孤立性肠系膜上动脉夹层腔内治疗及其中远期疗效
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摘要
目的探讨孤立性肠系膜上动脉夹层(ISMAD)血管腔内治疗策略,评价腔内治疗中远期效果。方法回顾性分析2012年3月至2018年4月南京医科大学附属南京医院通过血管腔内治疗的34例ISMAD患者临床、影像学和随访资料,其中Sakamoto分型Ⅱ型3例(8.8%),Ⅲ型24例(70.6%),Ⅳ型7例(20.6%)。结果 34例患者均成功完成腔内治疗,其中19例接受单纯裸支架植入,15例接受支架结合弹簧圈栓塞夹层假腔。单纯支架植入患者中有2例分别于随访第3、13个月发现假腔明显扩大,再次予弹簧圈栓塞治疗。所有患者随访3～40个月,平均(11.5±9.8)个月,术后6个月夹层完全重塑率达100%(34/34),支架内血流通畅,未出现假腔扩大、夹层复发等事件。结论单纯裸支架植入和支架结合弹簧圈栓塞治疗ISMAD安全可行,中远期疗效满意。
Objective To discuss the endovascular treatment strategy for isolated superior mesenteric artery dissection(ISMAD) and to evaluate the mid-to-long-term efficacy of endovascular treatment. Methods The clinical data, imaging materials and the follow-up results of 34 patients with ISMAD, who received endovascular treatment during the period from March 2012 to April 2018 at the Affiliated Nanjing Hospital of Nanjing Medical University of China, were retrospectively analyzed. Of the 34 patients with ISMAD,Sakamoto type Ⅱ was seen in 3 patients(8.8%), type Ⅲ in 24 patients(70.6%) and type Ⅳ in 7 patients(20.6%). Results Successful endovascular treatment of ISMAD was accomplished in all 34 patients. Among the 34 patients, simple bared stent implantation was employed in 19, embolization of dissection pseudocavity with stent plus spring coil was adopted in 15. Among the 19 patients receiving simple stent implantation, the pseudocavity became obviously enlarged in 2 patients at 3 and 13 months after treatment respectively. All patients were followed up for 3-40 months, with a mean of(11.5±9.8) months. The complete remolding rate of dissection at 6 months after treatment was 100%(34/34), the blood flow in the stent was unobstructed, and no further enlargement of pseudocavity or recurrence of dissection occurred. Conclusion For the treatment of ISMAD, both simple bared stent implantation and embolization of dissection pseudocavity with stent plus spring coil are safe and effective with satisfactory mid-to-long-term curative efficacy.(J Intervent Radiol,2019, 28: 525-530)
Objective To discuss the endovascular treatment strategy for isolated superior mesenteric artery dissection(ISMAD) and to evaluate the mid-to-long-term efficacy of endovascular treatment. Methods The clinical data, imaging materials and the follow-up results of 34 patients with ISMAD, who received endovascular treatment during the period from March 2012 to April 2018 at the Affiliated Nanjing Hospital of Nanjing Medical University of China, were retrospectively analyzed. Of the 34 patients with ISMAD,Sakamoto type Ⅱ was seen in 3 patients(8.8%), type Ⅲ in 24 patients(70.6%) and type Ⅳ in 7 patients(20.6%). Results Successful endovascular treatment of ISMAD was accomplished in all 34 patients. Among the 34 patients, simple bared stent implantation was employed in 19, embolization of dissection pseudocavity with stent plus spring coil was adopted in 15. Among the 19 patients receiving simple stent implantation, the pseudocavity became obviously enlarged in 2 patients at 3 and 13 months after treatment respectively. All patients were followed up for 3-40 months, with a mean of(11.5±9.8) months. The complete remolding rate of dissection at 6 months after treatment was 100%(34/34), the blood flow in the stent was unobstructed, and no further enlargement of pseudocavity or recurrence of dissection occurred. Conclusion For the treatment of ISMAD, both simple bared stent implantation and embolization of dissection pseudocavity with stent plus spring coil are safe and effective with satisfactory mid-to-long-term curative efficacy.(J Intervent Radiol,2019, 28: 525-530)
引文
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[3]Sakamoto I,Ogawa Y,Sueyoshi E,et al.Imaging appearances and management of isolated spontaneous dissection of the superior mesenteric artery[J].Eur J Radiol,2007,64:103-110.
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[6]Luan JY,Guan X,Li X,et al.Isolated superior mesenteric artery dissection in China[J].J Vasc Surg,2016,63:530-536.
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[15]Rong JJ,Qian AM,Sang HF,et al.Immediate and middle term outcome of symptomatic spontaneous isolated dissection of the superior mesenteric artery[J].Abdom Imaging,2015,40:151-158.
[16]Leung DA,Schneider E,Kubik-Huch R,et al.Acute mesenteric ischemia caused by spontaneous isolated dissection of the superior mesenteric artery:treatment by percutaneous stent placement[J].Eur Radiol,2000,10:1916-1919.
[17]Casella IB,Bosch MA,Sousa WO Jr.Isolated spontaneous dissection of the superior mesenteric artery treated by percutaneous stent placement:case report[J].J Vasc Surg,2008,47:197-200.
[18]Chu S,Hsu M,Chen C,et al.Endovascular repair of spontaneous isolated dissection of the superior mesenteric artery[J].Clin Radiol,2012,67:32-37.
[19]Kim JH,Roh BS,Lee YH,et al.Isolated spontaneous dissection of the superior mesenteric artery:percutaneous stent placement in two patients[J].Korean J Radiol,2004,5:134-138.
[20]Katsura M,Mototake H,Takara H,et al.Management of spontaneous isolated dissection of the superior mesenteric artery:case report and literature review[J].World J Emerg Surg,2011,6:16.
[21]Wen D,Wang Z,Yu J,et al.Endovascular stent-graft repair of spontaneous isolated dissection of the superior mesenteric artery[J].Cardiovasc Intervent Radiol,2018,41:692-698.
[22]Li N,Lu QS,Zhou J,et al.Endovascular stent placement for treatment of spontaneous isolated dissection of the superior mesenteric artery[J].Ann Vasc Surg,2014,28:445-451.
[23]苏浩波,顾建平,楼文胜,等.裸支架腔内血管重建术治疗孤立性肠系膜上动脉夹层动脉瘤[J].介入放射学杂志,2011,20:948-952.
[24]Baldino G,Mortola P,Cambiaso M,et al.Endovascular treatment with flow-diverting stents of symptomatic superior mesenteric artery after dissection aneurysm[J].J Vasc Surg Cases Innov Tech,2017,3:30-34.
[25]Ozaki T,Kimura M,Yoshimura N,et al.Endovascular treatment of spontaneous isolated dissecting aneurysm of the superior mesenteric artery using stent-assisted coil embolization[J].Cardiovasc Intervent Radiol,2006,29:435-437.
[26]Sun Y,Chen Z,Zhang X.Application of endovascular stent placement as a remedy for spontaneous isolated superior mesenteric artery dissection[J].Vascular,2014,22:350-355.
[27]Li DL,He YY,Alkalei AM,et al.Management strategy for spontaneous isolated dissection of the superior mesenteric artery based on morphologic classification[J].J Vasc Surg,2014,59:165-172.
[2]栾景源,李选.孤立性肠系膜上动脉夹层国内现状及展望[J].中国微创外科杂志,2016,16:865-869.
[3]Sakamoto I,Ogawa Y,Sueyoshi E,et al.Imaging appearances and management of isolated spontaneous dissection of the superior mesenteric artery[J].Eur J Radiol,2007,64:103-110.
[4]Mizuno A,Iguchi H,Sawada Y,et al.Real clinical management of patients with isolated superior mesenteric artery dissection in Japan[J].J Cardiol,2018,71:155-158.
[5]陈跃鑫,刘昌伟,刘暴.孤立性肠系膜上动脉夹层的病例荟萃分析[J].中华外科杂志,2008,88:3345-3348.
[6]Luan JY,Guan X,Li X,et al.Isolated superior mesenteric artery dissection in China[J].J Vasc Surg,2016,63:530-536.
[7]Kim H,Park H,Park S,et al.Outcomes of spontaneous isolated superior mesenteric artery dissection without antithrombotic use[J].Eur J Vasc Endovasc Surg,2018,55:132-137.
[8]Park Y,Park C,Park K,et al.Inference from clinical and fluid dynamic studies about underlying cause of spontaneous isolated superior mesenteric artery dissection[J].J Vasc Surg,2011,53:80-86.
[9]Wu ZY,Yi J,Xu HM,et al.The significance of the angle between superior mesenteric artery and aorta in spontaneous isolated superior mesenteric artery dissection[J].Ann Vasc Surg,2017,45:117-126.
[10]Subhas G,Gupta A,Nawalany M,et al.Spontaneous isolated superior mesenteric artery dissection:a case report and literature review with management algorithm[J].Ann Vasc Surg,2009,23:788-798.
[11]Min S,Yoon K,Min S,et al.Current strategy for the treatment of symptomatic spontaneous isolated dissection of superior mesenteric artery[J].J Vasc Surg,2011,54:461-466.
[12]Zhu YT,Peng YH,Xu MY,et al.Treatment strategies and outcomes of symptomatic spontaneous isolated superior mesenteric artery dissection:a systematic review and meta-analysis[J].JEndovasc Ther,2018,25:640-648.
[13]Tameo MN,Dougherty MJ,Calligaro KD.Spontaneous dissection with rupture of the superior mesenteric artery from segmental arterial mediolysis[J].J Vasc Surg,2011,53:1107-1112.
[14]Nakai M,Sato H,Sato M,et al.Endovascular stenting and stent-graft repair of a hemorrhagic superior mesenteric artery pseudoaneurysm and dissection associated with pancreaticoduodenectomy[J].J Vasc Interv Radiol,2012,23:1381-1384.
[15]Rong JJ,Qian AM,Sang HF,et al.Immediate and middle term outcome of symptomatic spontaneous isolated dissection of the superior mesenteric artery[J].Abdom Imaging,2015,40:151-158.
[16]Leung DA,Schneider E,Kubik-Huch R,et al.Acute mesenteric ischemia caused by spontaneous isolated dissection of the superior mesenteric artery:treatment by percutaneous stent placement[J].Eur Radiol,2000,10:1916-1919.
[17]Casella IB,Bosch MA,Sousa WO Jr.Isolated spontaneous dissection of the superior mesenteric artery treated by percutaneous stent placement:case report[J].J Vasc Surg,2008,47:197-200.
[18]Chu S,Hsu M,Chen C,et al.Endovascular repair of spontaneous isolated dissection of the superior mesenteric artery[J].Clin Radiol,2012,67:32-37.
[19]Kim JH,Roh BS,Lee YH,et al.Isolated spontaneous dissection of the superior mesenteric artery:percutaneous stent placement in two patients[J].Korean J Radiol,2004,5:134-138.
[20]Katsura M,Mototake H,Takara H,et al.Management of spontaneous isolated dissection of the superior mesenteric artery:case report and literature review[J].World J Emerg Surg,2011,6:16.
[21]Wen D,Wang Z,Yu J,et al.Endovascular stent-graft repair of spontaneous isolated dissection of the superior mesenteric artery[J].Cardiovasc Intervent Radiol,2018,41:692-698.
[22]Li N,Lu QS,Zhou J,et al.Endovascular stent placement for treatment of spontaneous isolated dissection of the superior mesenteric artery[J].Ann Vasc Surg,2014,28:445-451.
[23]苏浩波,顾建平,楼文胜,等.裸支架腔内血管重建术治疗孤立性肠系膜上动脉夹层动脉瘤[J].介入放射学杂志,2011,20:948-952.
[24]Baldino G,Mortola P,Cambiaso M,et al.Endovascular treatment with flow-diverting stents of symptomatic superior mesenteric artery after dissection aneurysm[J].J Vasc Surg Cases Innov Tech,2017,3:30-34.
[25]Ozaki T,Kimura M,Yoshimura N,et al.Endovascular treatment of spontaneous isolated dissecting aneurysm of the superior mesenteric artery using stent-assisted coil embolization[J].Cardiovasc Intervent Radiol,2006,29:435-437.
[26]Sun Y,Chen Z,Zhang X.Application of endovascular stent placement as a remedy for spontaneous isolated superior mesenteric artery dissection[J].Vascular,2014,22:350-355.
[27]Li DL,He YY,Alkalei AM,et al.Management strategy for spontaneous isolated dissection of the superior mesenteric artery based on morphologic classification[J].J Vasc Surg,2014,59:165-172.
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