Department of Vascular Surgery, Cleveland Clinic and Foundation, Cleveland, Ohio.
Department of Vascular Surgery, Cleveland Clinic and Foundation, Cleveland, Ohio.
J Vasc Surg. 2020 Jan;71(1):111-120. doi: 10.1016/j.jvs.2019.01.094. Epub 2019 Jul 18.
The objective of this study was to evaluate the contemporary results of interventions in the celiac axis (CA) and superior mesenteric artery (SMA) for chronic mesenteric ischemia (CMI) and factors associated with patency and symptom-free survival.
A retrospective review of patients with CMI treated with angioplasty and stenting with bare-metal stents from 2003 to 2014 was conducted. Demographic, history, risk factor, preoperative testing, and technical variables were collected and subject to univariate analysis, with end points of patency loss. The patients were divided into early (2003-2008) and late (2009-2014) groups to compare early and contemporary results. Correlates of patency were then subject to further univariate and multivariable analysis.
From 2003 to 2014, there were 150 patients (39 men, 111 women; age, 70.7 ± 11.1 years) with CMI who underwent interventions on the CA (56 vessels) and the SMA (133 vessels); 38 patients had both CA and SMA intervention. Primary patency for the CA was 86% (95% confidence interval [CI], 73-99) at 1 year and 66% (95% CI, 46-87) 3 years; for the SMA, primary patency was 81% (95% CI, 72-89) at 1 year and 69.0% (95% CI, 58-81) at 3 years. Increased age was associated with improved results in the SMA (hazard ratio [HR], 0.96; 95% CI, 0.92-1.00; P = .028). Chronic total occlusion in the SMA conferred worse patency compared with stenosis (HR, 2.38; 95% CI, 1.03-5.47; P = .042), and younger patients (<70 years) had a higher proportion of SMA occlusion (38.9% vs 22.8; P = .045). In the SMA, comparing early (2003-2008; 68 patients) vs late (2009-2014; 65 patients), primary patency was better in the late experience (3 years, 59% vs 77%; P = .016). The late cohort was older (early, 68.1 ± 12.5 years vs 72.5 ± 9.7 years; P = .024). The late cohort had a higher incidence of ostial flaring of the stent (early, 44.1%; late, 72.3%; P < .001). Multivariable analysis revealed only ostial flaring to be associated with improved patency in the SMA (HR, 0.29; 95% CI, 0.12-0.69; P = .006).
Intervention for CMI has acceptable midterm results, and with experience and adoption of newer techniques, the results appear to be improving. Patients older than 70 years have better results than younger patients, and this may reflect a more malignant presentation in the younger patients. Ostial flaring proved to be the single factor on multivariate analysis associated with improved patency and was adopted in the late group. These data support the continued use of bare-metal stents in the treatment of CMI.
本研究旨在评估用于慢性肠系膜缺血（CMI）的腹腔动脉（CA）和肠系膜上动脉（SMA）干预的当代结果，以及与通畅性和无症状生存相关的因素。
回顾性分析了 2003 年至 2014 年期间接受血管成形术和裸金属支架支架置入治疗的 CMI 患者。收集人口统计学、病史、危险因素、术前检查和技术变量，并进行单因素分析，终点为通畅性丧失。将患者分为早期（2003-2008 年）和晚期（2009-2014 年）两组，以比较早期和当代的结果。然后对通畅性的相关因素进行进一步的单因素和多因素分析。
2003 年至 2014 年间，有 150 例（39 名男性，111 名女性；年龄 70.7±11.1 岁）CMI 患者接受了 CA（56 支血管）和 SMA（133 支血管）干预；38 例患者同时接受了 CA 和 SMA 干预。CA 的主要通畅率为 1 年时 86%（95%置信区间 [CI]，73-99），3 年时 66%（95% CI，46-87）；SMA 的主要通畅率为 1 年时 81%（95% CI，72-89），3 年时 69.0%（95% CI，58-81）。年龄增加与 SMA 的结果改善相关（风险比 [HR]，0.96；95% CI，0.92-1.00；P=0.028）。SMA 中的慢性完全闭塞与狭窄相比，通畅性较差（HR，2.38；95% CI，1.03-5.47；P=0.042），年轻患者（<70 岁）的 SMA 闭塞比例更高（38.9% vs 22.8%；P=0.045）。在 SMA 中，与早期（2003-2008 年；68 例）相比，晚期（2009-2014 年；65 例）的主要通畅率在晚期经验中更好（3 年时，59% vs 77%；P=0.016）。晚期队列年龄较大（早期，68.1±12.5 岁 vs 72.5±9.7 岁；P=0.024）。晚期队列中支架口膨出的发生率较高（早期，44.1%；晚期，72.3%；P<0.001）。多因素分析显示，只有支架口膨出与 SMA 的通畅性改善相关（HR，0.29；95% CI，0.12-0.69；P=0.006）。
CMI 的介入治疗具有可接受的中期结果，随着经验的积累和新技术的采用，结果似乎在改善。年龄大于 70 岁的患者比年轻患者的结果更好，这可能反映了年轻患者的病情更为严重。支架口膨出在多因素分析中被证明是与通畅性改善相关的唯一因素，并且在晚期组中得到了采用。这些数据支持继续使用裸金属支架治疗 CMI。
