■血管内主动脉修复术已成为肾下主动脉瘤的首选治疗方法。主动脉搏动可能会带来有关内移植物尺寸的问题。这项研究的目的是确定主动脉疾病患者的主动脉搏动,并评估搏动对动脉瘤生长的影响。
■在这项回顾性研究中,对31例接受保守治疗的小腹主动脉瘤患者的计算机断层扫描血管造影(CTA)图像进行分析。使用在R-R周期的30%和90%处的原始心电图(ECG)门控数据集的重建。管腔分割后,在舒张期和收缩期测量以下区域的总主动脉横截面积:Z0,Z3,Z5,Z6,Z8和Z9.从收缩压(EDsys)和舒张(EDdia)横截面积计算有效直径(ED),以确定绝对(EDsys-EDdia,mm)和相对脉动性[(EDsys-EDdia)/EDdia,%].在基线图像和每位患者的最后一次术前随访研究中测量动脉瘤的直径。
■总共完成了806次测量,每位患者24次搏动和2次生长测量。每个点的平均搏动值如下:Z0:0.7±0.8mm,Z3:1.0±0.6mm,Z5:1.0±0.6mm,Z6:0.8±0.7mm,Z8:0.7±1.0mm,Z9:0.9±0.9mm。随访时间为5.5±2.2年,在此期间观察到13.42±9.09mm(每年2.54±1.55mm)的增长。在搏动性值和动脉瘤的生长速率之间没有发现相关性。
■对于绝大多数患有主动脉疾病的患者,主动脉的搏动性在亚毫米范围内,因此可能与内移植物大小无关。升主动脉的搏动性小于降段的搏动性,使Z0植入的额外超大尺寸值得怀疑。
结论:主动脉腔内修复术需要精确的术前计划。主动脉直径的脉动变化可能会引起有关内移植物尺寸的问题。在我们的回顾性单中心研究中,在ECG门控CTA图像上测量AAA患者的主动脉搏动。降主动脉搏动值达到最大值,然而,沿主动脉的任何点的绝对搏动值均不超过1mm。因此,主动脉搏动对EVAR假体尺寸的重要性值得怀疑。未发现搏动性与AAA生长之间的相关性。
UNASSIGNED: Endovascular aortic repair has become the preferred elective treatment of infrarenal aortic aneurysms. Aortic pulsatility may pose problems regarding endograft sizing. The aims of this study are to determine the aortic pulsatility in patients with aortic disease and to evaluate the effect of pulsatility on the growth of aneurysms.
UNASSIGNED: In this retrospective study, analyses of computed tomography angiography (CTA) images of 31 patients under conservative treatment for small abdominal aortic aneurysms were performed. Reconstructions of the raw electrocardiography (ECG) gated dataset at 30% and 90% of the R-R cycle were used. After lumen segmentation, total aortic cross-sectional area was measured in diastole and systole in the following zones: Z0, Z3, Z5, Z6, Z8, and Z9. Effective diameters (EDs) were calculated from the systolic (EDsys) and diastolic (EDdia) cross-sectional areas to determine absolute (EDsys - EDdia, mm) and relative pulsatility [(EDsys - EDdia) / EDdia, %]. Diameter of the aneurysms was measured on baseline images and the last preoperative follow-up study of each patient.
UNASSIGNED: A total of 806 measurements were completed, 24 pulsatility and 2 growth measurements per patient. The mean pulsatility values at each point were as follows: Z0: 0.7±0.8 mm, Z3: 1.0±0.6 mm, Z5: 1.0±0.6 mm, Z6: 0.8±0.7 mm, Z8: 0.7±1.0 mm, Z9: 0.9±0.9 mm. Follow-up time was 5.5±2.2 years during which a growth of 13.42±9.09 mm (2.54±1.55 mm yearly) was observed. No correlation was found between pulsatility values and growth rate of the aneurysms.
UNASSIGNED: The pulsatility of the aorta is in a submillimetric range for the vast majority of patients with aortic disease, thus probably not relevant regarding endograft sizing. Pulsatility of the ascending aorta is smaller than that of the descending segment, making an additional oversize of a Z0 implantation questionable.
CONCLUSIONS: Endovascular aortic repair reqiures precise preoperative planning. Pulsatile changes of the aortic diameter may pose issues regarding endograft sizing. In our retrospective single-centre study, aortic pulsatility of patients with AAA was measured on ECG gated CTA images. Pulsatility values reached a maximum at the descending aorta, however absolute pulsatility values did not exceed 1 mm at any point along the aorta. Therefore, significance of aortic pulsatility regarding the sizing of EVAR prostheses is questionable. Correlation between pulsatility and AAA growth was not found.