Department of Vascular Surgery, The Second Affiliated Hospital of Zhejiang, University's Medical School, Hangzhou, 310051, Zhejiang, China.
Department of General Surgery, The Second Affiliated Hospital of Zhejiang, University's Medical School, Hangzhou, 310051, Zhejiang, China.
Updates Surg. 2024 Aug;76(4):1169-1181. doi: 10.1007/s13304-024-01821-7. Epub 2024 Mar 28.
The role of endovascular stent therapy (EST) in the treatment of spontaneous isolated superior mesenteric artery dissection (SISMAD) has gained momentum in recent years but remains controversial. We gathered research examining the advantages and disadvantages of EST for SISMAD patients. Primary outcomes involved both immediate and long-term results. Random or fixed effect models were used for effect size (ES) calculation with 95% confidence interval (CI) based on 50% heterogeneity threshold. Our analysis incorporated data from 21 studies including 611 SISMAD cases treated by EST. Our findings show a complication rate of approximately 1% following EST (95%CI 0.01-0.02, I = 0%, P = 0.97), with a bare minimum mortality rate of < 1% (95%CI 0.00-0.01, I = 0%, P > 0.05) and a reintervention rate of < 1% (95%CI 0.00-0.01, I = 0%, P = 0.89). We also found technique success and symptom resolution approaching 94% and 99%, respectively, in the immediate postoperative phase. In the long run, we observed a recurrence of symptoms at 3% (95%CI 0.00-0.06, I = 58.6%, P < 0.01), creation of new dissections at 1% (95%CI 0.00-0.02, I = 0%, P = 0.73), aneurysm progression at 2% (95%CI 0.00-0.03, I = 42.7%, P = 0.12), reintervention due to complications at 3% (95%CI 0.00-0.05, I = 0%, P = 0.43) and stenotic stents at 12% (95%CI 0.04-0.23, I = 77.5%, P < 0.01). Nevertheless, high levels of stent patency 98% (95% CI 0.97-1.00, I = 0%, P = 0.51) and complete remodeling 88% (95% CI 0.82-0.94, I = 65.5%, P < 0.05) were observed postoperatively. Overall, EST presents minimal complications and promising long-term outcomes for SISMAD, although the prevalence of stent stenosis requires further attention.
血管内支架治疗（EST）在自发性孤立性肠系膜上动脉夹层（SISMAD）治疗中的作用近年来备受关注，但仍存在争议。我们收集了研究 EST 治疗 SISMAD 患者的优缺点的研究。主要结果包括即时和长期结果。根据 50%的异质性阈值，使用随机或固定效应模型计算效应大小（ES），置信区间为 95%。我们的分析纳入了 21 项研究的数据，包括 611 例接受 EST 治疗的 SISMAD 病例。我们的研究结果显示，EST 后并发症发生率约为 1%（95%CI 0.01-0.02，I=0%，P=0.97），死亡率极低<1%（95%CI 0.00-0.01，I=0%，P>0.05），再干预率<1%（95%CI 0.00-0.01，I=0%，P=0.89）。我们还发现，术后即刻阶段的技术成功率和症状缓解率分别接近 94%和 99%。从长远来看，我们观察到 3%的症状复发率（95%CI 0.00-0.06，I=58.6%，P<0.01），1%的新发夹层形成率（95%CI 0.00-0.02，I=0%，P=0.73），2%的动脉瘤进展率（95%CI 0.00-0.03，I=42.7%，P=0.12），3%的并发症再干预率（95%CI 0.00-0.05，I=0%，P=0.43），12%的狭窄支架率（95%CI 0.04-0.23，I=77.5%，P<0.01）。然而，术后支架通畅率高达 98%（95% CI 0.97-1.00，I=0%，P=0.51），完全重构率为 88%（95% CI 0.82-0.94，I=65.5%，P<0.05）。总体而言，EST 治疗 SISMAD 并发症少，长期疗效好，但支架狭窄的发生率仍需进一步关注。
