复杂性肠系膜上动脉瘤开放手术1例报道_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

杨果 ^1,2 , 李艺媛 ¹ , 刘洋 ¹ ,  黄斌 ¹

1. ;
2. ;

Corresponding author：

黄斌, Email: xgwkhb@126.com

Keywords：

肠系膜上动脉; 复杂性动脉瘤; 开放手术

DOI：

10.7507/1007-9424.202310051

Video：

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目的总结开放手术治疗1例复杂性肠系膜上动脉瘤（superior mesenteric artery aneurysm，SMAA）的体会。方法报道1例罕见的复杂性肠系膜上动脉瘤（superior mesenteric artery aneurysm，SMAA）患者，分析其诊断及治疗方案。结果患者为年轻女性，主要表现为逐渐加重的腹部疼痛，腹部CT血管成像检查示肠系膜上动脉中段多发动脉瘤，最大者3.4 cm×3.3 cm，累及3条主要分支，动脉瘤局部压迫胰腺，致使胰腺向前、向外移位。综合患者临床表现、解剖条件和生存预期，最终实施开放性SMAA切除+人工血管重建术。术后患者恢复良好，无肠缺血坏死，大便隐血阴性。结论 SMAA患者术前应综合考虑和评估，选择最优的治疗策略。当SMAA累及多个主要分支、腔内治疗无法保证术后效果时，开放手术仍是一种行之有效的治疗方法。

Citation： 杨果, 李艺媛, 刘洋, 黄斌. 复杂性肠系膜上动脉瘤开放手术1例报道. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2024, 31(4): 479-483. doi: 10.7507/1007-9424.202310051 Copy

1.	Chaer RA, Abularrage CJ, Coleman DM, et al. The Society for Vascular Surgery clinical practice guidelines on the management of visceral aneurysms. J Vasc Surg, 2020, 72(1S): 3S-39S. doi: 10.1016/j.jvs.2020.01.039.
2.	Obara H, Kentaro M, Inoue M, et al. Current management strategies for visceral artery aneurysms: an overview. Surg Today, 2020, 50(1): 38-49.
3.	Stone WM, Abbas M, Cherry KJ, et al. Superior mesenteric artery aneurysms: is presence an indication for intervention? J Vasc Surg, 2002, 36(2): 234-237.
4.	Lorelli DR, Cambria RA, Seabrook GR, et al. Diagnosis and management of aneurysms involving the superior mesenteric artery and its branches—a report of four cases. Vasc Endovascular Surg, 2003, 37(1): 59-66.
5.	Wang L, Shu C, Li Q, et al. Experience of managing superior mesenteric artery aneurysm and its midterm follow-up results with 18 cases. Vascular, 2021, 29(4): 516-526.
6.	Johal M, Kalaravy M, Ali F, et al. Evolving diagnostic and therapeutic options for visceral artery aneurysms. Ann Vasc Surg, 2021, 76: 488-499.
7.	Björck M, Koelemay M, Acosta S, et al. Editor’s choice—Management of the diseases of mesenteric arteries and veins: Clinical Practice Guidelines of the European Society of Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg, 2017, 53(4): 460-510.
8.	孙晓宁, 郑月宏. 肠系膜上动脉瘤的治疗策略. 协和医学杂志, 2020, 11(5): 537-541.
9.	Wang S, Xiong J. Giant distal superior mesenteric artery aneurysm without symptoms. J Vasc Surg, 2023, 78(6): 1548-1549.
10.	Pitcher GS, Cirillo-Penn NC, Mendes BC, et al. Aneurysms of the superior mesenteric artery and its branches. J Vasc Surg, 2022, 76(1): 149-157.
11.	Shanley CJ, Shah NL, Messina LM. Uncommon splanchnic artery aneurysms: pancreaticoduodenal, gastroduodenal, superior mesenteric, inferior mesenteric, and colic. Ann Vasc Surg, 1996, 10(5): 506-515.
12.	Jia Z, Huang Y, Shi H, et al. Comparison of CTA and DSA in the diagnosis of superior mesenteric artery dissecting aneurysm. Vascular, 2018, 26(4): 346-351.
13.	Lei Y, Liu J, Lin Y, et al. Clinical characteristics and misdiagnosis of spontaneous isolated superior mesenteric artery dissection. BMC Cardiovasc Disord, 2022, 22(1): 239. doi: 10.1186/s12872-022-02676-9.
14.	Dong Z, Fu W, Chen B, et al. Treatment of symptomatic isolated dissection of superior mesenteric artery. J Vasc Surg, 2013, 57(2 Suppl): 69S-76S. doi: 10.1016/j.jvs.2012.07.060.
15.	Yun WS, Kim YW, Park KB, et al. Clinical and angiographic follow-up of spontaneous isolated superior mesenteric artery dissection. Eur J Vasc Endovasc Surg, 2009, 37(5): 572-577.
16.	Jacobs CR, Fatima J, Scali ST, et al. Surgical treatment of true superior mesenteric artery aneurysms. Ann Vasc Surg, 2021, 71: 74-83.
17.	Barrionuevo P, Malas MB, Nejim B, et al. A systematic review and meta-analysis of the management of visceral artery aneurysms. J Vasc Surg, 2019, 70(5): 1694-1699.
18.	Wolk S, Distler M, Radosa C, et al. Management and outcome of true visceral and renal artery aneurysm repair. Langenbecks Arch Surg, 2021, 406(3): 623-630.
19.	Hosn MA, Xu J, Sharafuddin M, et al. Visceral artery aneurysms: decision making and treatment options in the new era of minimally invasive and endovascular surgery. Int J Angiol, 2019, 28(1): 11-16.
20.	Fargion AT, Falso R, Speziali S, et al. Results of current endovascular treatments for visceral artery aneurysms. J Vasc Surg, 2023, 78(2): 387-393.
21.	Gong C, Sun MS, Leng R, et al. Endovascular embolization of visceral artery aneurysm: a retrospective study. Sci Rep, 2023, 13(1): 6936. doi: 10.1038/s41598-023-33789-6.
22.	DeCarlo C, Mohebali J, Dua A, et al. Morbidity and mortality associated with open repair of visceral aneurysms. J Vasc Surg, 2022, 75(2): 632-640.
23.	Sousa J, Costa D, Mansilha A. Visceral artery aneurysms: review on indications and current treatment strategies. Int Angiol, 2019, 38(5): 381-394.
24.	Qiu C, Liu Z, Huang L, et al. Covered stents for treatment of visceral artery aneurysms: A multicenter study. J Vasc Interv Radiol, 2022, 33(6): 640-647.
25.	Lin Y C, Liao T C, Lin C T, et al. Salvage surgeries for splanchnic artery aneurysms after failed endovascular therapy: case series. Int J Surg, 2023, 109(7): 1842-1851.
26.	Zhang Y, Xiang D, Lu Q, et al. A systematic review and meta-analysis of the performance of flow-diverting stents in the treatment of peripheral and visceral artery aneurysms. Catheter Cardiovasc Interv, 2021, 97(3): 461-469.
27.	Fukunaga N, Shimoji A, Tamura N. In situ right gastroepiploic artery as a conduit for treating mycotic aneurysm of the superior mesenteric artery. Eur J Vasc Endovasc Surg, 2024, 67(1): 184. doi: 10.1016/j.ejvs.2023.11.003.
28.	Pfister K, Kasprzak P, Oikonomou K, et al. Management of Visceral artery aneurysms with preservation of organ perfusion: More than twenty years experience. Zentralbl Chir, 2018, 143(5): 516-525.
29.	Martinelli O, Giglio A, Irace L, et al. Single-center experience in the treatment of visceral artery aneurysms. Ann Vasc Surg, 2019, 60: 447-454.
30.	Kordzadeh A, Watson J, Panayiotopolous YP. Mycotic aneurysm of the superior and inferior mesenteric artery. J Vasc Surg, 2016, 63(6): 1638-1646.
31.	Higashiura W, Takara H, Kitamura R, et al. Endovascular therapy for distal superior mesenteric artery mycotic aneurysms due to infective endocarditis. J Endovasc Ther, 2019, 26(6): 879-884.
32.	Hammad A S, Gilani R, Adnan M A, et al. Treatment of superior mesenteric artery mycotic aneurysm by synthetic vascular graft: A case report. J Pak Med Assoc, 2023, 73(4): 925-928.
33.	Huang YK, Hsieh HC, Tsai FC, et al. Visceral artery aneurysm: risk factor analysis and therapeutic opinion. Eur J Vasc Endovasc Surg, 2007, 33(3): 293-301.
34.	Pulli R, Dorigo W, Troisi N, et al. Surgical treatment of visceral artery aneurysms: A 25-year experience. J Vasc Surg, 2008, 48(2): 334-342.
35.	Grotemeyer D, Duran M, Park EJ, et al. Visceral artery aneurysms—follow-up of 23 patients with 31 aneurysms after surgical or interventional therapy. Langenbecks Arch Surg, 2009, 394(6): 1093-1100.
36.	冯桂林, 周旻, 林越, 等. 肠系膜上动脉瘤17例诊治分析. 中国实用外科杂志, 2021, 41(2): 205-209.
37.	Gao P, Li G, Chen J, et al. The impact of endovascular treatment on clinical outcomes of stable symptomatic patients with spontaneous superior mesenteric artery dissection. J Vasc Surg, 2021, 73(4): 1269-1276.
38.	Sun J, Wang L, Que Y, et al. Management of Patients with Uncomplicated Symptomatic Isolated Mesenteric Artery Dissection: a Multicentre Experience. Eur J Vasc Endovasc Surg, 2022, 64(5): 507-514.
39.	Ahn S, Mo H, Han A, et al. The use of antithrombotics is not beneficial for conservative management of spontaneous isolated dissection of the superior mesenteric artery: A meta-analysis. Ann Vasc Surg, 2019, 60: 415-423.
40.	Ben A I, Huguet A, Nuzzo A, et al. Acute Isolated Mesenteric Artery Dissection: Four Year Experience From a French Intestinal Stroke Centre. Eur J Vasc Endovasc Surg, 2022, 64(6): 656-664.
41.	Shi Y, Ni G, Zhao B, et al. Management of symptomatic spontaneous isolated superior mesenteric artery dissection: A single centre experience with mid term follow up. Eur J Vasc Endovasc Surg, 2020, 60(6): 863-871.
42.	赵纪春. 开放手术在血管腔内治疗时代的作用和地位. 中国普外基础与临床杂志, 2023, 30(5): 515-516.

1. Chaer RA, Abularrage CJ, Coleman DM, et al. The Society for Vascular Surgery clinical practice guidelines on the management of visceral aneurysms. J Vasc Surg, 2020, 72(1S): 3S-39S. doi: 10.1016/j.jvs.2020.01.039.
2. Obara H, Kentaro M, Inoue M, et al. Current management strategies for visceral artery aneurysms: an overview. Surg Today, 2020, 50(1): 38-49.
3. Stone WM, Abbas M, Cherry KJ, et al. Superior mesenteric artery aneurysms: is presence an indication for intervention? J Vasc Surg, 2002, 36(2): 234-237.
4. Lorelli DR, Cambria RA, Seabrook GR, et al. Diagnosis and management of aneurysms involving the superior mesenteric artery and its branches—a report of four cases. Vasc Endovascular Surg, 2003, 37(1): 59-66.
5. Wang L, Shu C, Li Q, et al. Experience of managing superior mesenteric artery aneurysm and its midterm follow-up results with 18 cases. Vascular, 2021, 29(4): 516-526.
6. Johal M, Kalaravy M, Ali F, et al. Evolving diagnostic and therapeutic options for visceral artery aneurysms. Ann Vasc Surg, 2021, 76: 488-499.
7. Björck M, Koelemay M, Acosta S, et al. Editor’s choice—Management of the diseases of mesenteric arteries and veins: Clinical Practice Guidelines of the European Society of Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg, 2017, 53(4): 460-510.
8. 孙晓宁, 郑月宏. 肠系膜上动脉瘤的治疗策略. 协和医学杂志, 2020, 11(5): 537-541.
9. Wang S, Xiong J. Giant distal superior mesenteric artery aneurysm without symptoms. J Vasc Surg, 2023, 78(6): 1548-1549.
10. Pitcher GS, Cirillo-Penn NC, Mendes BC, et al. Aneurysms of the superior mesenteric artery and its branches. J Vasc Surg, 2022, 76(1): 149-157.
11. Shanley CJ, Shah NL, Messina LM. Uncommon splanchnic artery aneurysms: pancreaticoduodenal, gastroduodenal, superior mesenteric, inferior mesenteric, and colic. Ann Vasc Surg, 1996, 10(5): 506-515.
12. Jia Z, Huang Y, Shi H, et al. Comparison of CTA and DSA in the diagnosis of superior mesenteric artery dissecting aneurysm. Vascular, 2018, 26(4): 346-351.
13. Lei Y, Liu J, Lin Y, et al. Clinical characteristics and misdiagnosis of spontaneous isolated superior mesenteric artery dissection. BMC Cardiovasc Disord, 2022, 22(1): 239. doi: 10.1186/s12872-022-02676-9.
14. Dong Z, Fu W, Chen B, et al. Treatment of symptomatic isolated dissection of superior mesenteric artery. J Vasc Surg, 2013, 57(2 Suppl): 69S-76S. doi: 10.1016/j.jvs.2012.07.060.
15. Yun WS, Kim YW, Park KB, et al. Clinical and angiographic follow-up of spontaneous isolated superior mesenteric artery dissection. Eur J Vasc Endovasc Surg, 2009, 37(5): 572-577.
16. Jacobs CR, Fatima J, Scali ST, et al. Surgical treatment of true superior mesenteric artery aneurysms. Ann Vasc Surg, 2021, 71: 74-83.
17. Barrionuevo P, Malas MB, Nejim B, et al. A systematic review and meta-analysis of the management of visceral artery aneurysms. J Vasc Surg, 2019, 70(5): 1694-1699.
18. Wolk S, Distler M, Radosa C, et al. Management and outcome of true visceral and renal artery aneurysm repair. Langenbecks Arch Surg, 2021, 406(3): 623-630.
19. Hosn MA, Xu J, Sharafuddin M, et al. Visceral artery aneurysms: decision making and treatment options in the new era of minimally invasive and endovascular surgery. Int J Angiol, 2019, 28(1): 11-16.
20. Fargion AT, Falso R, Speziali S, et al. Results of current endovascular treatments for visceral artery aneurysms. J Vasc Surg, 2023, 78(2): 387-393.
21. Gong C, Sun MS, Leng R, et al. Endovascular embolization of visceral artery aneurysm: a retrospective study. Sci Rep, 2023, 13(1): 6936. doi: 10.1038/s41598-023-33789-6.
22. DeCarlo C, Mohebali J, Dua A, et al. Morbidity and mortality associated with open repair of visceral aneurysms. J Vasc Surg, 2022, 75(2): 632-640.
23. Sousa J, Costa D, Mansilha A. Visceral artery aneurysms: review on indications and current treatment strategies. Int Angiol, 2019, 38(5): 381-394.
24. Qiu C, Liu Z, Huang L, et al. Covered stents for treatment of visceral artery aneurysms: A multicenter study. J Vasc Interv Radiol, 2022, 33(6): 640-647.
25. Lin Y C, Liao T C, Lin C T, et al. Salvage surgeries for splanchnic artery aneurysms after failed endovascular therapy: case series. Int J Surg, 2023, 109(7): 1842-1851.
26. Zhang Y, Xiang D, Lu Q, et al. A systematic review and meta-analysis of the performance of flow-diverting stents in the treatment of peripheral and visceral artery aneurysms. Catheter Cardiovasc Interv, 2021, 97(3): 461-469.
27. Fukunaga N, Shimoji A, Tamura N. In situ right gastroepiploic artery as a conduit for treating mycotic aneurysm of the superior mesenteric artery. Eur J Vasc Endovasc Surg, 2024, 67(1): 184. doi: 10.1016/j.ejvs.2023.11.003.
28. Pfister K, Kasprzak P, Oikonomou K, et al. Management of Visceral artery aneurysms with preservation of organ perfusion: More than twenty years experience. Zentralbl Chir, 2018, 143(5): 516-525.
29. Martinelli O, Giglio A, Irace L, et al. Single-center experience in the treatment of visceral artery aneurysms. Ann Vasc Surg, 2019, 60: 447-454.
30. Kordzadeh A, Watson J, Panayiotopolous YP. Mycotic aneurysm of the superior and inferior mesenteric artery. J Vasc Surg, 2016, 63(6): 1638-1646.
31. Higashiura W, Takara H, Kitamura R, et al. Endovascular therapy for distal superior mesenteric artery mycotic aneurysms due to infective endocarditis. J Endovasc Ther, 2019, 26(6): 879-884.
32. Hammad A S, Gilani R, Adnan M A, et al. Treatment of superior mesenteric artery mycotic aneurysm by synthetic vascular graft: A case report. J Pak Med Assoc, 2023, 73(4): 925-928.
33. Huang YK, Hsieh HC, Tsai FC, et al. Visceral artery aneurysm: risk factor analysis and therapeutic opinion. Eur J Vasc Endovasc Surg, 2007, 33(3): 293-301.
34. Pulli R, Dorigo W, Troisi N, et al. Surgical treatment of visceral artery aneurysms: A 25-year experience. J Vasc Surg, 2008, 48(2): 334-342.
35. Grotemeyer D, Duran M, Park EJ, et al. Visceral artery aneurysms—follow-up of 23 patients with 31 aneurysms after surgical or interventional therapy. Langenbecks Arch Surg, 2009, 394(6): 1093-1100.
36. 冯桂林, 周旻, 林越, 等. 肠系膜上动脉瘤17例诊治分析. 中国实用外科杂志, 2021, 41(2): 205-209.
37. Gao P, Li G, Chen J, et al. The impact of endovascular treatment on clinical outcomes of stable symptomatic patients with spontaneous superior mesenteric artery dissection. J Vasc Surg, 2021, 73(4): 1269-1276.
38. Sun J, Wang L, Que Y, et al. Management of Patients with Uncomplicated Symptomatic Isolated Mesenteric Artery Dissection: a Multicentre Experience. Eur J Vasc Endovasc Surg, 2022, 64(5): 507-514.
39. Ahn S, Mo H, Han A, et al. The use of antithrombotics is not beneficial for conservative management of spontaneous isolated dissection of the superior mesenteric artery: A meta-analysis. Ann Vasc Surg, 2019, 60: 415-423.
40. Ben A I, Huguet A, Nuzzo A, et al. Acute Isolated Mesenteric Artery Dissection: Four Year Experience From a French Intestinal Stroke Centre. Eur J Vasc Endovasc Surg, 2022, 64(6): 656-664.
41. Shi Y, Ni G, Zhao B, et al. Management of symptomatic spontaneous isolated superior mesenteric artery dissection: A single centre experience with mid term follow up. Eur J Vasc Endovasc Surg, 2020, 60(6): 863-871.
42. 赵纪春. 开放手术在血管腔内治疗时代的作用和地位. 中国普外基础与临床杂志, 2023, 30(5): 515-516.

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CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

复杂性肠系膜上动脉瘤开放手术1例报道

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