Mizuno Atsushi, Iguchi Hayato, Sawada Yuuka, Nomura Hiroshi, Komiyama Nobuyuki, Watanabe Sachiko, Yoshikawa Aki
St. Luke's International Hospital, Tokyo, Japan.
Global Health Consulting Japan Co. Ltd, Tokyo, Japan.
J Cardiol. 2018 Feb;71(2):155-158. doi: 10.1016/j.jjcc.2017.08.006. Epub 2017 Sep 30.
Due to the rarity of this condition, clinical treatment and outcomes in isolated superior mesenteric artery dissection (ISMAD) patients remain unknown. The primary aim of this retrospective multicenter study was to elucidate the treatment strategies and in-hospital outcomes for ISMAD patients by using administrative data.
We retrospectively analyzed patients that were primarily diagnosed with ISMAD using the Diagnosis Procedure Combination data collected at 141 hospitals in Japan in 2015. Patients with comorbidities that included "aneurysm" were excluded.
A total of 221 ISMAD without aneurysm patients (male: 90.5%; mean age: 52.5±10.1 years) were enrolled, and 95 (67.4%) of these encountered just one ISMAD case per year. We found only one (0.5%) in-hospital death and length of stay for ISMAD patients was 13.2±9.1 days. One-third of patients received antiplatelet therapy (32.1%) and anticoagulation therapies, such as heparin (38.9%) and warfarin (10.0%). A total of 146 (66.1%) patients received antihypertensive treatment (either orally or via an intravenous route) during hospitalization. Twelve (5.4%) patients underwent surgical procedures during hospitalization as follows: 4 (33.3%) patients underwent bypass surgery, 3 (25.0%) patients underwent exploratory laparotomies, 2 (16.7%) patients underwent bowel resection, 1 (8.3%) patient underwent a thrombectomy, and 2 (16.7%) patients underwent surgical angioplasties.
We found that conservative therapy for ISMAD patients without aneurysm is safe and is also associated with a low rate of surgical intervention in clinical practice.
由于这种疾病较为罕见，孤立性肠系膜上动脉夹层（ISMAD）患者的临床治疗及预后情况尚不明确。这项回顾性多中心研究的主要目的是利用管理数据阐明ISMAD患者的治疗策略及住院期间的预后情况。
我们回顾性分析了2015年在日本141家医院收集的诊断程序组合数据中初诊为ISMAD的患者。排除患有包括“动脉瘤”在内的合并症的患者。
共纳入221例无动脉瘤的ISMAD患者（男性占90.5%；平均年龄52.5±10.1岁），其中95例（67.4%）每年仅遇到1例ISMAD病例。我们发现住院期间仅有1例（0.5%）死亡，ISMAD患者的住院时长为13.2±9.1天。三分之一的患者接受了抗血小板治疗（32.1%）以及抗凝治疗，如肝素（38.9%）和华法林（10.0%）。共有146例（66.1%）患者在住院期间接受了降压治疗（口服或静脉途径）。12例（5.4%）患者在住院期间接受了手术，具体如下：4例（33.3%）患者接受了搭桥手术，3例（25.0%）患者接受了剖腹探查术，2例（16.7%）患者接受了肠切除术，1例（8.3%）患者接受了血栓切除术，2例（16.7%）患者接受了手术血管成形术。
我们发现，对于无动脉瘤的ISMAD患者而言，保守治疗是安全的，且在临床实践中手术干预率也较低。
