Endovascular Versus Surgical Revascularization for the Management of Chronic Mesenteric Ischemia.

BACKGROUND: Chronic mesenteric ischemia (CMI) can be treated with surgical revascularization (SR) or endovascular revascularization (ER). MATERIALS AND METHODS: Systematic review of 12 studies comparing ER and SR in CMI. Primary end point was perioperative (30 days) survival. A secondary composite end point consisted of perioperative mortality, nonfatal cardiac events, nonfatal stroke, and nonfatal bowel ischemia. Further end points included late survival, primary patency, and symptom improvement. RESULTS: The cumulative odds ratio (OR) for perioperative mortality was 0.78 (95% confidence interval [CI]: 0.40-1.50, P = .45) and 0.56 (95% CI: 0.28-1.11, P = .10) for the composite end point. The cumulative OR for survival after the 30th day was 0.83 (95% CI: 0.47-1.46), P = .51. Late primary patency was reported in 8 studies, with a cumulative OR of 3.57 (95% CI: 1.83-6.97, P = .0002)-favoring SR. CONCLUSION: In the first meta-analysis to compare ER and SR in CMI, there were no differences in mortality and morbidity. Patency rates were better following SR.

Temporal artery biopsy for giant cell arteritis: retrospective audit.

OBJECTIVES: Temporal artery biopsy (TAB) is performed in suspected cases of sight-threatening giant cell arteritis (GCA). We aimed to determine the feasibility of TAB in patients who are suspected of having GCA. DESIGN, SETTING AND PARTICIPANTS: A retrospective audit of all patients undergoing TAB at a single teaching hospital between 2005 and 2011, identified from the histopathology database. MAIN OUTCOME MEASURES: (1) Clinical profile and biochemical criteria associated with positive histology. (2) Proportion of negative histology patients who were commenced on steroid therapy. RESULTS: One hundred and fifty-three TAB were performed (mean age 70.8 years, men:women = 3:2, 110 Caucasian: 43 Asian). Thirty-two biopsies were positive for GCA and 121 were negative. In total, 68 (61%) of 112 negative TAB patients were clinically diagnosed with GCA despite histological findings (P < 0.001). Nine out of 153 biopsies were non-arterial. Histologically positive TAB patients were of higher mean age (77.1 [95% CI 74.5-79.7] versus 69.1 [95% CI 66.7-71.6]; P < 0.001) and had a higher erythrocyte sedimentation rate (ESR) (60 [95% CI 46.1-73.9] versus 39.8 [95% CI 34.2-45.3]; P < 0.01)] than those with negative histology. CONCLUSIONS: Raised ESR and higher age may be the most useful indicators of GCA. Many histologically negative individuals were nevertheless clinically diagnosed and managed as GCA.