Miyayama Shiro, Yamashiro Masashi, Ikeda Rie, Yokka Akira, Komiya Hideaki, Sakuragawa Naoko, Terada Takuro, Yamamoto Hidekazu
Department of Diagnostic Radiology, Fukui-ken Saiseikai Hospital, Japan.
Department of Hepatobiliary-Pancreatic Surgery, Fukui-ken Saiseikai Hospital, Japan.
Interv Radiol (Higashimatsuyama). 2023 Nov 1;8(3):173-183. doi: 10.22575/interventionalradiology.2023-0005.
Injury of the visceral artery is a potentially fatal complication of iatrogenic procedures, trauma, and tumors. A stent graft can achieve rapid exclusion of the injured arterial portion and minimize the risk of ischemic complications by preserving arterial flow to organs. Although various types of stent grafts are available worldwide, Viabahn has only been approved for visceral arterial injury in Japan. The reported technical and clinical success rates, including cases with injured pelvic or thoracic arterial branches, are 80%-100% and 66.7%-100%, respectively. Severe ischemic complications are rare; however, fatal ischemia occurs when the stent graft is immediately occluded. The necessity of antiplatelet therapy is controversial, and a target artery diameter ≤ 4 mm is a significantly higher risk factor of stent-graft occlusion.
内脏动脉损伤是医源性操作、创伤和肿瘤潜在的致命并发症。覆膜支架可快速封闭受损动脉段,并通过维持器官动脉血流将缺血并发症风险降至最低。尽管全球有多种类型的覆膜支架,但Viabahn仅在日本被批准用于内脏动脉损伤。报道的技术成功率和临床成功率,包括盆腔或胸段动脉分支损伤病例,分别为80%-100%和66.7%-100%。严重缺血并发症罕见;然而,覆膜支架立即闭塞时会发生致命性缺血。抗血小板治疗的必要性存在争议,且靶动脉直径≤4 mm是覆膜支架闭塞的显著高危因素。