Salvatore T. Scali, MD, Diego Ayo, MD, Kristina A

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Presentation transcript:

Outcomes of antegrade and retrograde open mesenteric bypass for acute mesenteric ischemia Salvatore T. Scali, MD, Diego Ayo, MD, Kristina A. Giles, MD, Sarah Gray, MD, Paul Kubilis, MS, Martin Back, MD, MS, Javairiah Fatima, MD, Dean Arnaoutakis, MD, MPH, Scott A. Berceli, MD, PhD, Adam W. Beck, MD, Gilbert J. Upchurch, MD, Robert J. Feezor, MD, Thomas S. Huber, MD, PhD Journal of Vascular Surgery Volume 69, Issue 1, Pages 129-140 (January 2019) DOI: 10.1016/j.jvs.2018.04.063 Copyright © 2018 Society for Vascular Surgery Terms and Conditions

Fig 1 This Kaplan-Meier life table curve estimates the primary patency of open mesenteric bypass (OMB) after treatment of acute mesenteric ischemia (AMI). Owing to the short-term follow-up and relatively small number of at risk grafts in the retrograde bypass cohort, a single curve is demonstrated for all patients in the analysis. Patency-related reintervention events did not differ between antegrade or retrograde bypass groups; however, a retrograde configuration did trend toward a higher risk of any bypass-related reintervention and/or operation. Journal of Vascular Surgery 2019 69, 129-140DOI: (10.1016/j.jvs.2018.04.063) Copyright © 2018 Society for Vascular Surgery Terms and Conditions

Fig 2 The overall freedom from any open mesenteric bypass (OMB)-related reoperation and/or reintervention was not different between an antegrade and retrograde configuration by life-table analysis (log-rank, P = .07). However, a retrograde bypass configuration was associated with a greater reintervention hazard (hazard ratio [HR], 3.0; 95% confidence interval [CI], 0.9-11.0; P = .08). The standard error of the mean exceeds 10% for the retrograde bypass cohort after 4 months owing to sample size; however, the standard error of the mean for the antegrade cohort is <10% for the displayed intervals. Journal of Vascular Surgery 2019 69, 129-140DOI: (10.1016/j.jvs.2018.04.063) Copyright © 2018 Society for Vascular Surgery Terms and Conditions

Fig 3 A, The overall survival for all patients with acute mesenteric ischemia (AMI) managed with open mesenteric bypass (OMB) is displayed. Approximately 75% of the observed deaths during follow-up occurred as in-hospital events most commonly owing to multiorgan dysfunction syndrome. Despite this sobering result, surviving patients tended to do well after discharge as reflected in the relatively stable estimated slope in the survival curve. B, Comparison of overall survival between the antegrade and retrograde OMB cohorts. Notably, no significant difference in survival is observed based upon the type of bypass configuration strategy that was chosen. SE, standard error. Journal of Vascular Surgery 2019 69, 129-140DOI: (10.1016/j.jvs.2018.04.063) Copyright © 2018 Society for Vascular Surgery Terms and Conditions

Fig 4 Forest plot highlighting the specific univariate predictors of any postoperative mortality after open mesenteric bypass (OMB) for acute mesenteric ischemia (AMI). The strongest predictor was the occurrence of any complication with several other specific complication subtypes being strongly associated with poor outcome. Bypass configuration was not associated with differential mortality risk (hazard ratio [HR], 0.96; 95% confidence interval [CI], 0.46-2.03; P = .9). GI, Gastrointestinal; PRBC, packed red blood cells. Journal of Vascular Surgery 2019 69, 129-140DOI: (10.1016/j.jvs.2018.04.063) Copyright © 2018 Society for Vascular Surgery Terms and Conditions