自发性孤立性肠系膜上动脉夹层的腔内治疗  

Endovascular Treatment of Spontaneous Isolated Superior Mesenteric Artery Dissection

作　　者：邵江[1] 徐乐吟 来志超[1] 刘暴[1] Shao Jiang;Xu Leyin;Lai Zhichao(Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China)

机构地区：[1]中国医学科学院北京协和医学院北京协和医院血管外科,北京100730

出　　处：《中国微创外科杂志》2021年第6期491-494,共4页Chinese Journal of Minimally Invasive Surgery

基　　金：北京市自然科学基金项目(7182131);中国医学科学院医学与健康科技创新工程项目(2018-I2M-AI-004);中国医学科学院中央级公益性科研院所基本科研业务费专项资金(2019XK320004)。

摘　　要：目的探讨自发性孤立性肠系膜上动脉夹层(spontaneous isolated superior mesenteric artery dissection,SISMAD)腔内治疗的安全性及有效性。方法2014年1月~2019年12月我科对35例SISMAD行腔内治疗,包括支架植入、球囊扩张、弹簧栓塞、经溶栓导管直接溶栓等。结果腔内治疗的技术成功率85.7%(30/35),5例因导丝无法选入真腔而失败。术后症状均在2 d内消失。1例左肱动脉假性动脉瘤形成。33例随访中位时间32个月(6~71个月),26例随访期间行CTA、多普勒超声等影像学检查,技术成功的23例中,95.6%(22/23)的患者实现肠系膜上动脉重塑,仅1例术后2年出现肠系膜上动脉远端闭塞,78.8%(26/33)的患者术后症状完全消失,随访期间无二次腔内治疗者。结论腔内治疗是SISMAD一种安全有效的治疗方法。Objective To investigate the safety and efficacy of endovascular treatment of spontaneous isolated superior mesenteric artery dissection(SISMAD).Methods A total of 35 patients with SISMAD who received endovascular treatment between January 2014 and December 2019 in our hospital were retrospectively enrolled in the study.Endovascular therapies included stent placement,balloon angioplasty,coil embolization,and catheter directed thrombolysis.Results The rate of technical success was 85.7%(30/35).The procedure failed in 5 patients because the guide wires could not enter the true lumens.Symptoms disappeared in all the patients in 2 days after intervention.Complications included one case of pseudoaneurysm formation in the left brachial artery.The median follow-up duration was 32 months(range,6-71 months),and 26 of them underwent CTA,Doppler ultrasound and other imaging examinations.There were 95.6%(22/23)of the patients with technical success having complete remodeling in the superior mesenteric artery.Only one patient had occlusion in the distal superior mesenteric artery after 2 years.There were 78.8%(26/33)of the patients having no symptom recurrence,and no patient had second endovascular intervention during follow-ups.Conclusion Endovascular treatment of SISMAD is safe and effective.

关 键 词：肠系膜上动脉 夹层 腔内治疗 

分 类 号：R73[医药卫生—肿瘤]