孤立性肠系膜上动脉夹层腔内治疗及其中远期疗效

Endovascular treatment of isolated superior mesenteric artery dissection and its mid-to-long-term curative efficacy

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 typeⅡwas seen in 3 patients(8.8%),typeⅢin 24 patients(70.6%)and typeⅣin 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.