Научно-практический журнал
«Клиническая физиология кровообращения»

ISSN 1814-6910 (Print)
ISSN 2410-9134 (Online)

 

Главный редактор

Лео Антонович Бокерия, доктор медицинских наук, профессор, академик РАН и РАМН, президент ФГБУ «НМИЦ ССХ им. А.Н. Бакулева» МЗ РФ


Каталог статей ➤ КФК. 2023; 20 (2): 89-202 ➤ Успешное хирургическое лечение аневризмы верхней брыжеечной артерии в сочетании с экстравазальной компрессией чревного ствола у пациентки с гематурией

Успешное хирургическое лечение аневризмы верхней брыжеечной артерии в сочетании с экстравазальной компрессией чревного ствола у пациентки с гематурией

Авторы: Аракелян В.С.1, Букацелло Р.Г.1,2, 2, Гамзаев Н.Р.1, Черных Н.А.1, Кидакоев Р.З-Г. 1

Организация:
1 ФГБУ «Национальный медицинский исследовательский центр сердечно-сосудистой хирургии им. А.Н. Бакулева» Минздрава России, Москва, Российская Федерация
2 ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России, Москва, Российская Федерация

Для корреспонденции: Сведения доступны для зарегистрированных пользователей.

Раздел: Клинические случаи

DOI: https://doi.org/10.24022/1814-6910-2023-20-2-193-202

УДК: 616.136.46-007.64-089

Библиографическая ссылка: Клиническая физиология кровообращения. 2023; 2 (20): 193-202

Цитировать как: Аракелян В.С., Букацелло Р.Г., Гамзаев Н.Р., Черных Н.А., Кидакоев Р.З-Г. . Успешное хирургическое лечение аневризмы верхней брыжеечной артерии в сочетании с экстравазальной компрессией чревного ствола у пациентки с гематурией. Клиническая физиология кровообращения. 2023; 2 (20): 193-202. DOI: 10.24022/1814-6910-2023-20-2-193-202

Поступила / Принята к печати:  23.05.2023 / 15.06.2023

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Аннотация

Лечение аневризм верхней брыжеечной артерии и ее ветвей остается серьезным вызовом для хирургического сообщества. В обзоре представлены тактические особенности двух основных направлений при лечении патологии артерий висцерального бассейна: классическое – хирургическое и рентгенэндоваскулярное с использованием как окклюзионных методов, так и различных видов стентов. Критериями, усложняющими выбор предпочтительного варианта лечения, являются размеры, тип и локализация аневризмы, анатомия спланхнического артериального бассейна, особенности висцеральной гемодинамики и выраженность коллатерализации, анатомическое соседство с органами брюшной полости и ряд других. Несмотря на постоянное совершенствование эндоваскулярной техники вмешательств и позитивные результаты этого малоинвазивного альтернативного варианта лечения висцеральных аневризм, в клинический практике встречаются случаи, при которых внутрисосудистый способ «выключения» аневризмы оказывается технически сложным или невыполнимым и несет риски мезентериальной ишемии.

При выборе варианта коррекции комплексная оценка состояния всех висцеральных артерий и анатомии спланхнического бассейна в ряде случаев является определяющей. В представленном клиническом случае описан опыт лечения комбинированного поражения мезентериальных артерий, потребовавшего разработки детальных этапности и техники операции одновременно в двух бассейнах висцерального артериального русла для профилактики возможных ишемических и геморрагических осложнений.

Литература

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  1. Wang L., Shu C., Li Q., Jiang X., Li X., He H. et al. Experience of managing superior mesenteric artery aneurysm and its midterm follow-up results with 18 cases. Vascular. 2021; 29 (4): 516–26. DOI: 10.1177/1708538120962884
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  3. Okubo R., Kikuchi S., Otani N., Tsutsui M., Kamiya H. Giant superior mesenteric artery aneurysm treated by endovascular treatment in a very elderly female. Vasc. Specialist Int. 2023; 39: 10. DOI: 10.5758/vsi.230020
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  6. Sahajwani S., Tolaymat B., Khalifeh A., Hosseini M., Santini-Dominguez R., Blitzer D. et al. Presentation and management of rare saccular superior mesenteric artery trunk and branch aneurysms. J. Vasc. Surg. Cases Innov. Tech. 2022; 8 (2): 281–6. DOI: 10.1016/j.jvscit.2020.07.011
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  8. Chaer R.A., Abularrage C.J., Coleman D.M., Eslami M.H., Kashyap V.S., Rockman C. 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
  9. Rebelo A., Ronellenfitsch U., Partsakhaschwilli J., Kleeff J., John E., Ukkat J. Endovascular and open repair of visceral aneurysms: A retrospective single-center analysis. Exp. Ther. Med. 2023; 25 (6): 252. DOI: 10.3892/etm.2023.11951
  10. Khairallah M.K., Morgan R.A., Das R. Technical considerations of endovascular management of true visceral artery aneurysms. CVIR Endovasc. 2023; 6: 31. DOI: 10.1186/s42155-023-00368-9
  11. Kok H.K., Asadi H., Sheehan M., Given M.F., Lee M.J. Systematic review and single-center experience for endovascular management of visceral and renal artery aneurysms. J. Vasc. Interv. Radiol. 2016; 27 (11): 1630–41. DOI: 10.1016/j.jvir.2016.07.030
  12. Marone E.M., Rinaldi L.F. Current debates in the management of visceral artery aneurysms: where the guidelines collide. J. Clin. Med. 2023; 12 (9): 3267. DOI: 10.3390/jcm12093267
  13. Ferrero E., Ferri M., Viazzo A., Robaldo A., Carbonatto P., Pecchio A. et al. Visceral artery aneurysms, an experience on 32 cases in a single center: treatment from surgery to multilayer stent. Ann. Vasc. Surg. 2011; 25 (7): 923–35. DOI: 10.1016/j.avsg.2011.04.006
  14. Cappucci M., Zarco F., Orgera G., López-Rueda A., Moreno J., Laurino F. et al. Tratamiento endovascular de aneurismas y pseudoaneurismas de arterias viscerales mediante stents recubiertos: análisis de resultados inmediatos y a largo plazo. Cir. Esp. 2017; 95: 283–92. DOI: 10.1016/j.ciresp.2017.04.011
  15. Ruffino M.A., Rabbia C.; Italian Cardiatis Registry Investigators Group. Endovascular repair of peripheral and visceral aneurysms with the Cardiatis multilayer flow modulator: one-year results from the Italian Multicenter Registry. J. Endovasc. Ther. 2012; 19 (5): 599–610. DOI: 10.1583/JEVT-12-3930MR2.1
  16. Yasumoto T., Osuga K., Yamamoto H., Ono Y., Masada M., Mikami K. et al. Long-term outcomes of coil packing for visceral aneurysms: correlation between packing density and incidence of coil compaction or recanalization. J. Vasc. Interv. Radiol. 2013; 24 (12): 1798–807. DOI: 10.1016/j.jvir.2013.04.030
  17. Shukla A.J., Eid R., Fish L., Avgerinos E., Marone L., Makaroun M. et al. Contemporary outcomes of intact and ruptured visceral artery aneurysms. J. Vasc. Surg. 2015; 61 (6): 1442–7. DOI: 10.1016/j.jvs.2015.01.005
  18. Zhang Y., Liu Z., Shen G., Zhang J., Assa C.R., Hong D. Treatment of distal splenic artery aneurysm by laparoscopic aneurysmectomy with end-to-end anastomosis: а case report. Medicine (Baltimore). 2017; 96 (19): e6260. DOI: 10.1097/MD.0000000000006260
  19. Reed N.R., Oderich G.S., Manunga J., Duncan A., Misra S., de Souza L.R. et al. Feasibility of endovascular repair of splenic artery aneurysms using stent grafts. J. Vasc. Surg. 2015; 62 (6): 1504–10.
  20. Buck D.B., Curran T., McCallum J.C., Darling J., Mamtani R., van Herwaarden J.A. et al. Management and outcomes of isolated renal artery aneurysms in the endovascular era. J. Vasc. Surg. 2016; 63 (1): 77–81. DOI: 10.1016/j.jvs.2015.07.094
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Об авторах

  • Аракелян Валерий Сергеевич, д-р мед. наук, профессор, руководитель отделения хирургии артериальной патологии; ORCID
  • Букацелло Роман Геннадьевич, канд. мед. наук, ст. науч. сотр. отделения хирургии артериальной патологии, сердечно-сосудистый хирург; ORCID
  • Гамзаев Назим Рагимович, канд. мед. наук, ст. науч. сотр. отделения хирургии артериальной патологии, сердечно-сосудистый хирург; ORCID
  • Черных Николай Александрович, аспирант отделения хирургии артериальной патологии, сердечно-сосудистый хирург; ORCID
  • Кидакоев Рустам Забыт-Гериевич, аспирант отделения хирургии артериальной патологии, сердечно-сосудистый хирург; ORCID

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