Aneurysmal Repair Increase in Local Energy Loss for Fusiform Abdominal Aortic Aneurysm: Assessments With 4D flow MRI.
Aneurysmal Repair Increase in Local Energy Loss for Fusiform Abdominal Aortic Aneurysm: Assessments With 4D flow MRI.
复制标题
梭形腹主动脉瘤局部能量损失的动脉瘤修复增加：4D 流 MRI 评估。
DOI：
10.1002/jmri.28359
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发表时间：
2022
影响因子：
4.4
通讯作者：
Itatani Keiichi
中科院分区：
文献类型：
--
作者：
Horiguchi Ryota;Takehara Yasuo;Sugiyama Masataka;Hyodo Ryota;Komada Tomohiro;Matsushima Masaya;Naganawa Shinji;Mizuno Takashi;Sakurai Yasuo;Sugimoto Masayuki;Banno Hiroshi;Komori Kimihiro;Itatani Keiichi
背景尽管腹主动脉瘤腔内修复术（EVAR）由于其低侵入性而成为腹主动脉瘤（AAA）的首选治疗方法，其对局部血流动力学的影响尚未得到充分评估。目的阐明腹主动脉瘤腔内修复术如何影响能量损失（EL）方面的局部血流动力学。研究类型前瞻性单组研究。场强/序列A 3.0 T/使用相位对比三维电影梯度回波序列的4D流动MRI。（中位数[四分位距]年龄：77.0 [73.0，78.8]岁，11例男性）计划进行腹主动脉瘤腔内修复术，作为梭形AAA的初始治疗。评估4D flow MRI，覆盖腹主动脉和双侧髂总动脉以及相应的覆膜支架（SG）在腹主动脉瘤腔内修复术前后进行了管腔检查。在腹主动脉瘤腔内修复术前1周内和术后1个月内测量血浆脑钠肽（BNP）。比较腹主动脉瘤腔内修复术前后的血流动力学数据，包括平均速度和局部EL。EL与AAA颈角和BNP相关。将患者细分为变形（N= 5）和未变形SG亚组（N= 8），并在每个亚组中比较腹主动脉瘤腔内修复术前/后BNP。统计参数或非参数方法。斯皮尔曼等级相关系数（r）。使用Bland-Altman图的观察者间/观察者内变异性。结果腹主动脉瘤腔内修复术后平均流速（cm/sec）为腹主动脉瘤腔内修复术后的5倍：4.79 ± 0.32 vs. 0.91 ± 0.02。腹主动脉瘤腔内修复术后总EL（mW）增加1.7倍：0.487（0.420，0.706）vs. 0.292（0.192，0.420）。总EL与腹主动脉瘤腔内修复术前（r= 0.691）和腹主动脉瘤腔内修复术后（r= 0.718）的AAA瘤颈角成比例。BNP（pg/mL）与腹主动脉瘤腔内修复术后总EL成比例（r= 0.773）。在变形SG组中，腹主动脉瘤腔内修复术后EL（0.349 [0.261，0.416]）增加2.4倍至0.848（0.597，1.13），BNP为90.3（53.6，105）至100（67.2，123）。结论腹主动脉瘤腔内修复术后局部EL增加1.7倍。变形SG组中EL的较大增加可能是虚弱患者的潜在问题。证据等级1技术有效性阶段2
BackgroundAlthough endovascular aneurysmal repair (EVAR) is a preferred treatment for abdominal aortic aneurysm (AAA) owing to its low invasiveness, its impact on the local hemodynamics has not been fully assessed.PurposeTo elucidate how EVAR affects the local hemodynamics in terms of energy loss (EL).Study TypeProspective single‐arm study.Field Strength/SequenceA 3.0 T/4D flow MRI using a phase‐contrast three‐dimensional cine‐gradient‐echo sequence.PopulationA total of 13 consecutive patients (median [interquartile range] age: 77.0 [73.0, 78.8] years, 11 male) scheduled for EVAR as an initial treatment for fusiform AAA.Assessment4D flow MRI covering the abdominal aorta and bilateral common iliac arteries and the corresponding stent‐graft (SG) lumen was performed before and after EVAR. Plasma brain natriuretic peptide (BNP) was measured within 1 week before and 1 month after EVAR. The hemodynamic data, including mean velocity and the local EL, were compared pre‐/post‐EVAR. EL was correlated with AAA neck angle and with BNP. Patients were subdivided into deformed (N= 5) and undeformed SG subgroups (N= 8) and pre‐/post‐EVAR BNP compared in each.StatisticsParametric or nonparametric methods. Spearman's rank correlation coefficients (r). The interobserver/intraobserver variabilities with Bland–Altman plots. APvalue < 0.05 is considered significant.ResultsThe mean velocity (cm/sec) at the AAA was five times greater after EVAR: 4.79 ± 0.32 vs. 0.91 ± 0.02. The total EL (mW) increased by 1.7 times after EVAR: 0.487 (0.420, 0.706) vs. 0.292 (0.192, 0.420). The total EL was proportional to the AAA neck angle pre‐EVAR (r= 0.691) and post‐EVAR (r= 0.718). BNP (pg/mL) was proportional to the total EL post‐EVAR (r= 0.773). In the deformed SG group, EL (0.349 [0.261, 0.416]) increased 2.4‐fold to 0.848 (0.597, 1.13), and the BNP 90.3 (53.6, 105) to 100 (67.2, 123) post‐EVAR.ConclusionThe local EL showed a 1.7‐fold increase after EVAR. The larger increase in the EL in the deformed SG group might be a potential concern for frail patients.Evidence Level1Technical EfficacyStage 2