Zhang Wayne W, Killeen J David, Chiriano Jason, Bianchi Christian, Teruya Theodore H, Abou-Zamzam Ahmed M
Division of Vascular Surgery, Department of Surgery, Loma Linda University School of Medicine, Loma Linda, California.
Ann Vasc Surg. 2009 Jan-Feb;23(1):90-4. doi: 10.1016/j.avsg.2008.07.003. Epub 2008 Sep 6.
Spontaneous dissection of a visceral artery without associated aortic dissection is rare, although more cases have recently been reported because of the advancement of diagnostic techniques. The risk factors, causes, and natural history of spontaneous isolated visceral artery dissection are unclear. Treatment with open surgery, endovascular stenting, or anticoagulation therapy has been proposed; however, there is no consensus on the optimal management. We present three cases of spontaneous and isolated dissection of visceral arteries. Dissection involved the superior mesenteric artery in one and the celiac artery in two. All three patients presented with acute abdominal pain but lacked any peritoneal irritation. The patients were treated nonoperatively with anticoagulants or antiplatelets. No surgical or endovascular intervention was performed. Follow-up imaging studies demonstrated improvement of the dissection in two patients and no change in one patient. All patients were symptom-free over a mean follow-up of 17 months. Nonoperative treatment with close observation is an acceptable strategy in the management of spontaneous isolated dissection of visceral arteries. Emergent intervention is not mandatory in symptomatic patients without evidence of acute bowel ischemia or hemorrhage.
不伴有主动脉夹层的内脏动脉自发性夹层很少见，不过由于诊断技术的进步，最近报告的病例有所增多。自发性孤立性内脏动脉夹层的危险因素、病因及自然病程尚不清楚。有人提出采用开放手术、血管内支架置入或抗凝治疗；然而，对于最佳治疗方案尚无共识。我们报告3例自发性孤立性内脏动脉夹层病例。其中1例夹层累及肠系膜上动脉，2例累及腹腔干。所有3例患者均表现为急性腹痛，但无腹膜刺激征。这些患者接受了抗凝剂或抗血小板药物的非手术治疗。未进行手术或血管内干预。随访影像学检查显示，2例患者夹层有所改善，1例患者无变化。所有患者在平均17个月的随访期内均无症状。对于自发性孤立性内脏动脉夹层的治疗，密切观察下的非手术治疗是一种可接受的策略。对于没有急性肠缺血或出血证据的有症状患者，紧急干预并非必要。
