采用动脉支架植入治疗症状性自发孤立性内脏动脉夹层的价值  

Value of endovascular stents placement for treating symptomatic spontaneous isolated dissection of splanchnic artery

作　　者：韩向军[1] 张曦彤[1] 夏永辉[1] 梁松年[1] 徐克[1] 

机构地区：[1]中国医科大学附属第一医院放射科,沈阳110001

出　　处：《中华放射学杂志》2014年第6期489-491,共3页Chinese Journal of Radiology

摘　　要：目的：评价采用动脉支架植入术治疗症状性自发孤立性内脏动脉夹层（ SIDSA）的安全性及有效性。方法回顾性分析有急性持续性腹痛症状，经CTA和DSA确诊，并采用动脉支架植入术治疗的16例SIDSA患者资料。术后观察患者有无严重并发症及状况改善情况，随访观察症状是否复发及进行彩色超声多普勒和CTA复查。结果16例中，肠系膜上动脉SIDSA 12例，腹腔干动脉SIDSA 4例。夹层长度1.07～11.87 cm，中位长度为3.93 cm。肠系膜上动脉或腹腔干开口到夹层起始部间的距离为0.50～6.44 cm，中位距离为1.98 cm。11例成功植入支架11枚，其中覆膜支架8枚、裸支架3枚。1例腹腔干动脉SIDSA因真腔受压明显，术中导丝开通进入远端真腔失败。4例肠系膜上动脉夹层中，2例因破裂口与假腔均较小，1例因夹层累及范围过长，1例因真、假腔均参与远端肠管供血而放弃介入治疗。11例支架植入成功的患者术后均无出血及肠坏死、肝功能衰竭及脾梗死等严重并发症。10例患者腹部疼痛症状消失或明显缓解，1例术前合并肠系膜上静脉血栓和重度肠缺血的患者，术后行坏死小肠切除术。11例植入支架的患者随访1～74个月，中位随访时间为16个月。1例肠系膜上动脉SIDSA患者术后3个月因脑卒中死亡，其余患者无再发腹痛，复查彩色超声多普勒和CTA显示无异常。结论采用动脉支架植入术治疗SIDSA安全、有效。Objective To evaluate the safety and effectiveness of treating the endovascular stents placement for spontaneous isolated dissection of splanchnic artery （ SIDSA）.Methods Sixteen consecutive patients with diagnosis of SIDSA through CTA and DSA were retrospectively analyzed .All patients had acute persistent abdominal pain and treated by endovascular stents placement.The serious complications and symptoms improvement were reviewed after the operation.The symptoms recurrence and repeated color doppler ultrasonography and CTA were also reviewed in the follow up.Results Twelve superior mesenteric artery （ SMA） dissection and four celiac artery （ CA） dissection were diagnosed among sixteen patients.The dissection length was 1.07 to 11.87 cm and the median length was 3.93 cm.The distance from the original dissection to the orifice of superior mesenteric artery or celiac artery was 0.50 to 6.44 cm and the median was 1.98 cm.Eight stent-grafts and 3 bare stents were successfully implanted in 11 patients.One case with celiac dissection was failed to treat because of the severe compression of true lumen and the guide wire cann′t cannulate to the distal true lumen.Four patients with superior mesenteric artery dissection gave up interventional therapy , Among these 4 patients , 2 patients had small tear site and small false lumen , 1 patient had extremely long dissection , and one case had blood supply of target organs from both true and false lumen.No severe complications such as hemorrhage , intestinal necrosis , hepatic failure and splenic necrosis occurred during the eleven successful endovascular interventions.The abdominal pain in 10 cases was disappeared or significantly relieved , 1 case with superior mesenteric vein thrombosis and severe intestinal ischemia before intervention underwent intestinal resection for necrosis.The follow up period was 1 to 74 months in eleven successful cases , and the median follow-up period was 16 months.One patient with SMA dissection after endovascular treatment was died

关 键 词：动脉瘤 夹层 支架 放射学 介入性 

分 类 号：R543.1[医药卫生—心血管疾病]