Preoperative Embolization of the Inferior Mesenteric Artery in Colorectal Surgery
试验速览
- 阶段
- 不适用
- 状态
- 招募中
- 发起方
- 入组人数
- 30
- 试验地点
- 6
- 主要终点
- Measure of the Riolan arch (diameter in mm)
研究概览
简要总结
Preoperative embolization of the inferior mesenteric artery in colorectal surgery (EPAMIR).
This is a prospective, monocentric, non-randomized study.
详细描述
Colorectal surgery accounts for 60,000 acts per year in France. One of the feared complications after colorectal resection surgery is anastomotic leak (5-20% of cases), associated with significant morbidity and mortality. Ischemia of the colorectal or colo-anal anastomosis would be one of the main risk factors for the occurrence of a fistula (REF 1). During the operation, the inferior mesenteric artery is ligated and the remaining colon is vascularized only by Riolan's arch, the link between the networks of the inferior mesenteric artery and the superior mesenteric artery. Arterial ligation by operation is responsible for a transient drop in flow at the level of the anastomosis, while the arch develops.
Preoperative ischemic conditioning by arterial embolization is a technique already used in esophageal surgery (REF 2). The objective is to embolize the arterial branches that will be ligated during surgery a few weeks before the resection procedure, in order to allow hypertrophy of the remaining branches to allow better vascularization of the anastomosis on the day of the intervention. The CHUGA is one of the motor centers of this technique. In our experience, embolization performed 3 to 4 weeks before esophageal surgery allows a reduction in the rate of fistulas (p=0.02). These results made it possible to aggregate other centers towards this technique, and a request for PHRC-K is in progress.
In the context of ischemic conditioning before colorectal surgery, a proof of concept on 5 patients has just been completed by the University Hospital of Nîmes (REF 3) of which Dr Ghelfi (Radiologist) and Dr Trilling (Colorectal Surgeon) are investigators. The preliminary results seem suggested.
The responsibility and safety of preoperative embolization of the inferior mesenteric artery have already been validated by meta-analyses of data from patients who received AMI embolization before placement of a covered aortic stent (REF 4).
The objective of this study is to show that ischemic conditioning improves the vascular supply of the colon for risky procedures in colorectal surgery.
研究设计
- 研究类型
- Interventional
- 分配方式
- Na
- 干预模型
- Single Group
- 主要目的
- Treatment
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Adult patients
- •Patient to benefit from left colonic surgery or rectal surgery with upper ligation of the inferior mesenteric artery and colorectal or colo anastomosis
- •Person affiliated to or benefiting from social security
- •Person who has given written informed consent
排除标准
- •History of digestive resection or abdominal aorta surgery
- •Renal failure with GFR < 30 ml/min (MDRD)
- •History of severe allergy to iodine contrast medium
- •Pregnant, parturient, lactating women
- •Patient subject to a legal protection measure or unable to express his non-opposition (guardianship, curatorship)
- •Patient deprived of liberty by judicial or administrative decision
结局指标
主要结局
Measure of the Riolan arch (diameter in mm)
时间窗: CT-TAP before embolization and CT-TAP between 3 and 4 weeks after embolization, before surgery.
Evaluation of the difference in size (diameter in mm) of the Riolan arch
次要结局
- Evaluation of the rate of complications related to colorectal surgery(30 days after colorectal surgery)
- Evaluation of the rate of complications related to preoperative embolization of the inferior mesenteric artery(Between 21 and 30 days after embolization, before surgery.)
- Evaluation of the rate of anastomotic fistulas after colo-rectal surgery(30 days after colorectal surgery)