Guo Baolei, Guo Daqiao, Xu Xin, Chen Bin, Jiang Junhao, Yang Jue, Shi Zhenyu, Fu Weiguo
1 Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, People Republic of China.
Vasc Endovascular Surg. 2017 Oct;51(7):453-459. doi: 10.1177/1538574417720364. Epub 2017 Aug 2.
Chronic mesenteric ischemia (CMI) is an uncommon condition encountered by clinicians. Presentation may vary from asymptomatic to classical intestinal ischemia, although a clear pathophysiology has yet to be elucidated. Here, we have presented our institution's experience in the management of symptomatic CMI.
From February 2007 to February 2016, a retrospective study was performed of all consecutive patients with symptomatic CMI managed by endovascular treatment (ET). We reviewed these patients' demographics, comorbidities, clinical presentations, and treatment modalities. Perioperative and midterm outcomes included technical success, clinical symptom relief, complications, symptomatic recurrence, mortality, restenosis, and reintervention.
Thirty-five mesenteric arteries (74.3% stenotic/25.7% occluded) identified in 32 patients (12 females, 20 males) were treated with endovascular procedures. There were no 30-day deaths; the perioperative complication rate was 12.5%. Overall, the median postprocedural time to symptom relief was 7.6 days (range: 1-30 days). Twenty-two (68.8%) had complete remission of symptom, whereas 7 (21.9%) had partial improvement in symptom after ET. After a mean follow-up of 35.4 (25.9) months, 5 (15.6%) patients developed recurrent symptoms, with 4 requiring reinterventions. The primary patency was 93.7%, 82.6%, and 73.1% at 12, 24, and 36 months, respectively, and the freedom from symptomatic recurrence was 90.6%, 84.0%, 84.0%, and 84.0% at 6, 12, 24, and 36 months, respectively.
Endovascular treatment for patients with CMI had a high technical success rate and satisfactory clinical outcomes. Symptomatic recurrence was not frequent but found mainly within 12 months following the initial procedure.
慢性肠系膜缺血（CMI）是临床医生较少遇到的一种疾病。其表现可能从无症状到典型的肠道缺血各不相同，尽管确切的病理生理学机制尚未阐明。在此，我们介绍了本机构对有症状CMI的治疗经验。
2007年2月至2016年2月，对所有接受血管内治疗（ET）的连续性有症状CMI患者进行了一项回顾性研究。我们回顾了这些患者的人口统计学特征、合并症、临床表现和治疗方式。围手术期和中期结果包括技术成功率、临床症状缓解情况、并发症、症状复发、死亡率、再狭窄和再次干预情况。
32例患者（12例女性，20例男性）共35条肠系膜动脉（74.3%狭窄/25.7%闭塞）接受了血管内治疗。无30天死亡病例；围手术期并发症发生率为12.5%。总体而言，术后症状缓解的中位时间为7.6天（范围：1 - 30天）。22例（68.8%）症状完全缓解，而7例（21.9%）在ET后症状部分改善。平均随访35.4（25.9）个月后，5例（15.6%）患者出现复发症状，其中4例需要再次干预。12个月、24个月和36个月时的主要通畅率分别为93.7%、82.6%和73.1%，6个月、12个月、24个月和36个月时无症状复发的自由度分别为90.6%、84.0%、84.0%和84.0%。
CMI患者的血管内治疗技术成功率高，临床效果满意。症状复发并不常见，但主要发生在初次手术后12个月内。
