Division of Vascular and Endovascular Surgery, Gonda Vascular Center, Mayo Clinic, Rochester, MN 55905, USA.
J Endovasc Ther. 2012 Aug;19(4):489-94. doi: 10.1583/12-3900.1.
To describe a technique in which percutaneous orbital atherectomy is used to debulk heavily calcified superior mesenteric artery (SMA) occlusions as an adjunct in patients undergoing angioplasty and stenting.
The technique is demonstrated in a 62-year-old woman with a replaced right hepatic artery originating from an SMA occluded by densely calcified lesions. Via a left transbrachial approach, a 7-F MPA guide catheter was used to engage the ostium of the SMA, which was crossed using a catheter and guidewire. The calcified lesion was debulked using the 2-mm Diamondback 360° orbital atherectomy system. The wire was exchanged for a 0.014-inch filter wire and 0.018-inch guidewire. Using a 2-guidewire technique, the SMA was stented with a self-expanding stent for the distal lesion that crossed side branches and a balloon-expandable stent at the ostium. A 0.014-inch guidewire was placed into the replaced hepatic artery through a cell of the self-expanding stent, followed by deployment of a small balloon-expandable stent to address the residual lesion.
The use of orbital atherectomy to debulk occluded and heavily calcified SMA lesions may optimize the technical results with angioplasty and stenting.
描述一种技术，即在进行血管成形术和支架置入术时，使用经皮眶动脉切除术来去除重度钙化的肠系膜上动脉（SMA）闭塞物的体积，作为辅助手段。
该技术在一名 62 岁的女性中得到了演示，该女性的右肝动脉由起源于 SMA 闭塞的重度钙化病变的 SMA 取代。通过左经肱动脉入路，使用 7-FMPA 导引导管进入 SMA 口，使用导管和导丝穿过该口。使用 2mm 的 Diamondback 360°眶动脉切除术系统切除钙化病变。将导丝更换为 0.014 英寸的滤器导丝和 0.018 英寸的导丝。使用双导丝技术，用自膨式支架对远端病变进行支架置入，该病变穿过侧支，并在开口处使用球囊扩张式支架。将 0.014 英寸的导丝通过自膨式支架的一个单元放入替代的肝动脉中，然后部署一个小的球囊扩张式支架来解决残余病变。
使用眶动脉切除术来去除闭塞和重度钙化的 SMA 病变可能会优化血管成形术和支架置入术的技术结果。
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