孤立性肠系膜上动脉夹层血管腔内治疗策略

Endovascular treatment strategy for isolated superior mesenteric artery dissection

目的探讨孤立性肠系膜上动脉夹层(ISMAD)血管腔内治疗策略。方法选取2016年1月至2018年12月本院采用血管腔内支架植入治疗ISMAD的患者5例,分别使用覆膜支架及裸支架行血管腔内成形术。结果3例患者植入“ViabahnTM”覆膜支架后夹层破口即刻消失,2例患者植入“Pulsar-18”裸支架后夹层破口完全被支架覆盖,植入覆膜支架与裸支架患者肠系膜上动脉主干及分支血流均通畅。结论不同分型的ISMAD腔内处理各异。对Ⅰ型ISMAD患者,保守治疗无效后,可选用裸支架或覆膜支架;对Ⅱ型ISMAD患者,尽量选择合适尺寸覆膜支架封闭夹层的破口。

Objective To explore the endovascular treatment strategy for isolated superior mesenteric artery dissection(ISMAD).Methods 5 cases of ismad were treated by endovascular stent implantation in our hospital from January 2016 to December 2018,underwent endovascular angioplasty using covered stent and bare stent,respectively.Results After implantation of"ViabahnTM"covered stent in 3 patients,the break of dissection disappeared immediately,and the blood flow of superior mesenteric artery trunk and branches was unobstructed.2 patients were implanted with"Pulsar-18"bare stent.The break of dissection was completely covered and the blood flow of superior mesenteric artery trunk and branches was unobstructed.Conclusion Different types of ISMAD have different intracavitary treatment.For type I ISMAD patients,bare stent or covered stent can be used after conservative treatment is ineffective.For type II ISMAD patients,the appropriate size of covered stent should be chosen to seal the break of dissection.