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目的探讨血管腔内裸支架成形术治疗自发性孤立性肠系膜上动脉夹层(SIDSMA)的安全性及有效性。方法回顾性分析经CTA及DSA确诊的15例SIDSMA患者的临床资料。按照Yun分型将SIDSMA分为4型。所有患者均接受SMA腔内裸支架成形术,术后予抗凝治疗2天及抗血小板治疗6个月。术后1、6、12个月及以后每年1次进行临床症状及CTA随访。结果15例患者中Ⅰ型1例,Ⅱa型11例,Ⅱb型3例。技术成功率100%,共植入裸支架22枚,其中行单个裸支架植入8例,双层裸支架重叠植入7例。随访时间5～51个月,平均(30.0±14.5)个月。随访期间未出现症状复发及与支架植入相关并发症;CTA提示SMA支架通畅,夹层重塑。1例患者于术后7个月死于急性心脏疾病。结论血管腔内裸支架成形术治疗SIDSMA是一种安全、有效的方法。
Objective To investigate the safety and efficacy of endovascular stent-graft in the treatment of spontaneous solitary superior mesenteric artery dissection (SIDSMA). Methods The clinical data of 15 SIDSMA patients diagnosed by CTA and DSA were retrospectively analyzed. SIDSMA is divided into 4 types according to Yun classification. All patients underwent SMA brachytherapy with anticoagulation for 2 days and antiplatelet therapy for 6 months postoperatively. Clinical symptoms and CTA follow-up were performed once every year at 1, 6, 12 months and thereafter. Results Among the 15 patients, 1 was type Ⅰ, 11 was type Ⅱa and 3 was type Ⅱb. The technical success rate was 100%. Totally 22 bare stents were implanted. Among them, 8 were implanted with bare stents and 7 were implanted with double bare stents. Follow-up time was 5 to 51 months, with an average of (30.0 ± 14.5) months. During the follow-up period, no recurrence of symptoms and complications related to stent implantation occurred. CTA suggested that the SMA stent was smooth and the dissection was remodeled. One patient died of acute heart disease 7 months after surgery. Conclusion Intravascular stent implantation for the treatment of SIDSMA is a safe and effective method.