机械血栓清除装置治疗急性肠系膜上动脉栓塞的疗效与安全性

Efficacy and safety of mechanical thrombectomy devices in the treatment of acute superior mesenteric artery embolism

背景与目的:近年来,Acostream和Angiojet两种机械血栓清除装置已广泛应用于多种血栓栓塞性疾病的治疗,但两者用于治疗急性肠系膜上动脉栓塞(ASMAE)治疗的报道不多,且未见两者治疗ASMAE的对比研究。因此,本研究对笔者单位采用Acostream或Angiojet治疗的ASMAE病例进行总结比较,以期为临床治疗选择提供参考。方法:回顾性分析2019年1月—2023年1月衢州市人民医院血管外科使用机械血栓清除装置治疗的23例ASMAE患者的临床资料,其中10例采用Acostream血栓抽吸装置治疗(Acostream组),13例使用Angiojet机械碎栓治疗(Angiojet组)。比较两组患者基本资料(性别、年龄、发病时间、腹膜炎体征、栓塞部位、合并其他部位栓塞情况、既往患病情况)、术中观察指标(术中出血量、球囊和支架使用情况)、并发症(靶血管夹层发生率、远端动脉栓塞发生率、出血事件发生率)、术后肠坏死和围手术期死亡情况。分析两组患者术前、术后NRS疼痛评分、白细胞(WBC)、D-二聚体和血红蛋白水平,以及随访期间两组患者腹痛缓解率、血栓再发率、管腔再狭窄率。结果:两组患者基本资料差异均无统计学意义(均P>0.05)。Acostream组术中靶血管夹层发生率低于Angiojet组(10.0%vs.53.8%,P<0.05)。两组患者术中出血量、远端动脉栓塞、支架和球囊使用率、出血事件发生率、围手术期病死率差异无统计学意义(均P>0.05)。5例合并腹膜炎体征的患者中2例(两组各1例)在腔内手术后腹痛仍不缓解,腹腔镜探查明确肠坏死后行肠切除术。两组患者手术前后血红蛋白水平无明显变化(P>0.05),但术后NRS疼痛评分、WBC和D-二聚体水平均较术前下降(部分P<0.05),且两组间变化趋势相似。术后随访,所有患者腹痛症状完全缓解。Acostream组1例患者因急性脑梗死再次入院。复查腹主动脉计算机体层成像血管造影或全腹部增强CT,所有患者肠系膜上动脉主干无再发血栓及重度狭窄,无死亡患者。结论:Acostream和Angiojet血栓清除装置治疗ASMAE均安全、有效,Angiojet机械碎栓需注意靶血管夹层的形成,临床中需根据患者全身情况选择个体化的手术方案。

Background and Aims:In recent years,the Acostream and Angiojet mechanical thrombectomy devices have been widely used to treat various thromboembolic diseases.However,few reports have been on their use in treating acute superior mesenteric artery embolism(ASMAE),and no comparative studies on their efficacy in ASMAE treatment have been published.Therefore,this study was performed to summarize and compare the cases of ASMAE treated with Acostream or Angiojet in the authors'institution to provide a reference for clinical treatment selection.Methods:The clinical data of 23 ASMAE patients treated with mechanical thrombectomy devices in Department of Vascular Surgery,Quzhou People's Hospital between January 2019 and January 2023 were retrospectively analyzed.Of the patients,10 cases were treated with the Acostream thrombus suction device(Acostream group),and 13 cases received treatment with the Angiojet mechanical thrombus fragmentation device(Angiojet group).The basic patient data(sex,age,onset time,signs of peritonitis,embolism location,concomitant embolism in other areas,and past medical history),intraoperative observation indicators(intraoperative blood loss,usage of balloon and stent),complications(incidence of target vessel dissection,incidence of distal arterial embolism,and incidence of bleeding events),and postoperative intestinal necrosis and perioperative mortality were compared between the two groups.The pre-and postoperative NRS pain scores,white blood cell(WBC)counts,Ddimer levels,hemoglobin levels,and the rate of abdominal pain relief,thrombus recurrence rate,and lumen restenosis during follow-up were also analyzed.Results:The two groups had no statistically significant differences in the basic data(all P>0.05).The incidence of intraoperative target vessel dissection was lower in the Acostream group compared to the Angiojet group(10.0%vs.53.8%,P<0.05).The two groups had no significant differences regarding intraoperative blood loss,distal arterial embolism,stent,and balloon usage rate,the incidence of bleeding events,and perioperative mortality(all P>0.05).Among the 5 patients with signs of peritonitis,two cases(one from each group)did not experience pain relief after endovascular surgery and underwent bowel resection after laparoscopy confirmed intestinal necrosis.There were no significant changes in hemoglobin levels before and after surgery in either group(both P>0.05).However,postoperative NRS pain scores,WBC counts,and D-dimer levels decreased compared to preoperative levels(some P<0.05),with similar trends observed between the two groups.During postoperative follow-up,all patients experienced complete relief of abdominal pain symptoms.One patient in the Acostream group was readmitted due to acute cerebral infarction.Upon re-examination with abdominal aorta CTA or enhanced whole abdominal CT,no patients had recurrent thrombosis or severe stenosis in the superior mesenteric artery trunk,and no patients died.Conclusions:Both Acostream and Angiojet thrombectomy devices are safe and effective for treating ASMAE.However,attention should be given to the formation of target vessel dissection when using the Angiojet mechanical thrombectomy device.Clinical decisions should be based on the patient's overall condition when selecting an individualized surgical plan.