Please wait a minute...
浙江大学学报（医学版）
J Zhejiang Univ (Med Sci)  2020, Vol. 49 Issue (3): 383-388    DOI: 10.3785/j.issn.1008-9292.2020.06.05
    
Preliminary result of stents implantation for spontaneous isolated dissection of the superior mesenteric artery: a prospective single-arm study
SUN Jinhong1,2(),QIU Chenyang1,WU Ziheng1,ZHANG Hongkun1,*()
1. Department of Vascular Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
2. Department of Vascular Surgery, the Central Hospital of Lishui City, Lishui 323000, Zhejiang Province, China
Download: HTML( 4 )   PDF(4944KB)
Export: BibTeX | EndNote (RIS)      

Abstract  

Objective: To access the efficacy of stents for spontaneous isolated dissection of the superior mesenteric artery (SIDSMA). Method: The study is a prospective single-arm study which has been registered on Clinical Trials (NCT03916965). Clinical data and follow-up information of the SIDSMA patients who received stent implantation in the First Affiliated Hospital of Zhejiang University during April 1, 2019 and September 30, 2019 were collected. The patients were recommended to be followed up at 1, 3, 6 and 12 months. Results: A total of 34 patients were enrolled. Their mean age was (54±8) years. Abdominal pain was the most common symptom. Patients received (2.1±0.6) stents on the average. Post-operation hospital stay was (2.7±1.6) days, and the patients were followed up for (2.3±1.9) months (CT angiography) and (5.5±1.7) months (clinical visit/phone call). There was no recurrence of abdominal pain. The CT angiography showed complete remodeling and incomplete remodeling took place in 23 and 9 patients (69.7% and 27.3%), respectively. Two patients (6.1%) had mild in-stent stenosis. No stent rupture or migration was reported. Conclusion: This study demonstrated a satisfactory short-term result of stents implantation for SIDSMA, which indicated the endovascular treatment could be the first-line therapy for SIDSMA.

Key words： Mesenteric artery, superior      Artery dissection      Endovascular treatment      Prospective      Treatment outcome     
Received: 29 December 2019      Published: 24 July 2020
CLC:  R654  
Corresponding Authors: ZHANG Hongkun     E-mail: yazeixiangku@163.com;1198050@zju.edu.cn
Service
E-mail this article
Add to my bookshelf
Add to citation manager
E-mail Alert
RSS
Articles by authors
SUN Jinhong
QIU Chenyang
WU Ziheng
ZHANG Hongkun
Cite this article:

SUN Jinhong,QIU Chenyang,WU Ziheng,ZHANG Hongkun. Preliminary result of stents implantation for spontaneous isolated dissection of the superior mesenteric artery: a prospective single-arm study. J Zhejiang Univ (Med Sci), 2020, 49(3): 383-388.

URL:

http://www.zjujournals.com/med/10.3785/j.issn.1008-9292.2020.06.05     OR     http://www.zjujournals.com/med/Y2020/V49/I3/383


孤立性自发性肠系膜上动脉夹层腔内治疗的前瞻性单臂临床研究初步结果

目的: 探讨腔内治疗在孤立性自发性肠系膜上动脉夹层中的有效性。方法: 本研究为北美临床试验注册中心（Clinical Trials）注册的前瞻性单臂观察性研究（NCT03916965）。收集2019年4月1月至2019年9月30日在浙江大学医学院附属第一医院接受支架植入治疗的肠系膜上动脉夹层患者的临床资料及随访信息。术后建议患者1、3、6和12个月时门诊随访。结果: 总计有34例患者入组随访队列，平均年龄为（54±8）岁，最常见的临床表现为腹痛。平均每例患者植入（2.1±0.6）枚支架，术后平均住院日为（2.7±1.6）d。平均CT血管造影随访时间为（2.3±1.9）个月，门诊或电话随访时间为（5.5±1.7）个月，所有患者均无腹痛再发。33例患者影像学随访结果显示，23例（69.7%）患者夹层完全塑形，9例（27.3%）患者部分塑形，1例（3.0%）患者无变化，且无支架移位、断裂；2例（6.1%）患者出现无须干预的支架内轻度狭窄，余患者支架通畅。结论: 腔内治疗孤立性自发性肠系膜上动脉夹层短期效果确切，有望成为一线治疗手段。


关键词： 肠系膜上动脉,  动脉夹层,  腔内治疗,  前瞻性,  治疗结果 
Fig 1 CT angiography image of typical case after endovascular treatment for spontaneous isolated dissection of the superior mesenteric artery
[1]   LUAN J Y , GUAN X , LI X et al. Isolated superior mesenteric artery dissection in China[J]. J Vasc Surg, 2016, 63 (2): 530- 536
doi: 10.1016/j.jvs.2015.09.047
[2]   BJ?RCK M , KOELEMAY M , ACOSTA S et al. Editor's choice-management of the diseases of mesenteric arteries and veins:clinical practice guidelines of the European Society of Vascular Surgery (ESVS)[J]. Eur J Vasc Endovasc Surg, 2017, 53 (4): 460- 510
doi: 10.1016/j.ejvs.2017.01.010
[3]   WANG J , HE Y , ZHAO J et al. Systematic review and meta-analysis of current evidence in spontaneous isolated celiac and superior mesenteric artery dissection[J]. J Vasc Surg, 2018, 68 (4): 1228- 1240
[4]   HEO S H , KIM Y W , WOO S Y et al. Treatment strategy based on the natural course for patients with spontaneous isolated superior mesenteric artery dissection[J]. J Vasc Surg, 2017, 65 (4): 1142- 1151
doi: 10.1016/j.jvs.2016.10.109
[5]   QIU C , HE Y , LI D et al. Mid-term results of endovascular treatment for spontaneous isolated dissection of the superior mesenteric artery[J]. Eur J Vasc Endovasc Surg, 2019, 58 (1): 88- 95
doi: 10.1016/j.ejvs.2018.11.013
[6]   GHODASARA N , LIDDELL R , FISHMAN E K et al. High-value multidetector CT angiography of the superior mesenteric artery:what emergency medicine physicians and interventional radiologists need to know[J]. Radiographics, 2019, 39 (2): 559- 577
doi: 10.1148/rg.2019180131
[7]   AHN S , MO H , HAN A et al. The use of antithrombotics is not beneficial for conservative management of spontaneous isolated dissection of the superior mesenteric artery:a meta-analysis[J]. Ann Vasc Surg, 2019, 60 415- 423
[8]   ZHU Y , PENG Y , XU M et al. Treatment strategies and outcomes of symptomatic spontaneous isolated superior mesenteric artery dissection:a systematic review and meta-analysis[J]. J Endovasc Ther, 2018, 25 (5): 640- 648
doi: 10.1177/1526602818796537
[9]   ULLAH W , MUKHTAR M , ABDULLAH H M et al. Diagnosis and management of isolated superior mesenteric artery dissection:a systematic review and meta-analysis[J]. Korean Circ J, 2019, 49 (5): 400- 418
doi: 10.4070/kcj.2018.0429
[10]   XIAO Q Z , HAO M , LIN L et al. Clinical and CT angiographic follow-up outcome of spontaneous isolated intramural hematoma of the superior mesenteric artery[J]. Cardiovasc Intervent Radiol, 2019, 42 (8): 1088- 1094
doi: 10.1007/s00270-019-02212-x
[11]   KIM H , PARK H , PARK S J et al. Outcomes of spontaneous isolated superior mesenteric artery dissection without antithrombotic use[J]. Eur J Vasc Endovasc Surg, 2018, 55 (1): 132- 137
doi: 10.1016/j.ejvs.2017.11.002
[12]   FANG G , XU G , FANG Y et al. Primary conservative treatment for peritonitis-absent symptomatic isolated dissection of the superior mesenteric artery with severely compressed true lumen[J]. Vascular, 2020, 28 (2): 132- 141
doi: 10.1177/1708538119892751
[13]   LIU B , CHU C , FAN X et al. Endovascular stent placement for isolated superior mesenteric artery dissection with intestinal ischaemia[J]. Vasa, 2019, 48 (1): 73- 78
doi: 10.1024/0301-1526/a000738
[14]   WU Z , YI J , XU H et al. The significance of the angle between superior mesenteric artery and aorta in spontaneous isolated superior mesenteric artery dissection[J]. Ann Vasc Surg, 2017, 45 117- 126
doi: 10.1016/j.avsg.2017.06.156
[15]   ZHANG X , XIANG P , YANG Y et al. Correlation between computed tomography features and clinical presentation and management of isolated superior mesenteric artery dissection[J]. Eur J Vasc Endovasc Surg, 2018, 56 (6): 911- 917
doi: 10.1016/j.ejvs.2018.08.037
[16]   KIMURA Y , KATO T , NAGAO K et al. Outcomes and radiographic findings of isolated spontaneous superior mesenteric artery dissection[J]. Eur J Vasc Endovasc Surg, 2017, 53 (2): 276- 281
doi: 10.1016/j.ejvs.2016.11.012
[17]   JANG J H , CHO B S , AHN H Y et al. Optimal treatment strategy and natural history of isolated superior mesenteric artery dissection based on long-term follow-up CT findings[J]. Ann Vasc Surg, 2020, 63 179- 185
doi: 10.1016/j.avsg.2019.08.092
[18]   LOEFFLER J W , OBARA H , FUJIMURA N et al. Medical therapy and intervention do not improve uncomplicated isolated mesenteric artery dissection outcomes over observation alone[J]. J Vasc Surg, 2017, 66 (1): 202- 208
doi: 10.1016/j.jvs.2017.01.059
[19]   MIZUNO A , IGUCHI H , SAWADA Y et al. Real clinical management of patients with isolated superior mesenteric artery dissection in Japan[J]. J Cardiol, 2018, 71 (2): 155- 158
doi: 10.1016/j.jjcc.2017.08.006
[20]   BEN ABDALLAH I , EL BATTI S , HUGUET A et al. Conservative therapy vs. extensive stenting in superior mesenteric artery dissection:the right balance remains to be found[J]. Eur J Vasc Endovasc Surg, 2019, 57 (4): 603
doi: 10.1016/j.ejvs.2018.11.021
[21]   JIA Z , SU H , CHEN W et al. Endovascular treatment of patients with isolated mesenteric artery dissection aneurysm:bare stents alone versus stent assisted coiling[J]. Eur J Vasc Endovasc Surg, 2019, 57 (3): 400- 406
doi: 10.1016/j.ejvs.2018.08.057
[22]   KIM J , YOON C J , SEONG N et al. Spontaneous dissection of superior mesenteric artery:long-term outcome of stent placement[J]. J Vasc Interv Radiol, 2017, 28 (12): 1722- 1726
doi: 10.1016/j.jvir.2017.05.022
[1] LI Yanhong,DU Minlian,MA Huamei,CHEN Qiuli,CHEN Hongshan,ZHANG Jun. Efficacy of letrozole in treatment of male adolescents with idiopathic short stature[J]. J Zhejiang Univ (Med Sci), 2020, 49(3): 308-314.
[2] KONG Yuanmei,CHEN Hong,LIANG Li,ZHENG Maoni,FANG Yanlan,WANG Chunlin. Aromatase inhibitors combined with growth hormone in treatment of adolescent boys with short stature[J]. J Zhejiang Univ (Med Sci), 2020, 49(3): 283-290.
[3] WANG Chunlin,LIANG Li. Reconsideration of the third-generation non-steroidal aromatase inhibitors in pediatrics[J]. J Zhejiang Univ (Med Sci), 2020, 49(3): 275-282.
[4] XU De,LU Wenli,WANG Xueqing,WANG Junqi,XIE Yiwen,DONG Zhiya,WANG Wei. Efficacy and safety of letrozole in treatment of McCune-Albright syndrome girls with peripheral precocious puberty[J]. J Zhejiang Univ (Med Sci), 2020, 49(3): 291-296.
[5] WANG Qian,ZHANG Shule,MA Xue,LI Guimei,WANG Zengmin,WANG Fengxue. Efficacy of letrozole in treatment of children with congenital adrenal hyperplasia due to steroid 21-hydroxylase deficiency[J]. J Zhejiang Univ (Med Sci), 2020, 49(3): 302-307.
[6] CHEN Jun,LIU Danping,LIU Li,LIU Ping,XU Qingnian,XIA Lu,LING Yun,HUANG Dan,SONG Shuli,ZHANG Dandan,QIAN Zhiping,LI Tao,SHEN Yinzhong,LU Hongzhou. A pilot study of hydroxychloroquine in treatment of patients with moderate COVID-19[J]. J Zhejiang Univ (Med Sci), 2020, 49(2): 215-219.
[7] GAO Mingxuan,NIE Dejun,CHANG Yanfeng,XIE Weiqiang,WANG Yue,PU Xingyu,ZHANG Wei,LUO Wenyuan. Internal fixation of lateral and medial borders for displaced scapular body fractures via minimally invasive approach: results of 23 cases[J]. J Zhejiang Univ (Med Sci), 2019, 48(6): 651-656.
[8] CHEN Hongfang, GONG Xiaoxian, XU Dongjuan, WANG Zhimin, HU Haifang, WU Chenglong, ZHANG Xiaoling, MA Xiaodong, WANG Yaxian, HU Haitao, LOU Min, CHEN Zhicai, Improving In-hospital Stroke Service Utilisation (MISSION) in Zhejiang Province . Advanced treatment time improves outcomes of patients with ischemic stroke undergoing reperfusion therapy[J]. J Zhejiang Univ (Med Sci), 2019, 48(3): 247-253.
[9] ZHANG Lifeng,YANG Hui,ZHANG Xinmei,CHEN Zhengyun. Efficacy and adverse effects of levonorgestrel-releasing intrauterine system in treatment of adenomyosis[J]. J Zhejiang Univ (Med Sci), 2019, 48(2): 130-135.
[10] LOU Junyao,HUANG Xiufeng,ZHANG Lifeng,XU Ping,ZHANG Xinmei,CHEN Zhengyun. The second generation endometrial ablation (NovaSure) improves efficacy of levonorgestrel-releasing intrauterine system in management of adenomyosis[J]. J Zhejiang Univ (Med Sci), 2019, 48(2): 136-141.
[11] YU Zuanbiao,LIN Zuodong,LANG Dehai. Long-term efficacy of percutaneous mechanical thrombectomy combined with stent implantation in treatment of acute iliofemoral venous thrombosis[J]. J Zhejiang Univ (Med Sci), 2018, 47(6): 623-627.
[12] SHEN Hong,JI Feng. Efficacy and safety of digestive tract stent placement under direct visual endoscopy without X-ray monitoring in treatment of digestive tract stricture[J]. J Zhejiang Univ (Med Sci), 2018, 47(6): 643-650.
[13] YIN Xiaoliang,LANG Dehai,WANG Di. Comparison of mechanical thrombectomy with transcatheter thrombolysis for acute iliac femoral venous thrombosis[J]. J Zhejiang Univ (Med Sci), 2018, 47(6): 588-594.
[14] SHEN Yang,ZHANG Ruili,CHEN Guang,LI Fei,CHU Haiwei,HU Bin,ZHAO Wenjun. One case of hepatosplenic artery aneurysm with hepato-splenomesenteric trunk and literature review[J]. J Zhejiang Univ (Med Sci), 2018, 47(6): 601-605.
[15] WANG Xiaohui,HE Yangyan,WU Ziheng,ZHANG Hongkun. Efficacy of integrated minimally invasive treatment for iliac vein compression syndrome with varicose veins of lower extremities[J]. J Zhejiang Univ (Med Sci), 2018, 47(6): 577-582.