Malgor Rafael D, Oderich Gustavo S, McKusick Michael A, Misra Sanjay, Kalra Manju, Duncan Audra A, Bower Thomas C, Gloviczki Peter
Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minnesota 55905, USA.
Ann Vasc Surg. 2010 Nov;24(8):1094-101. doi: 10.1016/j.avsg.2010.07.001.
To describe the outcomes of single- and two-vessel mesenteric artery stents in patients with chronic mesenteric ischemia (CMI).
We reviewed 101 patients (41 men and 60 women; mean age, 73 ± 13 years) treated with mesenteric artery stents for atherosclerotic CMI between 1998 and 2008. Clinical data and outcomes were reviewed in patients treated with single superior mesenteric artery (SMA) stent (group A) or two-vessel celiac artery (CA) and SMA stent (group B). Isolated CA stenting was analyzed as a separate group (group C). End-points were taken as differences in morbidity and mortality and freedom from recurrent symptoms and reinterventions.
There were 61 patients in group A, 24 in group B, and 16 in group C. All three groups had similar demographics, cardiovascular risk factors, and clinical presentation. There were no differences in early mortality (2%, 4%, and 0%), morbidity (18%, 26%, and 12%), and symptom relief (95%, 78%, and 100%) between groups A, B, and C, respectively (p value was not significant). Mean follow-up was 41 ± 17 months. Freedom for reintervention at 1 and 3 years was similar among patients in groups A (86 ± 5% and 50 ± 9%), B (67 ± 11% and 67 ± 11%), and C (63 ± 13% and 63 ± 13%), respectively (p value was not significant). There were no significant differences in freedom from restenosis at 1 and 3 years among patients in groups A (54 ± 7% and 44 ± 9%), B (47 ± 12% and 39 ± 12%), and C (43 ± 13% and 34 ± 13%), respectively. Primary and secondary patency rates at 3 years were 57% and 96% for SMA and 61% and 87% for CA stents, respectively (p value was not significant). CA stent alone was associated with symptom recurrence in 6 of 16 patients (38%), as compared with the recurrence rate of 18% (11 of 61) in patients who underwent SMA stent placement (p = 0.06).
Two-vessel CA and SMA stenting do not reduce the incidence of recurrent symptoms or reinterventions when compared with single-vessel SMA stents in patients with CMI. CA stent alone carries a high risk of recurrence.
描述单支和双支肠系膜动脉支架置入术治疗慢性肠系膜缺血（CMI）患者的疗效。
我们回顾了1998年至2008年间接受肠系膜动脉支架置入术治疗动脉粥样硬化性CMI的101例患者（41例男性和60例女性；平均年龄73±13岁）。对接受单支肠系膜上动脉（SMA）支架置入术（A组）或双支腹腔干动脉（CA）和SMA支架置入术（B组）的患者的临床资料和疗效进行了回顾。将单纯CA支架置入术单独作为一组进行分析（C组）。终点指标为发病率、死亡率、无复发症状和无需再次干预的差异。
A组61例患者，B组24例患者，C组16例患者。三组患者的人口统计学特征、心血管危险因素和临床表现相似。A、B、C三组的早期死亡率（分别为2%、4%和0%）、发病率（分别为18%、26%和12%）和症状缓解率（分别为95%、78%和100%）无差异（P值无统计学意义）。平均随访时间为41±17个月。A组（86±5%和50±9%）、B组（67±11%和67±11%）和C组（63±13%和63±13%）患者1年和3年无需再次干预的情况相似（P值无统计学意义）。A组（54±7%和44±9%）、B组（47±12%和39±12%）和C组（43±13%和34±13%）患者1年和3年无再狭窄的情况无显著差异。SMA支架3年的初级和次级通畅率分别为57%和96%，CA支架分别为61%和87%（P值无统计学意义）。16例接受单纯CA支架置入术的患者中有6例（38%）出现症状复发，而行SMA支架置入术的患者复发率为18%（61例中有11例）（P = 0.06）。
与单支SMA支架置入术相比，双支CA和SMA支架置入术并不能降低CMI患者复发症状或再次干预的发生率。单纯CA支架置入术复发风险较高。
