Ben Hammamia M, Ben Mrad M, Hadhri S, Tarzi M, Miri R, Ghedira F, Derbel B, Ben Omrane S, Kalfat T, Ziadi J, Denguir R
Service de chirurgie cardiovasculaire La Rabta, université de Tunis El Manar, Tunis, Tunisie.
Service de chirurgie cardiovasculaire La Rabta, université de Tunis El Manar, Tunis, Tunisie.
J Med Vasc. 2019 Sep;44(5):318-323. doi: 10.1016/j.jdmv.2019.06.001. Epub 2019 Aug 19.
Atherosclerosis occurring in the digestive arteries is rare and often asymptomatic. When it becomes symptomatic, surgical care is indicated. Conventional procedures are giving way to improved endovascular techniques applied to the mesenteric arteries. The aim of this single-center study was to evaluate short- and mid-term outcome after endovascular revascularization of the mesenteric arteries.
We report a retrospective study about patients who underwent endovascular treatment of chronic mesenteric ischemia between 2013 and 2018.
Our population consisted of 10 patients. The average age was 60 years [range 45-78]. Clinical symptomatology associated abdominal pain and weight loss. All patients underwent computed tomographic angiography (CTA). Severe stenosis (>70%) involved the superior mesenteric artery (SMA) in ten cases, the celiac trunk in four cases and the inferior mesenteric artery in three. The procedure was performed under local anesthesia in all cases. The superior mesenteric artery was revascularized in all cases and the celiac trunk in two. Transluminal angioplasty was followed by deployment of a stent in all cases. The postoperative course was satisfactory. Outcome was good with all patients being symptom-free at one month. Our average follow-up was three years [range 1-5]. All patients underwent a Duplex ultrasound every six months. Recurrence of symptomatology was reported in two patients at 18 months and 24 months. The first patient underwent CTA that showed superior mesenteric artery and celiac trunk stent stenosis. The patient underwent a second transluminal angioplasty with a drug eluting balloon. The second patient was admitted to the emergency room for acute mesenteric ischemia related to acute thrombosis of the superior mesenteric artery stent. Laparotomy enabled extensive resection of the small bowel and aorto-mesenteric venous antegrade bypass, but the patient died the same day.
Endovascular treatment has an important role to play in the management of chronic mesenteric ischemia. It is associated with a high rate of technical success. Patients should be carefully followed-up because of the mid-term risk of recurrent symptoms associated with intra-stent restenosis or thrombosis.
发生于消化动脉的动脉粥样硬化较为罕见，且通常无症状。当出现症状时，则需进行手术治疗。传统手术正逐渐被应用于肠系膜动脉的改良血管内技术所取代。本单中心研究的目的是评估肠系膜动脉血管内血运重建术后的短期和中期疗效。
我们报告一项关于2013年至2018年间接受慢性肠系膜缺血血管内治疗患者的回顾性研究。
我们的研究对象包括10例患者。平均年龄为60岁[范围45 - 78岁]。临床症状包括腹痛和体重减轻。所有患者均接受了计算机断层血管造影（CTA）检查。严重狭窄（>70%）累及肠系膜上动脉（SMA）10例，腹腔干4例，肠系膜下动脉3例。所有病例均在局部麻醉下进行手术。所有病例均成功实现肠系膜上动脉血运重建，2例实现腹腔干血运重建。所有病例在腔内血管成形术后均植入了支架。术后过程顺利。所有患者在1个月时均无症状，疗效良好。我们的平均随访时间为3年[范围1 - 5年]。所有患者每6个月接受一次双功超声检查。2例患者分别在18个月和24个月时出现症状复发。第一例患者接受CTA检查显示肠系膜上动脉和腹腔干支架狭窄。该患者接受了第二次使用药物洗脱球囊的腔内血管成形术。第二例患者因肠系膜上动脉支架急性血栓形成导致急性肠系膜缺血而入住急诊室。剖腹手术进行了广泛的小肠切除和主动脉 - 肠系膜静脉顺行旁路手术，但患者于同日死亡。
血管内治疗在慢性肠系膜缺血的管理中发挥着重要作用。其技术成功率较高。由于存在与支架内再狭窄或血栓形成相关的中期症状复发风险，应对患者进行密切随访。
