在大型队列数据中，对慢性肠系膜缺血（CMI）的生存和术后结果的分析有限。目前的指南建议，对于年轻、健康的患者，当长期益处超过术中风险增加的情况，或对于不适宜行血管内修复（ER）的患者，应采用开放修复（OR）。本研究旨在探讨长期生存、再介入和价值在这些治疗模式之间是否存在差异。从纽约州全支付人员数据库中提取数据进行了一项回顾性队列分析，该数据库包含了人口统计学、诊断、治疗和费用等信息。使用国际疾病分类第九版（ICD-9）代码选择了CMI及其后ER或OR。为了排除ICD-9程序代码中非冠状血管扩张手术的模糊性，包括上肢和下肢血管扩张术，排除了有外周动脉疾病的患者。使用Kaplan-Meier分析比较了治疗模式间的一年和五年生存及再介入情况，并使用Cox比例风险测试找到与一年和五年生存及再介入相关的因素。使用线性回归分析进行了程序价值分析。 从2000年到2014年，共有744名患者符合纳入标准。其中，209名（28.1%）接受了OR，535名（71.9%）接受了ER。在经过匹配的倾向分析组中，一年（p=0.46）和五年（p=0.91）生存率没有差异。充血性心力衰竭（HR：2.8，95% CI：1.7-4.4；p<0.01）、癌症（HR：2.8，95% CI：1.3-5.8；p<0.01）和心律失常（HR：1.8，95% CI：1.1-2.8；p=0.02）与一年死亡率相关。癌症（HR：2.9，95% CI：1.6-5.5；p<0.01）、充血性心力衰竭（HR：2.2，95% CI：1.5-3.2；p<0.01）、慢性肺部疾病（HR：1.4，95% CI：1.0-2.0；p=0.04）和年龄（HR：1.03，95% CI：1.01-1.05；p<0.01）与五年死亡率相关。治疗方式与一年再介入在Kaplan-Meier分析中无关（p=0.29）。然而，ER在五年内再介入事件增多（p<0.01）。此外，ER与五年价值增加相关（0.7±0.9对比0.5±0.5年生命年/费用，指数入院次数（10k），p<0.01；b系数：0.2，95% CI：0.1-0.4，p<0.01）。 这是迄今为止最大的回顾性倾向匹配单中心队列，分析CMI干预后的长期生存结果。长期死亡率与治疗方式无关，而与患者合并症相关。因此，治疗选择应基于解剖学考虑和长期价值。在具备合适解剖结构的患者中，应优先考虑血管内修复而不是开放修复，因为前者的程序价值更高。 版权所有©2023，由Elsevier Inc.出版。

There are limited analyses of survival and postoperative outcomes in chronic mesenteric ischemia (CMI) utilizing data from large cohorts. Current guidelines recommend open repair (OR) for younger, healthier patients when long-term benefits outweigh increased perioperative risks or for poor endovascular repair (ER) candidates. This study investigates whether long-term survival, reintervention, and value differ between these treatment modalities.A retrospective cohort analysis was performed on data extracted from the Statewide Planning and Research Cooperative System, the New York statewide all-payer database containing demographics, diagnoses, treatments, and charges. Patients were selected for CMI and subsequent ER or OR using International Classification of Diseases, Ninth Revision (ICD-9) codes. Patients with peripheral arterial disease were excluded to account for ambiguity in the ICD-9 procedure code for angioplasty of non-coronary vessels, which includes angioplasty of upper and lower extremity vessels. Kaplan-Meier analysis was used to compare one- and five-year survival and reintervention between treatment modalities using a propensity-matched cohort. Cox proportional hazards testing was performed to find factors associated with one- and five-year survival and reintervention. Analysis of procedural value was performed using linear regression.From 2000 to 2014, 744 patients met inclusion criteria. Of these, 209 (28.1%) underwent OR and 535 (71.9%) ER. No difference between propensity-matched groups was found in one-year (p=0.46) or five-year (p=0.91) survival. Congestive heart failure (CHF) (hazard ratio (HR): 2.8, 95% confidence interval (CI): 1.7-4.4; p<0.01), cancer (HR: 2.8, 95% CI: 1.3-5.8; p<0.01), and dysrhythmia (HR: 1.8, 95% CI: 1.1-2.8; p=0.02) correlated with one-year mortality. Cancer (HR: 2.9, 95% CI: 1.6-5.5; p<0.01), CHF (HR: 2.2, 95% CI: 1.5-3.2; p<0.01), chronic pulmonary disease (HR: 1.4, 95% CI: 1.0-2.0; p=0.04), and age (HR: 1.03, 95% CI: 1.01-1.05; p<0.01) correlated with five-year mortality. Treatment modality was not associated with reintervention at one year on Kaplan-Meier analysis (p=0.29). However, ER showed increased instances of reintervention at five years (p<0.01). Additionally, ER was associated with an increased five-year value (0.7 ± 0.9 versus 0.5 ± 0.5 life years/charges at index admission($10k), p<0.01; b coefficient: 0.2, 95% CI:0.1-0.4, p<0.01).This is the largest retrospective propensity-matched single-study cohort to analyze long-term survival outcomes after intervention for CMI. Long-term mortality was independent of treatment modality and rather was associated with patient comorbidities. Therefore, treatment selection should depend on anatomic considerations and long-term value. Endovascular repair should be considered over open repair in patients with amenable anatomy based on the superior procedural value.Copyright © 2023. Published by Elsevier Inc.