Wang Huiyong, He Caiyun, Du Yipeng, Shi Jian, Hu Xiaolu, Huang Zheng
Department of Cardiology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
Department of Cardiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China.
J Thorac Dis. 2024 Nov 30;16(11):7342-7349. doi: 10.21037/jtd-24-881. Epub 2024 Nov 22.
Patients presenting with Stanford type A aortic dissection complicated by acute occlusion of the superior mesenteric artery (SMA) exhibit an exceedingly high mortality rate, even if emergency surgery for ascending aorta repair is performed. consequently, appropriate management of acute SMA occlusion arising from acute Stanford type A aortic dissection is crucial. This study aimed to evaluate the safety and efficacy of endovascular treatment of acute mesenteric occlusion first in stable patients with acute type A aortic dissection.
The study was a single-center case series. Data collected from 11 consecutive patients over 12 years, from March 2010 to November 2022, were retrospectively analyzed. All were expeditiously escorted to the interventional suite via the prioritized green channel of the chest pain center and received the endovascular treatment of acute mesenteric occlusion first. Post-procedure, patients were promptly transferred to the Intensive Care Unit for close monitoring and got standardized medication. After hospital discharge, patients underwent follow-up aortic computed tomography angiography (CTA) at 1 month, 6 months, and annually thereafter to ensure continuous monitoring of the patient's condition and timely identification of any potential complications.
All patients were male, with a mean age of 49.5 years. Time from abdominal distension and pain onset to admission to the catheterization laboratory was 4-13 (mean 6.9) hours. Endovascular repair of the SMA was successfully completed with uneventful hospital courses in all patients. Bowel sounds weakened in 6 cases and disappeared in 5, while bloody stools occurred in 3 without intestinal necrosis. At 2-32 months follow-up, the patients had no abdominal pain, distension nor other signs of mesenteric artery ischemia.
For patients with acute SMA occlusion caused by acute Stanford type A aortic dissection, endovascular treatment first to restore blood supply to the SMA appears feasible, safe and efficacious.
患有斯坦福A型主动脉夹层并伴有肠系膜上动脉（SMA）急性闭塞的患者，即便接受了升主动脉修复的急诊手术，死亡率仍极高。因此，妥善处理急性斯坦福A型主动脉夹层引发的急性SMA闭塞至关重要。本研究旨在评估在急性A型主动脉夹层稳定患者中，对急性肠系膜闭塞进行血管内治疗的安全性和有效性。
本研究为单中心病例系列研究。回顾性分析了2010年3月至2022年11月连续12年间11例患者的数据。所有患者均通过胸痛中心的优先绿色通道迅速护送至介入室，并首先接受急性肠系膜闭塞的血管内治疗。术后，患者立即被转至重症监护病房进行密切监测，并接受标准化药物治疗。出院后，患者在1个月、6个月及此后每年接受主动脉计算机断层扫描血管造影（CTA）随访，以确保持续监测患者病情并及时发现任何潜在并发症。
所有患者均为男性，平均年龄49.5岁。从腹胀和疼痛发作到进入导管室的时间为4 - 13（平均6.9）小时。所有患者均成功完成SMA的血管内修复，住院过程顺利。6例患者肠鸣音减弱，5例消失，3例出现血便，但均无肠坏死。在2 - 32个月的随访中，患者无腹痛、腹胀或其他肠系膜动脉缺血迹象。
对于急性斯坦福A型主动脉夹层导致的急性SMA闭塞患者，首先进行血管内治疗以恢复SMA血供似乎可行、安全且有效。
