Use of dynamic computed tomography to evaluate pre- and postoperative aortic changes in AAA patients undergoing endovascular aneurysm repair
Use of dynamic computed tomography to evaluate pre- and postoperative aortic changes in AAA patients undergoing endovascular aneurysm repair
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DOI：
10.1583/06-1976.1
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发表时间：
2007-02-01
影响因子：
2.6
通讯作者：
Verhagen, Hence J. M.
中科院分区：
文献类型：
--
作者：
Teutelink, Arno;Muhs, Bart E.;Verhagen, Hence J. M.
目的：利用动态计算机断层扫描血管造影术（CTA）对术前和术后腹主动脉瘤修复术（EVAR）患者描述动脉瘤颈内心脏诱发的主动脉运动，一个重要的EVAR密封区域。方法：利用64层Philips Brilliance CT扫描仪对15例连续术前和术后AAA患者采集心电图门控CTA clatasets。在动脉瘤瘤颈内的2个临床相关水平进行轴向搏动测量：最高肾动脉上方2 cm和最低肾动脉下方1 cm。结果：在心动周期中，动脉瘤瘤颈内存在明显的主动脉搏动。术前主动脉面积显著增加，最大增加达12.5%。覆膜支架的存在不影响主动脉搏动（p=NS）。在一个心动周期内，术后面积也发生了显著变化，最大增幅高达14.5%。直径测量显示了相同的模式，动脉瘤颈内和上方的术前和术后心内搏动显著（p < 0.05）。最大直径变化增加15%was evident.Conclusion：接受腹主动脉瘤腔内修复术的患者在动脉瘤颈内和上方经历主动脉直径变化。心脏移植物的存在并不能消除这种对心内压力变化的反应。静态CT成像可能无法充分识别主动脉搏动较大的患者，可能导致覆膜支架尺寸过小、覆膜支架移位、间歇性I型内漏和患者结局不良。目前基于静态CT的10%至15%尺寸过大的标准方案可能不适用于某些患者。
Purpose: To utilize dynamic computed tomographic angiography (CTA) on pre- and postoperative enclovascular aneurysm repair (EVAR) patients to characterize cardiac-induced aortic motion within the aneurysm neck, an essential EVAR sealing zone.Methods: Electrocardiographically-gated CTA clatasets were acquired utilizing a 64-slice Philips Brilliance CT scanner on 15 consecutive pre- and postoperative AAA patients. Axial pulsatility measurements were taken at 2 clinically relevant levels within the aneurysm neck: 2 cm above the highest renal artery and 1 cm below the lowest renal artery. Changes in aortic area and diameter were determined.Results: Significant aortic pulsatility exists within the aneurysm neck during the cardiac cycle. Preoperative aortic area increased significantly, with a maximum increase of up to 12.5%. The presence of an enclograft did not affect aortic pulsatility (p=NS). Postoperative area also changed significantly during a heart cycle, with a maximum increase of up to 14.5%. Diameter measurements demonstrated an identical pattern, with significant preand postoperative intracardiac pulsatility within and above the aneurysm neck (p < 0.05). An increase in maximum diameter change up to 15% was evident.Conclusion: Patients undergoing EVAR experience aortic diameter changes within and above the aneurysm neck. The presence of an enclograft does not abrogate this response to intracardiac pressure changes. Static CT imaging may not adequately identify patients with large aortic pulsatility, potentially resulting in enclograft undersizing, stent-graft migration, intermittent type I endoleaks, and poor patient outcomes. The current standard regime of 10% to 15% oversizing based on static CT may be inadequate for some patients.