Department of Interventional Radiology, First People's Hospital of Changzhou (Affiliated Hospital of Soochow University), Changzhou, China 213000.
Department of Interventional Radiology, Wujin People's Hospital, Jiangsu University, Changzhou, China 213003.
J Vasc Interv Radiol. 2021 Jan;32(1):49-55. doi: 10.1016/j.jvir.2020.09.002. Epub 2020 Nov 25.
To investigate the safety and effectiveness of primary conservative therapy for patients with symptomatic isolated mesenteric artery dissection (IMAD) with a severely compressed true lumen and/or a large dissecting aneurysm.
A total of 35 consecutive patients (all men; median age, 53 y) with symptomatic IMAD with a severely compressed true lumen and/or a large dissecting aneurysm but without intestinal necrosis or arterial rupture who were treated with primary conservative therapy between November 2018 and February 2020 were assessed. A severely compressed true lumen was defined as luminal stenosis > 70%. A large dissecting aneurysm was defined as dissecting aneurysm diameter ≥ 1.5 times larger than the normal mesenteric artery diameter.
There was a strong positive relationship among abdominal pain, degree of luminal stenosis, and length of dissection (R = 0.811; P < .001). Conservative treatment was successful in all patients. Abdominal pain was eliminated within 4.7 d ± 4.8 (range, 2-31 d) in all patients, within 3.6 d ± 1.2 (range, 2-6) in the 31 patients with minor or moderate abdominal pain, and within 13.3 d ± 11.9 (range, 6-31 d) in the 4 patients with severe abdominal pain. Complete or partial remodeling of the mesenteric artery was achieved in 6 (17.1%) and 29 (82.9%) patients, respectively, during 8.6 mo ± 4.3 of follow-up.
Primary conservative therapy can be used safely and effectively in patients with symptomatic IMAD with a severely compressed true lumen and/or a large dissecting aneurysm but without intestinal necrosis or arterial rupture.
研究对有症状孤立性肠系膜动脉夹层（IMAD）、真腔严重狭窄和/或大夹层动脉瘤但无肠坏死或动脉破裂的患者进行单纯保守治疗的安全性和有效性。
对 2018 年 11 月至 2020 年 2 月期间接受单纯保守治疗的 35 例有症状 IMAD 且真腔严重狭窄和/或大夹层动脉瘤但无肠坏死或动脉破裂的连续患者（均为男性；中位年龄 53 岁）进行评估。真腔严重狭窄定义为管腔狭窄＞70%。大夹层动脉瘤定义为夹层动脉瘤直径大于正常肠系膜动脉直径的 1.5 倍。
腹痛、管腔狭窄程度和夹层长度之间存在很强的正相关关系（R=0.811；P＜0.001）。所有患者的保守治疗均成功。所有患者腹痛均在 4.7 d±4.8（范围 2-31 d）内消除，31 例腹痛较轻或中度的患者在 3.6 d±1.2（范围 2-6）内消除，4 例腹痛严重的患者在 13.3 d±11.9（范围 6-31 d）内消除。在 8.6 mo±4.3 的随访中，分别有 6（17.1%）例和 29（82.9%）例患者肠系膜动脉完全或部分重塑。
对有症状 IMAD 且真腔严重狭窄和/或大夹层动脉瘤但无肠坏死或动脉破裂的患者，单纯保守治疗安全有效。
