.1016/j.avsg.2017.01.007. Epub 2017 Mar 28.
It is unknown whether increased endovascular treatment of chronic mesenteric ischemia has led to decreases in open surgery, acute mesenteric ischemia, or overall mortality. The present study evaluates the trends in endovascular and open treatment over time for chronic and acute mesenteric ischemia.
We identified patients with chronic or acute mesenteric ischemia in the Nationwide Inpatient Sample and Center for Disease Control and Prevention database from 2000 to 2012. Trends in revascularization, mortality, and total deaths were evaluated over time. Data were adjusted to account for population growth.
There were 14,810 revascularizations for chronic mesenteric ischemia (10,453 endovascular and 4,358 open) and 11,294 revascularizations for acute mesenteric ischemia (4,983 endovascular and 6,311 open). Endovascular treatment increased for both chronic (0.6-4.5/million, P < 0.01) and acute mesenteric ischemia (0.6-1.8/million, P < 0.01). However, concurrent declines in open surgery did not occur (chronic: 1-1.1/million, acute: 1.8-1.7/million). Among patients with acute mesenteric ischemia, the proportion with atrial fibrillation (18%) and frequency of embolectomy (1/million per year) remained stable. In-hospital mortality rates decreased for both endovascular (chronic: 8-3%, P < 0.01; acute: 28-17%, P < 0.01) and open treatment (chronic: 21-9%, P < 0.01; acute: 40-25%, P < 0.01). Annual population-based mortality remained stable for chronic mesenteric ischemia (0.7-0.6 deaths per million/year), but decreased for acute mesenteric ischemia (12.9-5.3 deaths per million/year, P < 0.01).
Population mortality from acute mesenteric ischemia declined from 2000 to 2012, correlated with dramatic increases in endovascular intervention for chronic mesenteric ischemia, and in spite of a stable rate of embolization. However, open surgery for both chronic and acute ischemia remained stable.
慢性肠系膜缺血血管内治疗的增加是否导致开放手术、急性肠系膜缺血或总体死亡率的降低尚不清楚。本研究评估了慢性和急性肠系膜缺血血管内治疗和开放治疗随时间的趋势。
我们在2000年至2012年的全国住院患者样本和疾病控制与预防中心数据库中识别出慢性或急性肠系膜缺血患者。评估了血管重建、死亡率和总死亡人数随时间的趋势。对数据进行了调整以考虑人口增长。
慢性肠系膜缺血血管重建14,810例（血管内治疗10,453例，开放手术4,358例），急性肠系膜缺血血管重建11,294例（血管内治疗4,983例，开放手术6,311例）。慢性（从0.6/百万增至4.5/百万，P<0.01）和急性肠系膜缺血（从0.6/百万增至1.8/百万，P<0.01）的血管内治疗均增加。然而，开放手术并未同时减少（慢性：从1/百万降至1.1/百万，急性：从1.8/百万降至1.7/百万）。在急性肠系膜缺血患者中，心房颤动患者比例（18%）和栓子切除术频率（每年1/百万）保持稳定。血管内治疗（慢性：从8%降至3%，P<0.01；急性：从28%降至17%，P<0.01）和开放治疗（慢性：从21%降至9%，P<0.01；急性：从40%降至25%，P<0.01）的住院死亡率均下降。慢性肠系膜缺血基于人群的年度死亡率保持稳定（每年0.7/百万至0.6/百万死亡），但急性肠系膜缺血的死亡率下降（从每年12.9/百万降至5.3/百万死亡，P<0.01）。
2000年至2012年，急性肠系膜缺血的人群死亡率下降，这与慢性肠系膜缺血血管内介入治疗的显著增加相关，尽管栓塞率稳定。然而，慢性和急性缺血的开放手术率保持稳定。
