Otsuka Hiroyuki, Sato Toshiki, Aoki Hiromichi, Nakagawa Yoshihide, Inokuchi Sadaki
Department of Emergency and Critical Care Medicine, Tokai University School of Medicine, Isehara City, Japan.
Vascular. 2018 Apr;26(2):169-174. doi: 10.1177/1708538117722879. Epub 2017 Aug 22.
Objectives To describe our clinical experiences and recommend a management strategy for spontaneous isolated dissection of a visceral artery. Methods A retrospective study of patients from December 2005 to December 2015 was performed. Thirty-two patients had spontaneous isolated dissection of a visceral artery. Clinical features, computed tomography findings, the treatment method, and follow-up results were evaluated. Results There were 28 men and 4 women (mean age, 54 years). Dissection locations were the celiac artery in 10, superior mesenteric artery in 17, and celiac artery and superior mesenteric artery in 5 patients. Celiac artery stenosis existed with spontaneous isolated dissection of a visceral artery at a high rate. After diagnosis, the blood pressure of all patients was immediately controlled to a lower level. Three patients with arterial rupture and one patient with bowel infarction underwent operations for complications. Overall, the treatment of dissection involved drug therapy alone. The last follow-up computed tomography results of the true lumen residual ratio and the length of the dissected artery improved compared to the values on admission; the maximum diameter of the dissected artery did not enlarge. Eleven patients almost completely improved. No patients had any adverse event. Conclusions Most patients with spontaneous isolated dissection of a visceral artery can be first treated conservatively for dissection with strict blood pressure control and surveillance.
目的 描述我们的临床经验，并推荐一种针对自发性孤立性内脏动脉夹层的管理策略。方法 对2005年12月至2015年12月期间的患者进行回顾性研究。32例患者发生自发性孤立性内脏动脉夹层。评估临床特征、计算机断层扫描结果、治疗方法及随访结果。结果 男性28例，女性4例（平均年龄54岁）。夹层部位：腹腔干动脉10例，肠系膜上动脉17例，腹腔干动脉和肠系膜上动脉5例。腹腔干动脉狭窄在自发性孤立性内脏动脉夹层中发生率较高。诊断后，所有患者血压立即控制在较低水平。3例动脉破裂患者和1例肠梗死患者因并发症接受手术。总体而言，夹层的治疗仅涉及药物治疗。与入院时相比，最后一次随访计算机断层扫描的真腔残留率和夹层动脉长度结果有所改善；夹层动脉的最大直径未扩大。11例患者几乎完全康复。无患者出现任何不良事件。结论 大多数自发性孤立性内脏动脉夹层患者可首先采用严格控制血压和监测的保守治疗方法。
