French Nationwide Outcomes after Revascularisation for Acute and Chronic Mesenteric Ischaemia.

Abstract

Acute and chronic mesenteric ischaemia (AMI and CMI) are associated with high morbidity and mortality rates. The aim of this study was to evaluate short and midterm outcomes after revascularisation for AMI and CMI and to compare endovascular and open surgical approaches. This nationwide, retrospective, observational study used the French National Health Data System (SNDS), a medico-administrative database, primarily intended for evaluation of medical costs and appropriateness of billing, but also containing information on patient risk factors, interventions, and outcomes. The SNDS was used to identify adults in France who underwent a first recorded revascularisation between January 2014 and December 2024 for a diagnosis of AMI or CMI along with their baseline characteristics, comorbidities, and procedure data. The primary outcome was all cause 30 day death. Secondary outcomes included 1 and 2 year death, and vascular re-interventions. Multivariable Cox proportional hazards models were used to identify factors associated with death and re-intervention. A total of 6 228 patients underwent revascularisation for AMI (mean age 69.3 ± 12.8 years; 57.2% men). Endovascular repair was associated with a lower 30 day mortality rate (16.5% vs. 36.7%, p < .001), 1 year and 2 year mortality rates, compared with open repair. After adjustment, endovascular repair remained associated with a reduced 30 day (hazard ratio [HR] 0.48, 95% confidence interval [CI] 0.43 - 0.54), 1 year (HR 0.62, 95% CI 0.57 - 0.67), and 2 year mortality rate (HR 0.68, 95% CI 0.63 - 0.74). For CMI, 5 016 patients were included (mean age 69.8 ± 12.1 years; 54.1% men). Endovascular repair was associated with a lower 30 day mortality rate (HR 0.39, 95% CI 0.27 - 0.56) but higher re-intervention risk (HR 3.75, 95% CI 2.29 - 6.12). Age > 64 years was associated with a higher mortality rate for both AMI and CMI. In this nationwide cohort, endovascular revascularisation was associated with lower 30 day and 1 year mortality rates for AMI, and a lower early mortality rate for CMI compared with open surgery. These findings support the use of endovascular strategies for mesenteric ischaemia, particularly for high risk patients, while underscoring the need for prospective comparative studies to further investigate long term outcomes.