Shah Tejaskumar, Singh Mukesh, Bhuriya Rohit, Kovacs Daniela, Khosla Sandeep
Department of Medicine, Chicago Medical School, Rosalind Franklin University of Medicine and Science, Chicago, Illinois.
Int J Angiol. 2013 Dec;22(4):245-50. doi: 10.1055/s-0033-1348879.
We report a rare clinical scenario of chronic mesenteric ischemia (CMI) patient with obstruction of all the three major gut vessels including celiac, superior mesenteric artery (SMA), and inferior mesenteric artery (IMA) with a sole artery supplying the collaterals through marginal artery of left colon (the "wandering artery of Drummond"). A 70-year-old man was presented to hospital with acute onset of dyspnea, diaphoresis, severe epigastric pain, nausea, and vomiting that started after lunch. Initially, patient was diagnosed and treated for non-ST elevation myocardial infarction (NSTEMI). Furthermore, work-up, including computed tomographic scan of abdomen followed by angiogram, revealed 100% obstruction of celiac and SMA, whereas inferior IMA had 90% ostial lesion with poststenotic dilatation and collaterals supplying to entire colon. Subsequently, IMA ostial lesion was stented through percutaneous intervention and patient noted significantly improved symptoms and quality of life. To conclude, percutaneous endovascular treatments confer favorable strategy for CMI, and it may either be curative or allow nutritional optimization before definitive surgery.
我们报告了一例罕见的慢性肠系膜缺血(CMI)病例,该患者的腹腔干、肠系膜上动脉(SMA)和肠系膜下动脉(IMA)这三大肠道血管均发生阻塞,仅通过左结肠边缘动脉(“Drummond游走动脉”)供应侧支循环。一名70岁男性因午餐后突发呼吸困难、出汗、严重上腹部疼痛、恶心和呕吐入院。最初,患者被诊断为非ST段抬高型心肌梗死(NSTEMI)并接受治疗。此外,包括腹部计算机断层扫描及随后的血管造影在内的检查显示,腹腔干和SMA完全阻塞,而IMA开口处有90%的病变,伴有狭窄后扩张,并有侧支循环供应整个结肠。随后,通过经皮介入对IMA开口处病变进行了支架置入,患者症状和生活质量明显改善。总之,经皮血管内治疗为CMI提供了一种有利的策略,它既可能治愈疾病,也可能在确定性手术前实现营养优化。