RESUMO
Analysed herein are the results of endovascular revascularization of the superior mesenteric artery (SMA). The study included a total of 18 patients with acute impairment of mesenteric circulation in the stage of intestinal ischaemia. The patients underwent multispiral computed tomography (MSCT) and once impairments of blood flow in the SMA were revealed, we performed endovascular revascularization of the artery. Patency of the SMA was assessed by repeat contrast-enhanced MSCT. Thirteen (72.2%) patients were found to have occlusion in the system of the SMA and five (27.8%) were diagnosed as having significant stenoses of the SMA. All 13 patients with occlusion of the SMA underwent vacuum thrombextraction followed by transluminal balloon angioplasty (TBA). Of these, thrombotic masses were obtained in 11 (84.6%) patients. Stents were implanted in 3 cases wherein TBA turned out inefficient. The patients with haemodynamically significant stenoses of the SMA were subjected to TBA followed by stent implantation. Good roentgenoendovascular results of restoration of blood flow through the SMA and its branches were obtained in 83.4% of cases. Assessing blood parameters and patients' condition severity revealed positive dynamics or a tendency towards improvement. The mortality rate amounted to 16.6%. A conclusion drawn is that this technique is efficient and appropriate for SMA lesions of any localization.
Assuntos
Procedimentos Endovasculares , Isquemia Mesentérica , Oclusão Vascular Mesentérica , Humanos , Artéria Mesentérica Superior , Oclusão Vascular Mesentérica/terapia , Circulação Esplâncnica , Stents , Resultado do TratamentoRESUMO
Treatment results of the acute intestinal ischemia in 72 patients were analyzed. Patients aged 69.2 ± 5.8 years. Occlusive vascular lesions of the intestinal vessels (thrombosis and embolism of the superior mesenteric artery and thrombosis of the superior mesenteric vein) were obliged to the ischemic disorders in 84.5% of patients. The rest 15.5% of patients demonstrated microvascular disorders (nonocclusive ischemia). The issue presents the novel algorithm for treatment and diagnostics of the acute intestinal ischemia.
Assuntos
Procedimentos Cirúrgicos do Sistema Digestório , Embolia/complicações , Isquemia , Oclusão Vascular Mesentérica/complicações , Trombose Venosa/complicações , APACHE , Doença Aguda , Idoso , Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Procedimentos Cirúrgicos do Sistema Digestório/mortalidade , Feminino , Humanos , Intestinos/irrigação sanguínea , Intestinos/fisiopatologia , Intestinos/cirurgia , Isquemia/etiologia , Isquemia/mortalidade , Isquemia/fisiopatologia , Isquemia/cirurgia , Masculino , Artéria Mesentérica Superior/diagnóstico por imagem , Artéria Mesentérica Superior/cirurgia , Veias Mesentéricas/diagnóstico por imagem , Veias Mesentéricas/cirurgia , Pessoa de Meia-Idade , Monitorização Intraoperatória , Duração da Cirurgia , Prognóstico , Radiografia , Estudos Retrospectivos , Fatores de Risco , Análise de Sobrevida , Resultado do TratamentoRESUMO
We report an observation of one of the rarest coronary arteries anomaly, type IV dual left arterior descending artery in 43-year-old man. The patient arrived with angina pectoris and underwent multispiral computed tomography of coronary arteries, having revealed abnormal anatomy as well as atherosclerotic lesion of coronary arteries. Hemodynamically signification stenoses were successfully eliminated by the way of coronary stending.