Yang Yimin, Han Tonglei, Lin Changpo, Luan Jingyang, Yang Jizhou, Mao Le, Fu Weiguo, Guo Daqiao, Zhu Ting
Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.
Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.
Asian J Surg. 2024 Aug 28. doi: 10.1016/j.asjsur.2024.08.046.
This study aims to assess the clinical results of endovascular intervention for spontaneous isolated superior mesenteric artery dissection (SISMAD) and its impact on superior mesenteric artery (SMA) remodeling in comparison to solely medical management.
All patients with SISMAD between January 2015 and August 2023 were included. The primary endpoints were the absence of major adverse events (MAEs), including dissection-related mortality, recurrence of mesenteric ischemia symptoms, and the necessity for intervention. The secondary endpoints were stenosis or occlusion of the SMA and morphologic remodeling of the dissections.
A total of 217 SISMAD patients were included. In this study, 127 (58.5 %) patients received medical management alone (conservative group), and 90 (41.5 %) underwent endovascular therapy (EVT group). In the EVT group, the technical success rate was 94.4 % (85/90). During follow-up, 13 (6.0 %) patients experienced MAEs, and 1 patient in the conservative group death related to SISMAD. The patients in EVT group showed more complete remodeling than those in the conservative group (76 (84.4 %) vs 66 (52.0 %), P < .0001). Survival analysis showed that the estimated MAEs-free survival rates were97.8 %, 95.6 %, and 95.6 % in EVT group and 98.4 %, 94.5 %, 92.9 % in conservative group at one, two, and three years, respectively. No significant difference was observed in both groups.
The findings indicate that both endovascular treatment and medical management alone yield comparable rates of MAE-free survival among patients with SISMAD. Additionally, endovascular therapy exhibits a higher rate of complete remodeling and greater freedom from stenosis or occlusion of the SMA.
本研究旨在评估血管内介入治疗自发性孤立性肠系膜上动脉夹层（SISMAD）的临床结果，以及与单纯药物治疗相比，其对肠系膜上动脉（SMA）重塑的影响。
纳入2015年1月至2023年8月期间所有患有SISMAD的患者。主要终点是无主要不良事件（MAE），包括夹层相关死亡率、肠系膜缺血症状复发以及干预的必要性。次要终点是SMA的狭窄或闭塞以及夹层的形态重塑。
共纳入217例SISMAD患者。在本研究中，127例（58.5%）患者仅接受药物治疗（保守组），90例（41.5%）接受血管内治疗（EVT组）。在EVT组中，技术成功率为94.4%（85/90）。随访期间，13例（6.0%）患者发生MAE，保守组有1例患者死于SISMAD。EVT组患者的重塑比保守组更完全（76例（84.4%）对66例（52.0%），P <.0001）。生存分析显示，EVT组在1年、2年和3年时无MAE的估计生存率分别为97.8%、95.6%和95.6%，保守组分别为98.4%、94.5%、92.9%。两组之间未观察到显著差异。
研究结果表明，血管内治疗和单纯药物治疗在SISMAD患者中无MAE的生存率相当。此外，血管内治疗表现出更高的完全重塑率，且SMA狭窄或闭塞的发生率更低。
