孤立性腹腔干扩张性疾病的腔内治疗

Endovascular treatment for isolated celiac trunk dilatation

目的:总结孤立性腹腔干扩张性疾病的腔内治疗经验。方法:回顾性分析2012年1月-2015年6月收治的孤立性腹腔干扩张性疾病患者的临床资料。收集所有入组患者的基线资料,包括性别、年龄、并发症、发病症状、影像学检查、腔内治疗措施及结果、随访及生存情况。结果:共11例孤立性腹腔干扩张性疾病患者入组,均经腹腔动脉CT血管造影明确诊断。其中腹腔干真性动脉瘤9例,平均瘤体最大径(3.2±1.7)cm;腹腔干夹层2例,1例夹层范围局限、另1例夹层延伸至近端肝总动脉。11例中男性7例,女性4例,平均(54.5±12.4)岁。所有患者均先进行腹腔干及分支动脉造影以明确病变及侧支血供情况。4例行腹腔干钢圈栓塞;2例行腹腔干动脉支架植入术;1例患者在造影过程中突发腹主动脉瘤破裂,中转开腹手术,最终死亡;余4例仅行造影术。共10例获随访,平均随访8.5个月,随访期间均无再发腹部症状,腹腔干各供血分支通过侧支或主干供血良好。结论:孤立性腹腔干扩张性疾病属临床少见病,腔内治疗对于该病有效可行,近期疗效可,中远期疗效仍需随访。

Objective： To summarize the experience of endovascular treatment for isolated celiac trunk dilatation （ICTD）. Methods： The clinical data of patients with ICTD, who was admitted during Jan. 2012 and Jun. 2015, were retrospectively analyzed. Detailed information of all the recruited patients was collected, including gender, age, comorbidities, initial symptoms, imaging examinations, endovascular treatment and its outcome, follow-up and survival status. Results： The study totally recruited 11 patients with ICTD and they were all diagnosed by computed tomographic angiography（CTA）. Nine of them were diagnosed with celiac trunk aneurysm with a mean maximum diameter of （3. 2 ±1. 7） cm. The remaining two were diagnosed with celiac trunk dissection. The dissection was constrained in one case, while the dissection was anterogradely propagated to proximal common hepatic artery. Among the 11 cases, 9 were men and 4 were women. And the mean age was （54. 5±12.4） year. The initial digital subtracted angiography （DSA） for celiac trunk and branch arteries was performed on all the patients so as to detect and confirm the blood supply of lesion and its lateral circulation. Finally, 4 patients were treated with coil embolization. And 2 patients received celiac artery stent implantation. Rupture of the abdominal aorta happened in 1 patient during the angiography. Although surgical operation was immediately carried out, the patient failed to survive eventually. And the remaining 4 patients were only treated with angiography. Ten patients were followed up. The mean follow-up time was 8. 5 months. There was no abdominal symptom in all patients, and the blood supply of each branch was conducted well through main or lateral circulation during this period. Conclusions： ICTD remains uncommon. Endovaseular treatment is effective and applicable for ICTD patients. The short term outcome is acceptable. Further follow-up is needed for long term outcome.