腹腔动脉和肠系膜上动脉狭窄的介入治疗

Treatment of celiac and mesenteric arteries stenoses with interventional radiologic techniques

目的评价介入技术治疗腹腔动脉(CA)和肠系膜上动脉(SMA)狭窄的安全性和临床疗效.方法对8例CA/SMA局限性狭窄患者进行了经皮穿刺经腔球囊血管成型术(PTA)和支架置入术,单纯CA狭窄2例、单纯SMA狭窄4例、CA和SMA均有狭窄2例.4例患者有典型进餐后腹痛,5例有上腹部血管杂音,8例于发病后均有不同程度的体重下降(平均8 kg).7例患者病因为动脉硬化,1例为膈肌中脚压迫综合征(MALS)所致.结果 PTA和支架置入均成功,其中治疗CA狭窄3例、SMA狭窄5例,7例用1个支架,1例用2个支架.治疗结束时复查造影显示置入支架的血管血流通畅,管径接近正常.术后于穿刺侧腹股沟区出现小血肿2例,无须外科处理、自行吸收.术后腹痛完全消失5例、有所减轻2例、无改善1例;术后3个月时,体重恢复至发病前水平者6例.8例患者随访6～72个月(平均42个月,中位值28个月),复查Doppler超声波无明确再狭窄证据.5例无症状、1例仍然有间歇性腹痛,2例分别于术后14个月、24个月死于其他原因.结论 PTA和支架置入术是治疗CA、SMA局限性狭窄的安全有效方法,尤适宜于存在外科治疗高风险的患者.

Objective To evaluate the safety and efficacy of the interventional techniques for management of celiac and mesenteric arteries stenoses. Methods Eight patients with celiac artery （CA） or superior mesenteric artery （SMA） focal stenotic lesions were treated with percutaneous transluminal balloon angioplasty （PTA） and stent placement. CA stenosis was present in 2 patients, SMA stenosis was present in 4, and both CA and SMA were involved in 2 patients. Postprandial pain was present in 4 patients, an epigastric bruit was present in 5. All patients presented with weight loss averaging 8 kg. The causes of the stenoses were atheroscleroses in 7 patients, median arcuate ligament syndrome （ MALS ） involvement of the CA in 1 patient. Results PTA and stent placement was technically successful in the 8 patients. Three patients underwent stent placement in CA, 5 patients in SMA. Seven patients were treated with 1 stent, one was treated with 2 stents. The post-procedural arteriograms showed good dilation of the stenotic lesions in all patients. The puncture site hematoma occurred in 2 patients without severe consequences. Complete alleviation of abdominal pain occurred in 5 patients, significant improvement in 2, and no improvement in 1 patient. At three months after the procedures, weights were regained in 6 patients. Clinical follow-up was available in all 8 patients, with a mean follow-up of 42 months （median 28 months, range 6 to 72 months）. Follow-up Doppler ultrasound examinations showed normal flow patterns, without evidences of re-stenosis in the stenting arteries. Five patients remained asymptomatic, one patient had intermittent abdominal pain even the stenting SMA to be patent. Two patients respectively died of unrelated CA/SMA stentoses in 14 and 24 months after the treatment. Conclusion PTA and stent placement are safe and effective methods for treatment of chronic CA and SMA focal stenoses, especially useful for these patients with a high surgical risk.