Dissection Level Within Aortic Wall Layers is Associated with Propagation of Type B Aortic Dissection: A Swine Model Study
Dissection Level Within Aortic Wall Layers is Associated with Propagation of Type B Aortic Dissection: A Swine Model Study
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主动脉壁层内的夹层水平与 B 型主动脉夹层的传播相关：猪模型研究
DOI：
10.1016/j.ejvs.2019.02.026
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发表时间：
2019-09-01
影响因子：
5.7
通讯作者：
Fu, Weiguo
中科院分区：
文献类型：
--
作者：
Guo, Baolei;Dong, Zhihui;Fu, Weiguo
目的：血流动力学和几何因素在急性B型主动脉夹层（TBAD）的发展中起关键作用。本研究的目的是评估所有主动脉层内的夹层水平与猪主动脉急性TBAD传播之间的关系。方法：选取12头猪，建立2种TBAD模型。在A模型（n = 6）中，主动脉壁撕裂是浅表的，靠近内膜（薄内膜瓣），而在B模型（n = 6）中，它是深的，靠近外膜（厚内膜瓣）。使用血管造影或计算机断层扫描评估解剖扩展，并使用多普勒线获得血流动力学测量。大多数猪在1、3、6、12、18和24个月时被随访；4只动物分别在3个月和6个月时被安乐死（每组2只）。结果：两种模型均成功建立。两种模型术中顺行传播距离中位数差异无统计学意义（p = 0.092）。24月龄时，模型B的纵向传播距离显著大于模型A （p = 0.016）。逆行繁殖无统计学差异（p = .691）。随着时间的推移，主动脉壁剥离在模型A的前三个月进展最为明显，而在模型b的前12个月继续进行。在原发撕裂水平（p = 0.001）和夹层中部（p = 0.004），真腔的流速明显大于假腔。3个月和6个月的组织病理学图像显示，两种模型的假腔外壁纤维呈线性拉伸，而内膜撕裂的深度在远端剥离处发展为浅表且相似。结论：在猪TBAD模型中，更深的内膜撕裂导致更大的夹层繁殖。
Objective: Haemodynamic and geometric factors play pivotal roles in the propagation of acute type B aortic dissection (TBAD). The aim of this study was to evaluate the association between dissection level within all aortic layers and the propagation of acute TBAD in porcine aorta.Methods: In twelve pigs, two models of TBAD were created. In model A (n = 6), the aortic wall tear was superficial and close to the intima (thin intimal flap), whereas in model B (n = 6) it was deep and close to the adventitia (thick intimal flap). Dissection propagation was evaluated using angiography or computed tomography scans, and the haemodynamic measurements were acquired using Doppler wires. Most pigs were followed up at 1, 3, 6, 12, 18, and up to 24 months; four animals were euthanised at three and six months, respectively (two from each group).Results: Both models were successfully created. No statistical difference was observed for the median antegrade propagation distance intra-operatively between the two models (p = .092). At 24 months, the longitudinal propagation distance was significantly greater in model B than in model A (p = .016). No statistical difference in retrograde propagation was noted (p = .691). Over time, aortic wall dissection progressed most notably over the first three months in model A, whereas it continued over the first 12 months in model B. Flow velocity was significantly greater in the true lumen than in false lumen at the level of the primary tear (p = .001) and in the middle of the dissection (p = .004). The histopathological images at three and six months demonstrated the fibres were stretched linearly at the outside wall of false lumen in both models, while the depth of intimal tears developed to be superficial and similar at the distal dissection.Conclusion: In this swine model of TBAD, a deeper intimal tear resulted in greater dissection propagation.