VESS14 - Long Term Value in Open and Endovascular Repair of Chronic Mesenteric Ischemia

Objectives: Guidelines recommend open surgical (OR) over endovascular revascularization (ER) for the treatment of chronic mesenteric ischemia (CMI) for younger patients. However, little is known about the long-term costs of these recommendations with respect to patients’ overall life expectancy. This study investigated whether 5-year value differs between these treatment modalities.

Methods: Patient data was extracted from the Statewide Planning and Research Cooperative System, the New York statewide all-payer database containing demographics, diagnoses, treatments, and charges. The database was queried for patients with an International Classification of Diseases code for CMI over a 15-year period, with specific exclusion of acute ischemia cases. Propensity match was performed using Charlson Comorbidity Index, age, sex, race, renal status, and pulmonary disease for a final cohort of patients. Multiple linear regression was utilized to determine factors associated with 5-year value, calculated as life years (LY)/$100k in charges adjusted for inflation. Charges were gathered from the index admission and any subsequent admissions over a 5-year period for mesenteric ischemia, mesenteric angiography, or follow-up reintervention.

Results: From 2000 to 2014, 744 patients underwent intervention for CMI. Of these, 209 (28.1%) underwent OR and 535 (71.9%) ER. After propensity matching (n=209 each group), ER group had higher value at 5 years post-procedure (6.63±8.51 versus 4.52±5.12 LY/$100k charges, p< 0.01). All-cause mortality was 53.6% and 68.4% at 5 years (p < 0.01) for OR and ER, respectively. Reintervention was more common in the ER group (37 versus 17 reinterventions, p=0.01). Multiple linear regression analysis found congestive heart failure (CHF), dysrhythmia, and cancer were negatively associated with value at 5 years while ER was positively associated (Table I).

Conclusions: Despite increased reinterventions, value in patients with CMI was higher in those undergoing ER in the largest propensity score matched dataset to date looking at value. Factors negatively associated with 5-year value were OR, CHF, dysrhythmia, and cancer. In patients with amenable anatomy, ER should be considered over OR based on the superior procedural value. Further research should prospectively examine comorbid conditions, presentation and patient reported outcomes to further validate whether ER is appropriate as the primary treatment modality for CMI.