摘要
目的探讨AngioJet机械性血栓清除装置治疗急性肠系膜上动脉栓塞(ASMAE)的可行性、安全性和有效性。方法回顾性分析2017年4月至2020年1月收治的12例ASMAE患者。其中男6例,女6例,年龄为(74.4±10.5)岁;肠系膜上动脉起始段闭塞1例,中段闭塞7例,起始段+中段闭塞4例。采用AngioJet装置实施肠系膜上动脉血栓清除,对治疗后还存在血管残余狭窄者予以球囊扩张成形和/或支架植入。术后早期根据症状、体证评估疗效,术后1、3、6个月进行腹部增强CT检查评估肠系膜上动脉通畅情况。结果所有患者均顺利完成抽栓治疗,技术成功率100%。抽吸时间为30~161 s,平均(81.0±39.3)s;术中尿激酶用量(10~30)×10;U,平均(15.8±6.7)×10;U。8例肠系膜上动脉栓塞部位完全再通,4例行补充性球囊扩张和/或支架治疗后血管恢复通畅,其中2例单纯扩张、1例支架植入、1例球囊扩张结合支架植入。无动脉损伤和肾功能损害等并发症。临床有效11例,无效1例,死亡1例。术后第1、3、6个月门诊随访,患者无腹痛、黑便、腹泻等症状。11例患者CTA检查提示肠系膜上动脉管腔血流通畅,无狭窄/闭塞表现。结论AngioJet机械性血栓清除装置治疗ASMAE方法安全可行,初步临床疗效满意。
Objective To evaluate the clinical feasibility,safety and efficacy of percutaneous AngioJet mechanical thrombectomy in treating acute superior mesenteric artery embolism(ASMAE).Methods The clinical data of 12 patients with ASMAE,who were admitted to the First Affiliated Hospital of Soochow University of China between April 2017 and January 2020,were retrospectively analyzed.The patients included 6 males and 6 females,with a mean age of(74.42±10.46)years.The occluded sites of superior mesenteric artery(SMA)included initial segment(n=1),middle segment(n=7)and both initial and middle segments(n=4).Percutaneous AngioJet mechanical thrombectomy was adopted in all the 12 patients.Additional balloon dilation angioplasty and/or stent implantation was carried out for the patients who had residual stenosis of SMA after AngioJet mechanical thrombectomy.Early after surgery,the therapeutic efficacy was assessed according to the clinical symptoms and physical examinations.One,3 and 6 months after the treatment,abdominal contrast-enhanced CT scan was performed to evaluate the patency of SMA.Results Successful AngioJet mechanical thrombectomy was accomplished in all the 12 patients,with a technical success rate of 100%.The mean aspiration time was(81.0±39.3)seconds(range of 30-161 seconds).The intraoperative used amount of urokinase was(10-30)×10;U,with a mean of(15.8±6.7)×10;U.Complete recanalization of occluded SMA segments was achieved in 8 patients,and in the other 4 patients the recanalization of occluded SMA segments was obtained after receiving supplementary balloon dilation angioplasty and/or stent implantation,including simple balloon dilation angioplasty(n=2),stent implantation(n=1)and balloon dilation angioplasty together with stent implantation(n=1).No postoperative complications such as arterial injury or renal function impairment occurred.Clinically effective outcome was obtained in 11 patients and ineffective outcome in one patient,and one patient died.Postoperative 1-,3-and 6-month follow-up check showed that patients had no symptoms such as abdominal pain,melena,diarrhea,etc.CT angiography in 11 patients revealed that the blood flow in SMA was unobstructed,and no stenosis or obstruction of SMA was detected.Conclusion For the treatment of ASMAE,percutaneous AngioJet mechanical thrombectomy is clinically safe and feasible with satisfactory clinical efficacy.
作者
樊宝瑞
金泳海
段鹏飞
杨超
徐一丁
杜鹏
倪才方
FAN Baorui;JIN Yonghai;DUAN Pengfei;YANG Chao;XU Yiding;DU Peng;NI Caifang(Department of Interventional Radiology,First Affiliated Hospital of Soochow University,Suzhou,Jiangsu Province 215006,China)
出处
《介入放射学杂志》
CSCD
北大核心
2021年第12期1229-1233,共5页
Journal of Interventional Radiology
基金
江苏省苏州市科技计划项目(SYS2020124)。
关键词
急性肠系膜上动脉栓塞
机械性血栓清除装置
腔内治疗
acute superior mesenteric artery embolism
mechanical thrombectomy device
endovascular treatment
