Université Paris Cité and Assistance Publique-Hôpitaux de Paris (APHP), Paris, France; Department of Vascular and Thoracic Surgery, Hôpital Bichat, APHP, Paris, France; SURVI (Structure d'URgences Vasculaires Intestinales, i.e., Intestinal Stroke Centre), Hôpitaux Beaujon/Bichat, APHP; Inserm, UMR_S 1140, Fondation Carpentier, Paris, France.
SURVI (Structure d'URgences Vasculaires Intestinales, i.e., Intestinal Stroke Centre), Hôpitaux Beaujon/Bichat, APHP.
Eur J Vasc Endovasc Surg. 2022 Dec;64(6):656-664. doi: 10.1016/j.ejvs.2022.08.032. Epub 2022 Sep 6.
This study aimed to report outcomes of patients with symptomatic acute isolated mesenteric artery dissection (IMAD) treated within a French intestinal stroke centre (ISC).
All patients with symptomatic IMAD referred to the ISC from January 2016 to January 2020 were included prospectively. Patients with aortic dissection and asymptomatic IMAD were not included. The standardised medical protocol included anticoagulation and antiplatelet therapy, gastrointestinal resting, and oral antibiotics. Operations were considered for acute mesenteric ischaemia (AMI).
Among the 453 patients admitted to an ISC during the study period, 34 (median age, 53 years [41 - 67]; 82% men) with acute symptomatic IMAD were included. According to the classification of Yun et al., IMADs were reported as follows: type I (n = 7, 20%), type IIa (n = 6, 18%), type IIb (n = 15, 44%), and type III (i.e., complete superior mesenteric artery [SMA] occlusion; n = 6, 18%). Overall, nine (26%) patients had AMI (type I/II, n = 3; type III, n = 6). On initial computerised tomography angiogram, nine (26%) patients had an associated visceral arterial dissection or pseudoaneurysm. All patients with types I/II (n = 28, 82%) followed a favourable clinical course with conservative therapy, with no need for any operation. All patients with type III (n = 6, 18%) underwent urgent laparotomy with SMA revascularisation (open, n = 4; stenting, n = 1) and or bowel resection (early, n = 3; late, n = 1). Rates of intestinal resection and short bowel syndrome were 12% and 8.8%, respectively. After a median follow up of 26 months [18 - 42], recurrence of symptoms occurred in four (12%) patients and aneurysmal change in 14 (41%), with no re-intervention.
Although IMAD was associated with a high frequency of AMI, a standardised protocol produced a low rate of intestinal resection. Conservative therapy seems appropriate in types I/II patients, whereas urgent SMA revascularisation should aim to avoid intestinal resection or death in type III patients.
本研究旨在报告在法国肠道卒中中心（ISC）接受治疗的有症状急性孤立性肠系膜动脉夹层（IMAD）患者的结局。
前瞻性纳入 2016 年 1 月至 2020 年 1 月期间因有症状 IMAD 而被转诊至 ISC 的所有患者。不包括主动脉夹层和无症状 IMAD 患者。标准化医疗方案包括抗凝和抗血小板治疗、胃肠道休息和口服抗生素。对于急性肠系膜缺血（AMI），则考虑手术。
在研究期间，ISC 共收治了 453 名患者，其中 34 名（中位年龄 53 岁[41-67]；82%为男性）为急性有症状 IMAD 患者。根据 Yun 等人的分类，IMAD 报告如下：I 型（n=7，20%）、IIa 型（n=6，18%）、IIb 型（n=15，44%）和 III 型（即完全肠系膜上动脉[SMA]闭塞；n=6，18%）。总体而言，9 名（26%）患者发生 AMI（I/II 型，n=3；III 型，n=6）。在初始计算机断层血管造影（CTA）上，9 名（26%）患者存在内脏动脉夹层或假性动脉瘤。所有 I/II 型（n=28，82%）患者均采用保守治疗，临床结局良好，无需任何手术。所有 III 型（n=6，18%）患者均接受紧急剖腹手术，行 SMA 血运重建（开放手术，n=4；支架植入术，n=1）和/或肠切除术（早期，n=3；晚期，n=1）。肠切除术和短肠综合征的发生率分别为 12%和 8.8%。中位随访 26 个月[18-42]后，4 名（12%）患者出现症状复发，14 名（41%）患者出现动脉瘤变化，均未再干预。
尽管 IMAD 与 AMI 发生率较高相关，但标准化方案使肠切除术的发生率较低。I/II 型患者采用保守治疗似乎较为合适，而 III 型患者则应紧急进行 SMA 血运重建，以避免肠切除术或死亡。
