Staged surgically created type B aortic dissection model with endovascular reintervention for different morphological features.
Staged surgically created type B aortic dissection model with endovascular reintervention for different morphological features.
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DOI：
10.1093/icvts/ivad133
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发表时间：
2023-11-02
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影响因子：
--
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中科院分区：
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了解形态学及其与治疗策略的关系对于实现主动脉夹层重塑至关重要。研究新的治疗设备和干预措施需要可控且可重复的大型动物模型。我们的实验方案涉及开发手术创建的 B 型主动脉夹层 (TBAD) 和血管内再干预诱导的 TBAD 猪模型。样本被随机分为 2 组：一组接受二次泪液生成 (STC) 手术，另一组接受假腔延伸 (FLE) 手术。术后1个月和3个月观察解剖特征，术后3个月每组2只动物被安乐死。主动脉和主要分支被整块收获，横切并准备用于组织学检查。所有通过手术创建的 TBAD 模型均成功生成，并且没有发生意外并发症。 12只动物中有11只成功建立了血管内再干预诱导的TBAD模型，其中STC组有6只，FLE组有5只。 STC组术中新继发撕裂平均直径为7.23mm，第30天略有增加（P=0.0026）。 FLE组术中新种植长度为（235.80±84.94）mm。 1 个月随访时的 FL 传播长度明显长于术中测量的 (P = 0.0362)。组织学评估表明，主动脉壁中层的弹性纤维被破坏，并且假腔外膜侧似乎明显被拉伸。我们的血管内再介入治疗是一种可靠的微创方法，可用于生成具有不同形态的特定 TBAD 模型。胸主动脉腔内修复术 (TEVAR) 已成为复杂性且越来越多的非复杂性 B 型主动脉夹层 (TBAD) 患者的一线治疗方法 [1, 2]。
Understanding morphology and how this relates to treatment strategy is critical for achieving remodelling in aortic dissection. A controllable and reproducible large animal model is required for investigating new therapeutic devices and interventions. Our experimental protocol involved the development of surgically created type B aortic dissection (TBAD) and endovascular reintervention-induced TBAD porcine models. The sample was randomly divided into 2 groups: 1 underwent a secondary tear creation (STC) procedure and the other underwent a false lumen extension (FLE) procedure. Anatomical features were observed at 1 and 3 months, and 2 animals in each group were euthanized at 3 months after the procedures. The aorta and main branches were harvested en bloc, cross-sectioned and prepared for histological examination. All surgically created TBAD models were successfully generated, and no unintended complications occurred. The endovascular reintervention-induced TBAD model was successfully created in 11 of 12 animals, with 6 in the STC group and 5 in the FLE group. In the STC group, the intraoperative mean diameter of the new secondary tear was 7.23 mm, and a slight increase was observed at first 30 days (P = 0.0026). In the FLE group, the intraoperative new propagation length was (235.80 ± 84.94) mm. The FL propagation length at the 1-month follow-up was significantly longer than that measured intraoperatively (P = 0.0362). Histological evaluation demonstrated that the elastic fibres in the media layer of the aortic wall were disrupted and appeared to be significantly stretched on the adventitial side of the false lumen. Our endovascular reintervention is a reliable, minimally invasive approach for producing specific TBAD models with different morphologies. Endovascular thoracic aortic repair (TEVAR) has become the first-line treatment for patients with complicated, and to an increasing extent, uncomplicated type B aortic dissection (TBAD) [1, 2].
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