Experimental analysis of risk factors for aneurismal sac re-expansion after stent-grafting

[引言]根据覆膜支架置入的临床使用，存在尽管动脉瘤形成血栓但动脉瘤尺寸未缩小的病例。此外，这些病例通常报告涉及继发性破裂的高风险。本研究的目的是连续测量覆膜支架置入阻断血流的动脉瘤中的排除囊压力变化，并阐明在手术后期成功缩小动脉瘤尺寸和降低动脉瘤内的排除囊压力的更多有用因素。[受试者和方法]使用猪连续测量覆膜支架置入后血流受阻的动脉瘤中的排除囊压力变化，并比较动脉瘤大小的变化。创建了无内漏和I型和II型内漏的动脉瘤模型，以指示影响动脉瘤内内压的因素。动脉血压和t内压 ...更多信息 术后6个月，用遥测压力传感器连续测量动脉瘤。此外，上述实验结果允许修复支架移植物的问题，并且将移植物放置在没有内漏以及I型和II型内漏的动脉瘤模型中。此外，处死猪，并检查动脉瘤中血栓的性质以及动脉瘤壁的病理学研究。[结果]体循环血压和动脉瘤内压与覆膜支架的厚度和有无内漏显著相关。此外，当在血管造影中未发现内漏时，无论锚定区的长度如何，动脉瘤内的内压与全身血压相比显著下降。对于I型和II型内漏，与急性期的全身血压相比，动脉瘤内的排除囊压力显著下降。然而，在长期内漏仍然存在的情况下，动脉瘤内的内压和体循环血压没有显著差异，并观察到红色血栓。[讨论和结论]没有研究在覆膜支架置入后几个月内同时测量体循环血压和动脉瘤内压，并报告与动脉瘤大小的关系，但本研究阐明了动脉瘤大小与体循环血压和动脉瘤内压之间的关系。急性期内，内漏未导致动脉瘤内压升高，但尽管缺乏血管造影术重大变化的证据，但仍观察到动脉瘤内压升高。当内漏持续6个月或更长时间时，治疗应迅速转为手术。少

[Introduction] There are, in accordance with clinical use of stent graft placement, cases in which aneurysm size is not reduced despite the aneurysm being thrombosed. In addition, these cases are often reported to involve a high risk of secondary rupture. The aim of this study was to continuously measure excluded sac pressure changes in an aneurysm in which blood flow had been blocked by stent graft placement and to clarify more useful factors for successful reduction of aneurysm size and decrease of excluded sac pressure within the aneurysm in the late stages of this procedure.[Subjects and methods] Excluded sac pressure changes in an aneurysm in which blood flow was blocked after stent graft placement were continuously measured using pigs, and changes in aneurysm size were compared. An aneurysm model with no endoleaks and type I and type II endoleaks was created to indicate factors affecting internal pressure within the aneurysm. Arterial blood pressure and internal pressure within t … More he aneurysm were continuously measured simultaneously for 6 months postoperatively using a telemetric pressure sensor implanted in the body. In addition, the above experimental results allowed remediation of problems with the stent graft, and the graft was placed in an aneurysm model with no endoleaks and type I and type II endoleaks. In addition, the pigs were sacrificed, and the nature of the thrombus in the aneurysm was examined together with a pathological study of the aneurysmal wall. [Results] Systemic blood pressure and internal pressure within the aneurysm had a significant correlation to the thickness of the graft portion of the stent graft and the presence or absence of an endoleak. In addition, internal pressure within the aneurysm dropped significantly in comparison to systemic blood pressure when an endoleak was not found in angiography, regardless of the length of the landing zone. With both type I and type II endoleaks, excluded sac pressure within the aneurysm dropped significantly in comparison to systemic blood pressure in acute stages. In cases where an endoleak remained over the long-term, however, there was no significant difference in internal pressure within the aneurysm and systemic blood pressure, and a red thrombus was noted. [Discussion and Conclusion] No studies simultaneously measured systemic blood pressure and internal pressure within the aneurysm for several months after stent graft placement and reported on the relationship to aneurysm size, but this study clarified the relationship between aneurysm size and systemic blood pressure and internal pressure within the aneurysm. An endoleak did not cause internal pressure within the aneurysm to rise during acute stages, but a rise in internal pressure within the aneurysm was noted despite the lack of evidence of major changes in angiography. Treatment should be quickly converted to surgery when an endoleak continues for 6 months or longer. Less