Blauw Juliëtte, Bulut Tomas, Eenhoorn Paul, Beuk Roland J, Brusse-Keizer Marjolein, Kolkman Jeroen J, Geelkerken Robert H
Division of Vascular Surgery, Department of Surgery, Medical Spectrum Twente, Enschede, The Netherlands.
Department of Surgery, Isala Clinics, Zwolle, The Netherlands.
J Cardiovasc Surg (Torino). 2017 Apr;58(2):321-328. doi: 10.23736/S0021-9509.16.09829-3. Epub 2016 Dec 19.
Studies that compared open surgical mesenteric artery repair (OSMAR) with percutaneous mesenteric artery stenting (PMAS) in patients with chronic mesenteric ischemia (CMI) are based on merely older studies in which only a minority of patients received PMAS. This does not reflect the current PMAS-first choice treatment paradigm. This article focused on the present opinions and changes in outcomes of OSMAR for CMI in the era of preferred use of PMAS.
Patients who received OSMAR for CMI from 1997 until 2014 in a tertiary referral centre for chronic mesenteric ischemia were included in this report. Patients were divided into two groups, the historical OSMAR preferred group and present PMAS preferred group.
Patient characteristics, SVS comorbidity severity score, clinical presentation and number of diseased mesenteric arteries were not significantly changed after the widespread introduction of PMAS. In the present PMAS first era there were trends of less open surgical mesenteric artery multivessel repair, less antegrade situated bypasses, decreased clinical success but improved survival after OSMAR.
Elective OSMAR should only be used in patients with substantial physiologic reserve and who have unfavourable mesenteric lesions, failed PMAS or multiple recurrences of in-stent stenosis/occlusion. PMAS in CMI patients is evolved from "bridge to surgery" to nowadays first choice treatment and "bridge to repeated PMAS" in almost all patients with CMI.
比较开放性肠系膜动脉修复术（OSMAR）与经皮肠系膜动脉支架置入术（PMAS）治疗慢性肠系膜缺血（CMI）患者的研究仅基于早期研究，其中只有少数患者接受了PMAS。这并不能反映当前以PMAS为首选治疗的模式。本文聚焦于在优先使用PMAS的时代，关于OSMAR治疗CMI的当前观点及结果变化。
本报告纳入了1997年至2014年在一家慢性肠系膜缺血三级转诊中心接受OSMAR治疗CMI的患者。患者分为两组，即历史上OSMAR优先组和当前PMAS优先组。
在广泛引入PMAS后，患者特征、血管外科学会合并症严重程度评分、临床表现及肠系膜动脉病变数量均无显著变化。在当前以PMAS为先的时代，开放性肠系膜动脉多支血管修复术减少、顺行旁路手术减少、临床成功率降低，但OSMAR术后生存率提高。
选择性OSMAR仅应用于生理储备充足、肠系膜病变不利、PMAS失败或支架内狭窄/闭塞多次复发的患者。CMI患者的PMAS已从“手术桥梁”演变为如今几乎所有CMI患者的首选治疗以及“重复PMAS的桥梁”。
