41例孤立性肠系膜上动脉夹层的治疗经验

目的:总结孤立性肠系膜上动脉夹层(ISMAD)的治疗经验。方法:回顾性分析2010年1月至2019年5月期间南京医科大学附属常州第二人民医院和南京市高淳人民医院收治的41例ISMAD患者的临床及随访资料,并对相关数据进行分析总结。结果:41例ISMAD患者中,32例(78.0%)患者成功进行内科保守治疗,6例患者予急诊支架置入治疗,2例患者内科保守治疗失败后给予支架置入治疗,1例患者内科保守治疗失败后给予球囊扩张治疗。随访(25.1±17.2)个月,32例内科保守治疗的患者中,25例(78.1%)患者的肠系膜上动脉(SMA)完全重塑形,另外7例患者SMA部分重塑形,25例(78.1%)患者完全重塑形的发生时间均在确诊后的12~24个月;8例支架置入治疗的患者中,7例夹层动脉瘤消失,1例夹层动脉瘤仍有残留;7例支架通畅,另外1例支架近端存在一定程度的再狭窄,但无支架闭塞。结论:绝大多数ISMAD可以经内科保守治疗,SMA完全重塑形发生于确诊后的2年内;部分内科保守治疗失败的患者可以置入自膨式裸支架治疗,但存在支架再狭窄的风险。

Clinical Experience on the Management of Isolated Superior Mesenteric Artery Dissection in 41 Patients

Objectives:To summarize the management experience of isolated superior mesenteric artery dissection(ISMAD).Methods:Forty-one patients,who hospitalized in our hospital with the diagnosis of ISMAD from January 2010 to May 2019,were included in this retrospective study.The clinical and follow-up data were analyzed.Results:Of the 41 ISMAD patients,32 patients were successfully treated with conservative management,6 patients received emergency stent implantation,2 patients were treated with stent implantation after failed conservative treatment,and 1 patient was treated with percutaneous transluminal angioplasty.The mean follow-up time was(25.1±17.2)months.Of the 32 patients treated with conservative treatment,25 cases reached complete remodeling of superior mesenteric artery(SMA),7 patients reached partial remodeling of SMA.The complete remodeling of SMA was occurred at 12-24 months after the diagnosis.Of the 8 patients treated with stent implantation,dissection aneurysm was disappeared in 7 cases,and residual in 1 case.Stent patency was evidenced in 7 cases and restenosis occurred in 1 case.There were no cases of occlusion of the stented arteries.Conclusions:Most cases of ISMAD can be successfully treated conservatively.The complete remodeling of SMA occurs within 2 years after the diagnosis.Self-expanding bare stent is a therapeutic option for patients with failed conservative treatment.However,there is a low risk of in stent restenosis.