Service de chirurgie Vasculaire et Thoracique, Hôpital Bichat, Hôpital Beaujon, AP-HP, Université de Paris, Paris, France; Structure d'Urgences Vasculaire Intestinale (SURVI), Hôpital Beaujon, AP-HP, Université de Paris, Paris, France.
Service de chirurgie Vasculaire et Thoracique, Hôpital Bichat, Hôpital Beaujon, AP-HP, Université de Paris, Paris, France; Structure d'Urgences Vasculaire Intestinale (SURVI), Hôpital Beaujon, AP-HP, Université de Paris, Paris, France.
J Vasc Surg. 2021 Sep;74(3):902-909.e3. doi: 10.1016/j.jvs.2021.02.038. Epub 2021 Mar 6.
Despite the continuing controversy of covered stents (CS) vs bare metal stents, the use of CS in mesenteric occlusive disease (MOD) has been recommended by expert centers. The aim of this study was to report midterm results with CS of the superior mesenteric artery.
Between January 2014 and October 2019, patients with MOD with a severe atheromatous stenosis or occlusion of the superior mesenteric artery treated by mesenteric CS were included. Clinical presentation included both acute mesenteric ischemia (AMI), chronic mesenteric ischemia, and asymptomatic patients planned for major surgery. Demographics, procedure details, and follow-up data were prospectively collected and retrospectively reviewed. Study end points included primary patency, primary assisted patency, and secondary patency.
During the study period, 86 patients (mean age, 70 ± 9 years; 57% males) were included. Clinical presentation was AMI (n = 42 [49%]), chronic mesenteric ischemia (n = 31 [36%]), and asymptomatic (n = 13 [15%]). The technical success rate was 97%. A total of 96 stents were implanted, including 86 proximal CS (Advanta V12, n = 73; Lifestream, n = 13). The mean length and mean diameter of the CS were 31.5 ± 6.3 mm and 6.9 ± 0.5 mm, respectively. Additional distal bare metal stents were used in 10 patients (12%) to overcome a kinking (n = 9) or a dissection (n = 1) downstream of the CS. All postoperative deaths occurred in patients with AMI (n = 11, 13%). During a median follow-up of 15.6 months (95% confidence interval [CI], 15.6 ± 3.6 months), 12 patients (14%) underwent reinterventions for either stent misplacement (n = 3), stent recoil (n = 3), stent thrombosis (n = 2), de novo stenosis at the distal edge of the CS (n = 2), or gastric ischemia (n = 1). At 1 year, overall the primary patency, primary assisted patency, and secondary patency rates were 83% (95% CI, 83% ± 9%), 99% (95% CI, 99% ± 3%), and 99% (95% CI, 99% ± 3%), respectively. At 2 years, the overall primary patency, primary assisted patency, and secondary patency rates were 76% (95% CI, 76% ± 13%), 95% (95% CI, 95% ± 8%) and 95% (95% CI, 95% ± 8%), respectively.
Mesenteric CS provide very satisfactory midterm results in patients with MOD, with an excellent primary assisted patency rate at 2 years, at the price of a significant reintervention rate.
尽管覆膜支架（CS）与裸金属支架（BMS）的争议仍在继续，但专家中心推荐在肠系膜闭塞性疾病（MOD）中使用 CS。本研究旨在报告肠系膜上动脉 CS 的中期结果。
2014 年 1 月至 2019 年 10 月，我们对因严重动脉粥样硬化性狭窄或肠系膜上动脉闭塞而接受 MOD 治疗的患者进行了肠系膜 CS 治疗。临床表现包括急性肠系膜缺血（AMI）、慢性肠系膜缺血和计划进行重大手术的无症状患者。前瞻性收集了人口统计学、手术细节和随访数据，并进行了回顾性分析。研究终点包括主要通畅率、辅助通畅率和次要通畅率。
在研究期间，共纳入 86 例患者（平均年龄 70±9 岁，57%为男性）。临床表现为 AMI（n=42 [49%]）、慢性肠系膜缺血（n=31 [36%]）和无症状（n=13 [15%]）。技术成功率为 97%。共植入 96 枚支架，包括 86 枚近端 CS（Advanta V12，n=73；Lifestream，n=13）。CS 的平均长度和平均直径分别为 31.5±6.3mm 和 6.9±0.5mm。为克服 CS 下游的扭曲（n=9）或夹层（n=1），10 例患者（12%）还使用了额外的远端 BMS。所有术后死亡均发生在 AMI 患者（n=11，13%）中。在中位随访 15.6 个月（95%置信区间 [CI]，15.6±3.6 个月）期间，12 例患者（14%）因支架放置不当（n=3）、支架回缩（n=3）、支架血栓形成（n=2）、CS 远端边缘新发狭窄（n=2）或胃缺血（n=1）而再次接受介入治疗。1 年时，总的主要通畅率、辅助通畅率和次要通畅率分别为 83%（95%CI，83%±9%）、99%（95%CI，99%±3%）和 99%（95%CI，99%±3%）。2 年时，总的主要通畅率、辅助通畅率和次要通畅率分别为 76%（95%CI，76%±13%）、95%（95%CI，95%±8%）和 95%（95%CI，95%±8%）。
肠系膜 CS 为 MOD 患者提供了非常满意的中期结果，2 年时辅助通畅率非常高，但再干预率也很高。
