Pisimisis George T, Oderich Gustavo S
Mayo Clinic, Rochester, MN 55905, USA.
Ann Vasc Surg. 2011 Jan;25(1):132.e7-11. doi: 10.1016/j.avsg.2010.04.004.
Revascularization for acute mesenteric ischemia can be challenging in patients with bowel gangrene, peritoneal contamination, and no good source of inflow for a bypass graft. A 70-year-old female patient presented with acute-on-chronic mesenteric ischemia, flush superior mesenteric artery (SMA) occlusion, and diffuse aorto-iliac occlusive disease. This study describes the technique of hybrid retrograde SMA recanalization and stent placement using a midline laparotomy is described. The mid-portion of the SMA was exposed and jejunal branches were controlled with silastic vessel loop. Retrograde access was established under direct vision and the occluded SMA segment was crossed, pre-dilated, and stented using a balloon-expandable stent. The SMA was flushed through a longitudinal arteriotomy, which was closed using a saphenous vein patch. Retrograde hybrid SMA stenting is an expeditious option to revascularize patients with acute on chronic mesenteric ischemia who have peritoneal contamination and no other good source of inflow to the mesenteric arteries.
对于患有肠坏疽、腹腔污染且没有良好旁路移植流入源的急性肠系膜缺血患者，进行血管重建可能具有挑战性。一名70岁女性患者出现急性慢性肠系膜缺血、肠系膜上动脉（SMA）近端闭塞以及弥漫性主-髂动脉闭塞性疾病。本研究描述了使用中线剖腹术进行杂交逆行SMA再通和支架置入的技术。暴露SMA中部，用硅橡胶血管环控制空肠分支。在直视下建立逆行通路，穿过闭塞的SMA段，进行预扩张，并使用球囊扩张支架置入支架。通过纵向动脉切开冲洗SMA，并用大隐静脉补片封闭。逆行杂交SMA支架置入术是一种快速的选择，可为患有急性慢性肠系膜缺血、腹腔污染且肠系膜动脉没有其他良好流入源的患者进行血管重建。
