腹腔动脉狭窄的介入治疗

Treatment of celiac artery stenosis with interventional techniques

目的 报道用介入方法治疗 2例腹腔动脉 (CA)狭窄的疗效。方法 2例患者有长期进餐后腹痛、伴有体重下降和上腹部血管杂音 ,Doppler超声提示CA狭窄 ,经腹主动脉造影证实。 1例CA狭窄为典型膈肌中脚综合征 (MALS) ,另 1例狭窄为动脉粥样硬化所致。介入技术包括常规经皮经腔血管成型 (PTA)和支架置入术。结果 腹主动脉造影显示 2例均为重度CA狭窄 ,狭窄程度大于 90 %。术中做PTA和支架置入 ,1例用球囊扩张式Palmaz支架、1例用Wallstents ,术后造影显示CA血流通畅。Doppler超声随访提示CA血流速度正常。术后 3个月随访 ,患者症状消失、体重增加 ;分别随访 16、2 6个月 ,无再狭窄证据。结论 PTA和支架置入是治疗CA狭窄的安全。

Objective To present two cases of celiac artery (CA) stenosis treated successfully by interventional technique.Methods Two patients characterised by chronic upper abdominal pain after eating, associated with weight loss and an epigastric bruit were treated with interventional procedure. The diagnosis was suggested by color Doppler imaging of the celiac axis and confirmed by aortography. One patient possessed the classic triad of median arcuate ligament syndrome (MALS). Arteriosclerosis was found to be responsible for the CA stenosis in another one. The interventional technique consisted of conventional PTA and stent placement in the CA. Results Abdominal arteriograms in both patients showed severe stenosis (>90%) of CA. The stenotic segments were dilated and stented during the same session. One patient with balloon expandable Palmaz stent placed in the proximal celiac artery, the another with 2 wallstents deployed in the CA trunk. The postprocedural arteriograms showed good dilation of the lesions with immediate improvement of CA blood flow. Follow-up Doppler ultrasound scans showed normal flow patterns in the CA. Three months after the procedures, their upper gastrointestinal symptoms had resolved and regained body weights. They remained well and free of symptoms, at 16 months and 26 months follow-up, respectively, after the procedure.Conclusions CA stenosis can successfully be treated with angioplasty and stenting.