专题研究(Monographic Study)

经腹腔干-胃十二指肠弓逆向介入治疗肠系膜上动脉开口处完全闭塞无残端病变1例

Published at: 2017年第26卷第6期

王桂立 1 , 韩思林 2 , 王利新 1
1 复旦大学附属中山医院 血管外科/复旦大学附属血管外科研究所,上海 200030
2 山东省枣庄市人民医院 血管外科,山东 枣庄 277000
通讯作者 利新 王 Email: wang.lixin@zs-hospital.sh.cn
DOI: 10.3978/j.issn.1005-6947.10.3978/j.issn.1005-6947.2017.06.005
基金:
国家自然科学基金资助项目 81570438

摘要

目的:探讨逆向入路支架植入治疗肠系膜上动脉(SMA)闭塞的技术。方法:回顾2017年2月1例于复旦大学附属中山医院血管外科行逆向开通SMA闭塞的患者临床资料。结果:患者为47岁女性,诊断为SMA闭塞引起的慢性肠系膜缺血(CMI),行腔内治疗再通SMA。由于SMA开口处完全闭塞性,无残端,经肱动脉和股动脉双侧入路均无法开通病变部位。利用腹腔干和SMA之间的胃十二指肠弓,通过此通路逆向开通SMA闭塞处;肱动脉入路导管和导丝对接后顺利正向通过病变,完成球囊扩张和支架植入术。术后患者CMI症状消失,3个月后随访CTA显示,支架定位良好,远端血管通畅。结论:对于常规血管内介入治疗方法失败的SMA闭塞患者,通过有效的侧支通路进行逆行开通是可行的。


Retrograde interventional therapy through celiac axis-gastroduodenal collaterals for a patient with flush ostial occlusion and no visible stump of superior mesenteric artery

Abstract

Objective: To investigate the technique of retrograde stent placement for superior mesenteric artery (SMA) occlusion. Methods: The data of a patient undergoing retrograde recanalization for symptomatic SMA occlusion in February 2017 in the Department of Vascular Surgery of Zhongshan Hospital, Fudan University were reviewed. Results: The patient was a 47-year-old woman, and was diagnosed as chronic mesenteric ischemia (CMI) caused by SMA occlusion, and then underwent endovascular treatment for SMA recanalization. Both brachial artery and femoral artery approaches failed to cross the lesion, due to the complete occlusion and no stump left at the origin of the SMA. Then, the SMA occlusion was revascularized via retrograde crossing through the gastroduodenal collateral pathway between the celiac axis and SMA. After docking with the guidewire, the catheter via brachial artery was anterogradely and uneventfully advanced through the lesion, and then balloon dilation and stent placement were completed. The symptoms of CMI of the patient disappeared after operation, and follow-up CTA performed 3 months later demonstrated appropriate stent positioning and distal vascular patency. Conclusion: For patients with SMA occlusion after failed attempts by conventional interventional approaches, retrograde recanalization through collateral pathway remains feasible.


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引用

引用本文: 桂立 王, 思林 韩, 利新 王. 经腹腔干-胃十二指肠弓逆向介入治疗肠系膜上动脉开口处完全闭塞无残端病变1例 [J]. 中国普通外科杂志, 2017, 26(6): 699-705.
Cite this article as: WANG Guili, HAN Silin, WANG Lixin . Retrograde interventional therapy through celiac axis-gastroduodenal collaterals for a patient with flush ostial occlusion and no visible stump of superior mesenteric artery [J]. Chin J Gen Surg, 2017, 26(6): 699-705.