裸支架腔内血管重建术治疗孤立性肠系膜上动脉夹层动脉瘤

摘要

目的 评价裸支架载瘤动脉腔内血管重建术治疗孤立性肠系膜上动脉夹层的安全性和疗效.方法 2007年至2010年对5例经腹部CT血管成像(CTA)及数字减影血管造影(DSA)明确诊断的肠系膜上动脉夹层动脉瘤患者行裸支架载瘤动脉腔内血管重建术治疗.按照Sakamoto血管影像学分型,Ⅰ、Ⅱ型各1例,Ⅲ型3例.患者术后继续给予抗凝、抗血小板治疗,术后1、3、6个月进行CTA或血管造影随访.结果 5例患者手术均获成功,其中支架联合弹簧圈栓塞2例,双支架重叠技术3例,无并发症发生.4例症状性患者术后3周内症状消失.5例患者术后3 ～ 6个月时肠系膜上动脉CTA及DSA显示动脉瘤腔不显影,支架腔内血流通畅.随访3 ～ 12个月(平均7.8个月)夹层动脉瘤无复发.结论 裸支架载瘤动脉腔内血管重建术是治疗孤立性肠系膜上动脉夹层安全、有效的方法.%Objective To evaluate the safely arid efficacy of percutaneous endovaseular reconstruction with endovaseular slent placement for Isolated spontaneous dissection of the superior mesenteric artery. Methods Five patients with Isolated spontaneous dissection of the superior mesenteric artery were enrolled in tliis study. The diagnosis was confirmed by abdominal computed tomography auglography (CTA ) and percutaneous transcatheter digital subtraction angiography (DSA ) in all the five patients. One asymptomatic case was discovered by medical examination, which was classified to type I (Sakamoto angiographic categorization). The other four cases were admitted to hospital with acute abdominal pain and diarrhea, which were classified to type JI( 1 case ) and type UK 3 cases). Fasting together with antiplatelet and antieoagulation therapy was initially employed. Then, percutaneous endovaseular reconstruction with stenting was carried out and the patients were kept on antiplatelet therapy. Follow-up checkups with CTA or DSA were conducted at 1. 3 and 6 months after the treatment. Remits Technical success was achieved in all five patients without anv complications, Combination of the coil cmbolization and endovaseular stent placement were preformed in 2 cases. The other 3 cases were successfully treated with simple double stent placement. The clinical symptoms in the four symptomatic patients disappeared gradually within 3 weeks. Follow-up CTA or DSA was adopted in 5 patients. Repeated auglography performed at 3 months after the procedure showed thai complete resolution of the dissection and successful restoration of the true lumen with sufficient distal flow of tlie SMA were obtained In five patients. Conclusion Percutaneous endovaseular reconstruction with stent placement is a feasible and effective treatment for isolated spontaneous dissection of the superior mesenteric artery.