Revascularization of the superior mesenteric artery alone for treatment of intestinal ischemia
Revascularization of the superior mesenteric artery alone for treatment of intestinal ischemia
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DOI：
10.1067/mva.2000.107314
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发表时间：
2000-07-01
影响因子：
4.3
通讯作者：
Porter, JM
中科院分区：
文献类型：
--
作者：
Foley, MI;Moneta, GL;Porter, JM
目的：许多作者推荐完全血运重建来治疗肠道缺血。餐后肠道充血仅限于肠系膜上动脉 (SMA) 的观察结果表明，仅 SMA 血运重建就足以治疗。我们优先通过 SMA 的单次旁路移植来管理肠道缺血，并在此使用这种方法更新我们的结果。方法：从前瞻性建立的血管外科登记处识别患者。对每位患者的急性与慢性肠道缺血、术前血管造影结果、所用手术、围手术期发病率和死亡率、晚期症状缓解、死亡原因以及生命表确定的生存率和移植物通畅性进行评估。通过后续血管造影或双重扫描来确定移植物的通畅性。结果：对 49 名患者（31 名女性，18 名男性；平均年龄，62 岁）进行了 50 例仅 SMA 的旁路移植术，用于治疗肠道缺血。在所有患者中，额外的内脏动脉均可用于旁路移植术。手术指征为21例患者出现急性症状，其中14例患有肠梗塞； 26名患者有慢性症状；以及 3 名患者与肾下主动脉手术联合进行预防。 32 个移植物源自主动脉或髂动脉，18 个源自主动脉移植物。有 40 个假体导管和 10 个自体导管。有慢性症状的患者围手术期死亡率为 3%，总体死亡率为 12%。所有幸存者的症状均得到改善。平均随访时间为 44 个月。 9 年辅助初次移植物通畅率为 79%，5 年患者生存率为 61%。由于移植物闭塞而导致复发性肠缺血的患者发生了两例晚期死亡。结论：仅对 SMA 进行旁路移植似乎是治疗肠缺血的有效且持久的方法。我们的结果似乎与报道的肠缺血“完全”血运重建的结果相同。当 SMA 是合适的受体血管时，在治疗肠道缺血时不需要对其他内脏血管进行多次旁路移植。
Objective: Complete revascularization is recommended by many authors for treatment of intestinal ischemia. The observation that postprandial intestinal hyperemia is limited to the superior mesenteric artery (SMA) has suggested to us that SMA revascularization alone should be adequate treatment. We preferentially manage intestinal ischemia with a single bypass graft to the SMA and herein update our results using this approach.Methods: Patients were identified from a prospectively established vascular surgical registry. Each patient was assessed for acute versus chronic intestinal ischemia, preoperative angiographic findings, operation used, perioperative morbidity and mortality, late symptomatic relief, cause of death, and life table-determined survival and graft patency. Graft patency was determined by follow-up angiography or duplex scanning.Results: Fifty bypass grafts to the SMA alone were performed in 49 patients (31 women, 18 men; mean age, 62 years) for treatment of intestinal ischemia. In all patients additional splanchnic arteries were available for bypass grafting. Operative indications were acute symptoms in 21 patients, 14 of whom had bowel infarction; chronic symptoms in 26 patients; and prophylaxis in conjunction with infrarenal aortic surgery in 3 patients. Thirty-two grafts originated from the aorta or an iliac artery, and 18 originated from an aortic graft. There were 40 prosthetic and 10 autogenous conduits. Perioperative mortality was 3% in patients with chronic symptoms and 12% overall. All survivors were symptomatically improved. Mean follow-up was 44 months. Nine-year assisted primary graft patency was 79%, and 5-year patient survival was 61%. Two late deaths occurred in patients with recurrent intestinal ischemia resulting from graft occlusions.Conclusions: Bypass grafting to the SMA alone appears to be both an effective and durable procedure for treatment of intestinal ischemia. Our results appear equal to those reported for "complete" revascularization for intestinal ischemia. When the SMA is a suitable recipient vessel, multiple bypass grafts to other splanchnic vessels are unnecessary in the treatment of intestinal ischemia.