Online publication December 10, 2015 191 原 著 55 21 1 2 2 1 2 2 2 2 1 要旨 : 8 21 19 2 4 1 20 SMA short segment J Jpn Coll Angiol 2015; 55: 191 196 Key words: superior mesenteric artery, dissection, conservative treatment, thrombosed false lumen, occluded true lumen はじめに SMA CT SMA SMA 21 対象と方法 2006 4 2014 1 SMA 21 retrospective 1. 患者背景 21 18 85 52 39 67 13 62 13 62 4 19 3 14 1 2 55 2014 10 doi: 10.7133/jca.15-00027 Marfan Table 1 2. 自覚症状と診断法 21 19 2 follow 4 19 1 SMA 2 4 10 kg CT 3. 解離の性状 SMA 9 43 SMA 14 67 5 24 2 6.6 cm 2.5 15 cm 15 71 6 29 2015 7 9 2015 11 10 THE JOURNAL of JAPANESE COLLEGE of ANGIOLOGY Vol. 55
192 4 19 3 1 4. 治療と Follow up Table 1 Patient characteristics Age (years) 52 (39 67) Sex (male) 18 (85%) Hypertension 13 (62%) Smoker 13 (62%) Dyslipidemia 4 (19%) Celebrovascular disease 3 (14%) Type 2 diabetes mellitus 0 (0%) Ischemic heart disease 0 (0%) Connective tissue disease 0 (0%) SMA follow follow follow CT SMA / CT follow 6 5 83 20.6 5 open surgery SMA 21 1 SMA 2 cm φ6 mm Fig. 1A, B 1 CPK LDH 1 9 60 4 67 4 4 2 2 12 11 9 2 1 17 5 20 5 3 2 1 1 15 follow 7 47 6 40 2 6 5 83 1 3 12 mm 18 mm SMA 結 果 症例提示 16 76 12 5.5 2 10 18 15 11 73 17 11 7 64 4 3 1 58 SMA 13.6 cm 4.3 cm 脈管学 Vol. 55
193 Figure 1 A: This patient was referred to us because of abdominal angina at four months after the onset of SMA dissection. Angiogram showed occlusion of SMA (arrow). B: Endovascular balloon angioplasty was employed to the patient. A B 4 15 CT 2 51 SMA 1.8 cm 18 cm 2.3 cm 1 cm Fig. 2A CT 5 CT Fig. 2B 10 31 3 57 SMA 10 cm 3 cm 1 cm CT 5 17 考察 SMA CT 1~3 50 SMA 1 2 cm 4 ULP entry SMA 1, 2 5, 6 3 1 SMA short segment 3 1 THE JOURNAL of JAPANESE COLLEGE of ANGIOLOGY Vol. 55
194 Figure 2 A: CT angiogram which was taken at other hospital showed acute occlusion (arrow heads) of true lumen of the SMA because of thrombosed false lumen. B: This CT was taken at 5 hours after the initial CT (Figure 2A) and showed spontaneous recanalization (arrow) of the occluded true lumen. A B 1 1 SMA SMA 1 SMA 14 2 15 20 cm 1 1 1 3 7~11 12 13 SMA short segment 2 6 1 2 cm 14, 15 TAE + 16, 17 SMA 6 脈管学 Vol. 55
195 1 18 結語 SMA 21 1 SMA 利益相反 文献 1 2013; 22: 695 701 2 9 2010; 71: 648 653 3 4 2010; 43: 863 869 4 Solis MM, Ranval TJ, McFarland DR, et al: Surgical treatment of superior mesenteric artery dissecting aneurysm and simultaneous celiac artery compression. Ann Vasc Surg 1993; 7: 457 462 5 3 2013; 45: 726 730 6 1 33 2012; 21: 37 42 7 1 2013, 33: 1181 1184 8 2013; 45: 1117 1121 9 Froment P, Alerci M, Vandoni RE, et al: Stenting of a spontaneous dissection of the superior mesenteric artery: a new therapeutic approach? Cardiovasc Intervent Radiol 2004; 27: 529 532 10 Morris JT, Guerriero J, Sage JG, et al: Three isolated superior mesenteric artery dissections: update of previous case reports, diagnostics, and treatment options. J Vasc Surg 2008; 47: 649 653 11 Lim EH, Jung SW, Lee SH, et al: Endovascular management for isolated spontaneous dissection of the superior mesenteric artery: report of two cases and literature review. J Vasc Interv Radiol 2011; 22: 1206 1211 12 Li N, Lu QS, Zhou J, et al: Endovascular stent placement for treatment of spontaneous isolated dissection of the superior mesenteric artery. Ann Vasc Surg 2014; 28: 445 451 13 Rong JJ, Qian AM, Sang HF, et al: Immediate and middle term outcome of symptomatic spontaneous isolated dissection of the superior mesenteric artery. Abdom Imaging 2015; 40: 151 158 14 1997; 6: 827 833 15 5 2005; 45: 541 546 16 Satokawa H, Seto Y, Yamamoto A, et al: A case report of aneuysmectomy after thrombo-intimectomy for spontaneous isolated superior mesenteric artery dissection. Ann Vasc Dis 2012; 5: 204 207 17 4 2008; 27: 29 32 18 165 2012; 21: 773 780 THE JOURNAL of JAPANESE COLLEGE of ANGIOLOGY Vol. 55
196 Efficacy of the Conservative Treatment for Isolated Dissection of the Superior Mesenteric Artery Takayuki Saito, 1 Taichi Tsuji, 2 Mika Goto, 2 Yukihide Numata, 1 Yoshizumi Asano, 2 Masahiro Kajiguchi, 2 Mitsunori Harada, 2 Shinji Mokuno, 2 and Yuji Yamanaka 1 1Department of Cardiovascular Surgery, Kariya Toyota General Hospital, Aichi, Japan 2 Department of Cardiology, Kariya Toyota General Hospital, Aichi, Japan Key words: superior mesenteric artery, dissection, conservative treatment, thrombosed false lumen, occluded true lumen We report herein a retrospective study which included 21 consecutive patients who were diagnosed with isolated superior mesenteric artery (SMA) dissection at our hospital between 2006 and 2014. False lumen was thrombosed in 15 patients (71%). One patient underwent endovascular treatment because of persistent abdominal angina at 4 months after the onset. The other patients including three, whose true lumen of SMA were completely occluded by thrombosed false lumen, were successfully treated with conservative therapy. If occlusion of true lumen of the SMA is located closely to the ostium and is only short segment, collateral flow to distal SMA and early spontaneous recanalization of occluded segment will attribute to a successful conservative treatment. (J Jpn Coll Angiol 2015; 55: 191 196) Online publication December 10, 2015 脈管学 Vol. 55