Department of Vascular and Thoracic Surgery, Bichat Hospital, Paris (Assistance Publique Hôpitaux de Paris - AP-HP), France; SURVI (Structure d'URgences Vasculaires Intestinales), Intestinal Stroke Centre, Assistance Publique Hôpitaux de Paris (AP-HP), France; Université de Paris, Paris, France.
Department of Vascular and Thoracic Surgery, Bichat Hospital, Paris (Assistance Publique Hôpitaux de Paris - AP-HP), France; SURVI (Structure d'URgences Vasculaires Intestinales), Intestinal Stroke Centre, Assistance Publique Hôpitaux de Paris (AP-HP), France; Université de Paris, Paris, France.
Eur J Vasc Endovasc Surg. 2021 Jul;62(1):55-63. doi: 10.1016/j.ejvs.2021.03.019. Epub 2021 May 6.
To report the intra-operative adverse events (IOAEs) and the initial and one year outcomes of retrograde open mesenteric stenting (ROMS) using balloon expandable covered stents for acute and chronic mesenteric ischaemia.
Clinical data and outcomes of all consecutive patients treated with ROMS for acute and chronic mesenteric ischaemia at an intestinal stroke centre between November 2012 and September 2019 were reviewed. ROMS was performed using balloon expandable covered stents. Endpoints included IOAEs, in hospital mortality, post-operative complications, and re-interventions. One year overall survival, freedom from re-intervention, primary patency and assisted primary patency rates were analysed using the Kaplan-Meier time to event method.
During the study period, 379 patients were referred to the centre for acute or chronic mesenteric ischaemia. Thirty-seven patients who underwent the ROMS procedure were included. All the patients had severe atherosclerotic mesenteric lesions. The ROMS technical success rate was 89% in this cohort. The rate of IOAEs was 19% and included four cases of retrograde recanalisation failure. All ROMS failures occurred in patients presenting with flush superior mesenteric artery occlusion and they were treated by mesenteric bypass. Ten patients (27%) underwent bowel resection, four of which resulted in a short bowel syndrome (11%). The in hospital mortality rate was 27%. Post-operative complications and re-intervention rates were 67% (n = 25) and 32% (n = 12), respectively. The median follow up was 20.2 months (interquartile range 29). The estimated one year overall survival for the cohort was 70.1% (95% confidence interval [CI] 52.5% - 82.2%). The estimated freedom from re-intervention at one year was 61.1% (95% CI 42.3 - 75.4). The one year primary patency and assisted primary patency rates were 84.54% (95% CI 63.34 - 94) and 92.4% (95% CI 72.8 - 98), respectively.
ROMS procedures offer acceptable one year outcomes for mesenteric ischaemia but are associated with frequent stent related complications. Precise pre-operative planning, high quality imaging, and meticulous stent placement techniques may limit the occurrence of such events.
报告使用球囊扩张覆膜支架治疗急性和慢性肠系膜缺血时逆行开放式肠系膜支架置入术（ROMS）的术中不良事件（IOAEs）和初始及 1 年结果。
回顾 2012 年 11 月至 2019 年 9 月期间在肠道卒中中心接受 ROMS 治疗的急性和慢性肠系膜缺血的所有连续患者的临床数据和结局。ROMS 使用球囊扩张覆膜支架进行。终点包括 IOAEs、住院死亡率、术后并发症和再介入。使用 Kaplan-Meier 时间事件方法分析 1 年总生存率、免于再介入率、初始通畅率和辅助初始通畅率。
在研究期间，379 名患者因急性或慢性肠系膜缺血被转介到该中心。37 名接受 ROMS 手术的患者被纳入该研究。所有患者均有严重的粥样硬化性肠系膜病变。该队列中 ROMS 技术成功率为 89%。IOAEs 的发生率为 19%，包括 4 例逆行再通失败。所有 ROMS 失败均发生在表现为 flush 肠系膜上动脉闭塞的患者中，他们接受了肠系膜旁路治疗。10 名患者（27%）接受了肠切除术，其中 4 名患者出现短肠综合征（11%）。住院死亡率为 27%。术后并发症和再介入率分别为 67%（n=25）和 32%（n=12）。中位随访时间为 20.2 个月（四分位间距 29）。该队列的 1 年总生存率估计为 70.1%（95%置信区间 [CI] 52.5% - 82.2%）。1 年免于再介入率估计为 61.1%（95% CI 42.3% - 75.4%）。1 年原发性通畅率和辅助原发性通畅率分别为 84.54%（95% CI 63.34% - 94%）和 92.4%（95% CI 72.8% - 98%）。
ROMS 手术为肠系膜缺血提供了可接受的 1 年结果，但与频繁的支架相关并发症相关。术前精确计划、高质量成像和精心的支架放置技术可能会限制此类事件的发生。
