Bruno Pagnin Schmid, Vinícius Adorno Gonçalves, Lucas Marcelo Dias Freire, Felipe Nasser, Fábio Hüsemann Menezes
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引用次数: 0
Abstract
Background: Chronic mesenteric ischemia (CMI) is a debilitating disease with a heavy burden on quality of life. Stenting of the superior mesenteric artery (SMA) is the first option for treatment, but there is a lack of consensus defining precise indications for open revascularization (OR).
Objectives: To describe a series of 4 patients with CMI treated with OR and to present an algorithm for the management of this condition.
Methods: Three patients presented with typical intestinal angina and weight loss. One patient was subjected to prophylactic revascularization during open abdominal aortic aneurysm repair. Surgical techniques included: 1) Bypass from the infrarenal aorta to the SMA; 2) Bypass from an aorto-bifemoral polyester graft to the SMA; 3) Bypass from the right iliac artery to the SMA; 4) Bypass from the right graft limb of an aorto-biiliac polyester graft to the median colic artery at Riolan's arcade. PTFE was used in all surgeries. All grafts were placed in a retrograde configuration, tunneled under the left renal vein, making a smooth C-loop. A treatment algorithm was constructed based on the institution's experience and a review of recent literature.
Results: All patients demonstrated resolution of symptoms and recovery of body weight. All grafts are patent after mean follow-up of two years.
Conclusions: Open revascularization using the C-loop configuration is a valuable technique for CMI and may be considered in selected cases. The algorithm constructed may help decision planning in other quaternary centers.
背景:慢性肠系膜缺血(CMI)是一种使人衰弱的疾病,对生活质量造成沉重负担。肠系膜上动脉(SMA)支架植入术是治疗的首选方案,但对于开放性血管重建术(OR)的确切适应症还缺乏共识:目的:描述4例接受开放性肠系膜上动脉再通术治疗的肠系膜上动脉硬化症(CMI)患者的系列病例,并介绍该病症的治疗方法:方法:三名患者出现典型的肠绞痛和体重减轻。一名患者在开腹主动脉瘤修补术中接受了预防性血管再通手术。手术技术包括1)从肾下主动脉到 SMA 的分流术;2)从主动脉-双股聚酯移植物到 SMA 的分流术;3)从右侧髂动脉到 SMA 的分流术;4)从主动脉-双髂聚酯移植物的右侧移植物肢到 Riolan's arcade 的正中结肠动脉的分流术。所有手术均使用聚四氟乙烯。所有移植物均以逆行方式放置,在左肾静脉下穿行,形成一个平滑的C形环。根据该机构的经验和对近期文献的回顾,制定了一套治疗算法:结果:所有患者的症状都得到了缓解,体重也得到了恢复。平均随访两年后,所有移植物均保持通畅:结论:使用 C 环结构进行开放性血管再通是治疗 CMI 的一项重要技术,可在选定病例中加以考虑。所构建的算法可能有助于其他四级中心的决策规划。
期刊介绍:
The Jornal Vascular Brasileiro is editated and published quaterly to select and disseminate high-quality scientific contents concerning original research, novel surgical and diagnostic techniques, and clinical observations in the field of vascular surgery, angiology, and endovascular surgery. Its abbreviated title is J. Vasc. Bras., which should be used in bibliographies, footnotes and bibliographical references and strips.