目的:本研究旨在使用四维(4D)流磁共振成像(MRI)量化血管内动脉瘤修复术(EVAR)前后肾血流的变化,并评估其与肾损害的相关性。
方法:在本回顾性分析中,18例患者使用Excluder或Endurant内移植物对肾下梭形腹主动脉瘤进行了选择性EVAR。在EVAR之前和之后1-4天进行4D流MRI扫描。在肾上主动脉(SupAo)定量血液动力学,双侧肾动脉(RRA和LRA),和肾下主动脉(InfAo)。心脏相位分辨血流值(BFVs),相对流量分布(RFD),和流量变化率(FCR)进行评估。术前和术后测量估计的肾小球滤过率(eGFR)。
结果:在排除两个异常值后,共分析了16例患者。前EVARBFV为23.1±8.3、3.7±1.3、3.4±1.2和15.1±5.9mL/周期,而SupAo的EVAR后BFV为20.9±6.9、3.8±1.1、3.2±0.9和12.1±4.3mL/周期,RRA,上帝军,还有InfAo,分别。比较排除(N=8)和Endurant(N=8),总肾脏FCR为121.8%[106.6-144.7]对101.3%[63.8-121.8](p=0.110),用排除器提示肾血流量的潜在改善,虽然没有统计学意义。在6个月时,总肾脏FCR与相对eGFR之间存在显着相关性(Spearman相关系数,0.789;p<0.001)。
结论:内移植物,特别是独家新闻,在某些患者中显示出改善肾动脉血流量的潜力。6个月时总肾脏FCR与相对eGFR之间的显着相关性表明,EVAR引起的急性血液动力学改变可能会影响术后肾功能。需要进一步的研究来证实这些发现并评估其临床意义。
OBJECTIVE: This study aims to quantify changes in renal blood flow before and after endovascular aneurysm repair (EVAR) using four-dimensional (4D) flow magnetic resonance imaging (MRI) and evaluate its correlation with renal impairment.
METHODS: In this retrospective analysis, 18 patients underwent elective EVAR for infrarenal fusiform abdominal aortic aneurysms using Excluder or Endurant endografts. 4D flow MRI scans were conducted before and 1-4 days after EVAR. Hemodynamics were quantified at the suprarenal aorta (SupAo), bilateral renal arteries (RRA and LRA), and infrarenal aorta (InfAo). Cardiac phase-resolved blood flow values (BFVs), relative flow distribution (RFD), and flow change rates (FCRs) were assessed. Estimated glomerular filtration rate (eGFR) was measured pre- and postoperatively.
RESULTS: A total of 16 patients were analyzed after excluding two outliers. Pre-EVAR BFVs were 23.1 ± 8.3, 3.7 ± 1.3, 3.4 ± 1.2, and 15.1 ± 5.9 mL/cycle, while post-EVAR BFVs were 20.9 ± 6.9, 3.8 ± 1.1, 3.2 ± 0.9, and 12.1 ± 4.3 mL/cycle in SupAo, RRA, LRA, and InfAo, respectively. Comparing Excluder (N = 8) and Endurant (N = 8), the total renal FCR was 121.8% [106.6-144.7] versus 101.3% [63.8-121.8] (p = 0.110), suggesting a potential improvement in renal blood flow with the Excluder, although not statistically significant. A significant correlation was found between the total renal FCR and the relative eGFR at 6 months (Spearman correlation coefficient, 0.789; p < 0.001).
CONCLUSIONS: The endografts, particularly the Excluder, showed potential in improving renal artery blood flow in some patients. The significant correlation between the total renal FCR and the relative eGFR at 6 months suggests that acute hemodynamic alterations induced by EVAR may impact post-operative renal function. Further research is needed to confirm these findings and assess their clinical implications.