Choi Ji Yoon, Kwon Oh Jung
Department of Surgery, Hanyang University Hospital, Seoul, Korea.
Ann Vasc Surg. 2013 Aug;27(6):750-7. doi: 10.1016/j.avsg.2012.09.016. Epub 2013 Jun 20.
Spontaneous isolated celiac and superior mesenteric artery dissection without aortic dissection is a rare disease. Recently, an increasing number of cases have been diagnosed and the prognosis has improved significantly because of technical progress in computed tomography (CT). However, management approaches vary from conservative treatment or endovascular repair to open surgery. This study analyzed the clinical findings of patients with spontaneous visceral artery dissection, and attempted to illuminate how to manage these cases.
From June 2005 to February 2012, a total of 17 patients were diagnosed with spontaneous isolated visceral artery dissection in the authors' hospital (4 celiac arteries, 12 superior mesenteric arteries, and 1 inferior mesenteric artery) based on CT findings. The clinical characteristics, Sakamoto's classification, imaging appearance, and early outcomes of these patients were retrospectively compared.
The mean age of the patients was 51.47 ± 8.65 years (range, 39-73 years) and the mean follow-up period was 35.18 ± 25.55 months (range, 1-79 months). Fifteen (88.2%) patients had abdominal pain and no ischemic changes of the bowel. The dissections initiated at a mean distance of 13.04 ± 10.41 mm (range, 4.00-43.39 mm) from the origin of the artery, with a mean length of 53.39 ± 28.06 mm (range, 10.00-108.46 mm). There were 4 type I (23.8%), 1 type II (5.9%), 9 type III (52.9%), and 3 type IV (17.6%) dissections according to Sakamoto's classification. Treatments included observation without anticoagulation treatment in 3 patients (17.6%), anticoagulation treatment in 12 (70.6%), and endovascular stenting in 2 (11.8%). The disease stabilized in all patients during follow-up.
If bowel perfusion is not compromised and patency is well compensated by collateral circulation, most patients can be managed conservatively with or without anticoagulation treatment. However, patients must be monitored closely and followed up regularly for early detection of progression.
自发性孤立性腹腔干和肠系膜上动脉夹层而无主动脉夹层是一种罕见疾病。近年来，随着计算机断层扫描（CT）技术的进步，越来越多的病例得以诊断，预后也有显著改善。然而，治疗方法从保守治疗、血管内修复到开放手术各不相同。本研究分析了自发性内脏动脉夹层患者的临床特征，并试图阐明如何处理这些病例。
2005年6月至2012年2月，作者所在医院共有17例患者根据CT表现被诊断为自发性孤立性内脏动脉夹层（4例腹腔干动脉、12例肠系膜上动脉和1例肠系膜下动脉）。对这些患者的临床特征、坂本分类、影像学表现及早期预后进行回顾性比较。
患者平均年龄为51.47±8.65岁（范围39 - 73岁），平均随访时间为35.18±25.55个月（范围1 - 79个月）。15例（88.2%）患者有腹痛但无肠缺血改变。夹层起始于距动脉起始处平均距离为13.04±10.41mm（范围4.00 - 43.39mm），平均长度为53.39±28.06mm（范围10.00 - 108.46mm）。根据坂本分类，有4例I型（23.8%）、1例II型（5.9%）、9例III型（52.9%）和3例IV型（17.6%）夹层。治疗方法包括3例患者（17.6%）未进行抗凝治疗的观察、12例（70.6%）的抗凝治疗以及2例（11.8%）的血管内支架置入。所有患者在随访期间病情稳定。
如果肠灌注未受影响且侧支循环能很好地代偿通畅，大多数患者可采用抗凝或不抗凝的保守治疗。然而，必须密切监测患者并定期随访以便早期发现病情进展。
