B型主动脉夹层累及肠系膜上动脉缺血侧支循环通路开放的初步研究

目的:探讨B型主动脉夹层累及肠系膜上动脉缺血灌注不良时侧支循环形成的临床意义。方法:回顾性分析2015年9月至2018年10月,就诊于我科的B型主动脉夹层累及肠系膜上动脉缺血灌注不良的15例患者影像学资料,男性14例,平均年龄51.4岁(38~66岁)。分析患者腔内修复手术前后主动脉CTA图像,测量肠系膜上动脉水平主动脉真腔和假腔面积,分别对肠系膜上动脉缺血灌注不良的类型、侧支循环通路开放情况及术后肠系膜上动脉灌注归转状况进行评估。结果:术前主动脉CTA显示,7例肠系膜上动脉属动力型缺血,其中3例侧支循环通路开放(2例腹腔干-肠系膜上动脉循环通路、1例肠系膜下动脉-肠系膜上动脉循环通路);8例肠系膜上动脉属静力型缺血,其中7例侧支循环通路开放(5例肠系膜下动脉-肠系膜上动脉循环通路、2例为腹腔干-肠系膜上动脉循环通路)。15例患者均成功行腔内修复术。术后主动脉CTA显示,肠系膜上动脉开口水平主动脉真腔面积占比增加(52.5%vs.33.4%,P<0.005)。7例属动力型缺血和6例属静力型缺血患者灌注改善且侧支循环通路未再开放。另2例属静力型缺血患者肠系膜上动脉灌注类型维持不变且侧支循环通路仍开放。结论:对于B型夹层累及肠系膜上动脉缺血灌注不良患者,侧支循环通路的开放缓解肠系膜上动脉缺血灌注不良状况。主动脉腔内修复术不仅可以有效隔绝夹层原发破口防止破裂而且能改善肠系膜上动脉缺血灌注情况。

The preliminary study of collateral circulation pathway open in the superior mesenteric artery malperfusion complicated by type B aortic dissection during endovascular aortic repair

Objective:To illustrate the clinical value of collateral circulation pathway open in the superior mesenteric artery ischemia complicated by type B aortic dissection.Methods:Retrospective analysis the imaging data of 15 patients with the superior mesenteric artery(SMA)malperfusion caused by type B aortic dissection from September 2015 to October 2018,including 14 males and 1 female with the mean age 51.4(38-66 years old).Abdominal discomfort on admission was mentioned in all patients.Under the analysis of aortic CTA image on the axis and 3 D reconstruction,to assess the perfusion pattern of superior mesenteric artery ischemia complicated by aortic dissection,and associated with collateral circulation formation in perioperative,perfusion pattern change in postoperative,as well as in comparison to area ratio measurement in aortic true lumen and false lumen in the level of the superior mesenteric artery.Results:All 15 patients displayed the SMA malperfusion caused by dissection,10 patients showed collateral circulation formation(66.7%,10/15),in which 7 patients with dynamic ischemia pattern including 2 collateral circulation from celiac trunk to SMA and 1 collateral circulation from inferior mesenteric artery(IMA)to SMA,as well as 8 patients with static ischemia pattern,including 2 collateral circulation from celiac trunk to SMA and 5 collateral circulation from IMA to SMA.Underwent with thoracic endovascular aortic repair for dissection and without SMA repair,perfusion pattern of SMA in13 patients change better in postoperative than in perioperative,as well circulation pathway disappeared.There was significant increase in aortic true lumen area ratio measurement compared with false lumen in postoperative(52.5%vs.33.4%,P<0.005).Additionally,other 2 patients’SMA perfusion pattern stand unchanged and circulation pathway still exist.Conclusions:Collateral circulation pathway partly released the end-organ malperfusion in the superior mesenteric artery ischemia complicated by type B aortic dissection.Endovascular aortic repair not only successfully covered the primary tear of aortic dissection but effectively improved the superior mesenteric artery perfusion.