经皮腔内介入治疗自发性孤立性肠系膜上动脉夹层16例

摘要

Objective To investigate the effect and safety of percutaneous endovascular treatment for spontaneous isolated superior mesenteric artery dissection (SISMAD).Methods Clinical data of 16 patients with SISMAD,who were treated in our hospital during the period from March 2009 to March 2016,were retrospectively analyzed.According to the Yun Angiographic Classification,there were 2 cases of Type Ⅰ,5 cases of Type Ⅱ a,and 9 cases of Type Ⅱ b.The patients were treated with endovascular treatment by twisting a guide wire to make it through the affected segment via multi-puncture approaches,and then underwent balloon dilatation and stent placement.Results All the 16 patients were treated with endovascular treatment,2 of which were treated with endovascular treatment after conservative treatment.The technical success rate was 100％.A total of 21 self-expanding stents were deployed in 16 patients,including one-layer stent in 11 patients and double stent placement in 5 cases.Intraoperative angiography showed blood in the true lumen of superior mesenteric artery (SMA) restored.The 16 patients were followed up for 3-36 months (mean,18.8 months).No abdominal pain occurred.The CTA showed no dissecting aneurysm and the stents were patent in SMA.Conclusion Percutaneous endovascular therapy is a safe and effective treatment for SISMAD.%目的 探讨经皮腔内介入治疗自发性孤立性肠系膜上动脉夹层(spontaneous isolated superior mesenteric artery dissection,SISMAD)的效果和安全性.方法 2009年3月～2016年3月16例SISMAD(Yun血管影像学分型,Ⅰ型2例,Ⅱa型5例,Ⅱb型9例)经多穿刺入路,导丝通过病变段,然后行球囊扩张及支架植入.结果 16例接受介入治疗,其中2例保守治疗无效后采用介入治疗,手术技术成功率100％.16例共植入21枚自膨式裸支架,其中植入单层支架11例,双支架重叠术5例,术中造影显示肠系膜上动脉(superior mesenteric artery,SMA)真腔血流通畅.16例随访3～36个月(平均18.8月),均无腹痛症状发生,肠系膜上动脉CTA显示夹层动脉瘤不显影,支架内血流通畅.结论 经皮腔内介入治疗SISMAD是一种安全、有效的方法.