Division of Vascular Surgery, Eastern Virginia Medical School, Norfolk, VA, USA.
J Vasc Surg. 2013 Apr;57(4):1062-6. doi: 10.1016/j.jvs.2012.10.081. Epub 2013 Jan 11.
Open bypass is the gold standard for treatment of mesenteric ischemia. With the refinement of endovascular therapy, visceral stenting is an attractive minimally invasive alternative, but the data are limited and which vessel responds best to stenting has not been addressed. This study compares the outcomes of superior mesenteric artery (SMA) and celiac artery (CA) stenting.
All consecutive patients who underwent visceral stenting between January 2002 and May 2009 were reviewed. Standard statistical analyses, including Kaplan-Meier tests, were performed. Primary patency was defined as peak systolic velocities <350 cm/s for CAs and <450 cm/s for SMAs. Clinical patency was maintenance of either primary patency or the absence of recurrent symptoms. At arteriography, stenosis ≥70% was considered a loss of primary patency.
One hundred twenty-one patients received 140 visceral stents in the SMA (n = 92; 65.7%), the CA (n = 40; 28.6%), and the inferior mesenteric artery (n = 8; 5.7%). Twenty-nine stents were placed in men (20.7%) and 111 stents were placed in women (79.3%) with a mean age of 72.9 years (range, 20.5-93.9). The combined SMA/CA stent mean follow-up was 12.8 months. Technical success was 100% for all. Overall 30-day morbidity and mortality rates were 14% and 0.8%, respectively. One-year primary patency was significantly higher for SMA than for CA stents: 55% versus 18%, respectively (P < .0001). Six-month clinical patency was 86% for the SMA and 67% for the CA (P < .005). Loss of CA primary patency was associated with stent diameter <6 mm (P = .042) and age <50 years (two patients; P = .038). These factors did not correlate with loss of primary patency for SMA. Overall freedom from bypass was 93% at 4 years.
Visceral stenting has an exceptionally high technical success rate with low procedural morbidity and mortality. Clinical primary patency and primary patency were significantly higher for the SMA group than for the CA group. Our data suggest that CA atherosclerotic lesions do not respond well to endovascular stenting, bringing into question its clinical utility.
开放旁路手术是治疗肠系膜缺血的金标准。随着腔内治疗技术的不断完善，内脏支架置入术作为一种有吸引力的微创治疗方法，但其数据有限，哪种血管对支架置入的反应最好尚未确定。本研究比较了肠系膜上动脉（SMA）和腹腔动脉（CA）支架置入的结果。
回顾性分析 2002 年 1 月至 2009 年 5 月期间连续接受内脏支架置入术的所有患者。进行了标准的统计学分析，包括 Kaplan-Meier 检验。主要通畅定义为腹腔动脉峰值收缩速度<350cm/s，SMA<450cm/s。临床通畅定义为保持主要通畅或无复发症状。在血管造影中，狭窄≥70%被认为是主要通畅的丧失。
121 例患者共置入 140 枚内脏支架，其中 SMA 92 例（65.7%），CA 40 例（28.6%），IMT 8 例（5.7%）。29 枚支架置入男性（20.7%），111 枚支架置入女性（79.3%），平均年龄 72.9 岁（范围 20.5-93.9）。SMA/CA 支架的平均随访时间为 12.8 个月。所有患者的技术成功率均为 100%。总体 30 天发病率和死亡率分别为 14%和 0.8%。SMA 支架的 1 年主要通畅率明显高于 CA 支架：分别为 55%和 18%（P<.0001）。SMA 的 6 个月临床通畅率为 86%，CA 为 67%（P<.005）。CA 主要通畅的丧失与支架直径<6mm（P=0.042）和年龄<50 岁（2 例；P=0.038）有关。这些因素与 SMA 主要通畅的丧失无关。总体而言，4 年内免于旁路手术的比例为 93%。
内脏支架置入术具有极高的技术成功率，手术发病率和死亡率低。SMA 组的临床和主要通畅率明显高于 CA 组。我们的数据表明，CA 动脉粥样硬化病变对腔内支架置入反应不佳，这引发了对其临床应用的质疑。
