症状性孤立性肠系膜上动脉夹层的腔内治疗分析

摘要

Objective To investigate the clinical features and the curative effect of endovascular treatment of symptomatic isolated dissection of superior mesenteric artery(SIDSMA). Methods The clinical data of 17 patients with SIDSMA from January 2010 to June 2015 were analyzed retrospectively. Results Endovascular stent placement(ESP)were performed successfully in 14 cases. Because it was difficult to perform stent implantation in the remaining patient,3 cases received conservative treatment. The ESP success rate was 82.4%,and 16 patients had relief of symptoms (94.1%),only one patient died during perioperative period.16 patients were followed up for 1-56 months(mean of 16.4months),one patient died of bowel necrosis 1 month postoperation. Conclusion ESP is indicated for the patients with SIDSMA has suspected bowel ischemia,compression of the true lumen of the SMA>80%,or SMA aneurysm of>2.0cm in diameter.ESP can also be provided to the patients in whom recurrence of symptoms .It should be evaluated beforehand whether the patients are at high risk of complications.%目的 探讨症状性孤立性肠系膜上动脉夹层(SIDSMA)的临床特点及腔内治疗疗效.方法 回顾性分析2010年1月至2015年6月17例SIDSMA患者的临床资料.结果 17例患者中14例成功植入支架,3例患者改为保守治疗,支架植入术(ESP)成功率82.4%,16例患者症状改善(占94.1%),围手术期死亡1例.16例患者获得随访1~56个月,平均16.4个月,1例患者术后1个月死于肠坏死.结论 对于症状反复、夹层动脉瘤直径>2cm、真腔受压狭窄>80%的SIDSMA患者可选择腔内支架治疗,但术前需充分评估其并发症风险.