犬嫁接性梭形动脉瘤包裹治疗的高频超声评价

Evaluation on wrapping treatment of grafted fusiform aneurysm with high frequency ultrasound(HFUS)in dog

目的分析包裹后动脉瘤的声像图特点和血流动力学情况,探讨高频超声(HFUS)对实验性动脉瘤包裹治疗术的检测价值。方法将10只犬双侧颈总动脉经HFUS和数字减影血管造影(DSA)检查确定制作成功的20枚梭形动脉瘤模型随机分4组,采用不同的材料进行包裹治疗,其中人造生物膜片5枚、膨体聚四氟乙烯膜片(e-PTFE)5枚、涤纶片5枚、自体颈外静脉(EJV)5枚。于术后1、4、8、12周再次行HFUS和DSA检测,并与包裹前动脉瘤模型结果对照分析。结果自体EJV包裹动脉瘤形态同动脉瘤模型,瘤腔内径大于载瘤动脉和吻合口内径。涤纶片包裹动脉瘤腔全部闭塞。e-PTFE和人造生物膜片包裹动脉瘤形态相同,二者瘤腔内径与吻合口、载瘤动脉内径接近。与对照组相比二者包裹动脉瘤腔内径均缩小。人造生物膜和e-PTFE包裹动脉瘤腔、吻合口和载瘤动脉血流形态为单一的、延续良好的层流,自体EJV包裹动脉瘤血流形态为涡流;不同材料包裹动脉瘤段的血流速度在不同部位有着不同的变化。结论人造生物膜片、e-PTFE包裹治疗梭形动脉瘤效果优于自体EIV和涤纶片。HFUS可清晰地显示包裹动脉瘤大小、前后壁、夹层演变过程,以及吻合口、瘤腔、载瘤动脉之血流动力学变化,可作为评价犬颈部梭形动脉瘤包裹治疗效果的有效手段。

Objective To analyze the sonographic features and the changes in hemodynamics of fusiform aneurysm of the carotid artery after being wrapped with biological membrane, e-PTFE, autogenous vein or dacron film, and to explore the value of high frequency ultrasound （HFUS） imaging in assessing the result of wrapping treatment of fusiform aneurysm of the carotid artery, Methods 20 fusiform carotid aneurysms were reproduced in 10 experimental dogs, and they were confirmed by HFUS and digital subtraction angiography （DSA）. The animels were divided into 4 groups randomly. Different wrapping materials were used including artificial biofilm （n=5）, e-Polytetrafluoroethylene （n=5）, amologons jugater vein （n=5） and dacron film （n=5）, respectively. HFUS and DSA were performed again for examination 1, 4, 8 and 12 weeks after wrapping surgery. The findings were then compared with that before wrapping. Results The appearance after antologous vein wrapping was similar to aneurysm before the operation, but there was significant difference in the tumor cavity diameter greater than the parent artery and its anastomosis diameter. All the aneurysmal cavities were occluded after dacron wrapping. The morphology of the aneurysm after e-PTFE wrapping was similar to that of artificial biological membrane wrapping. The internal diameter of wrapped aneurysm and the stoma of parent artery were similar, compared with the control group in which the aneurysm cavities were reduced after wrapping. The hemodynamic patterns in e-PTFE membrane and artificial biological membrane wrapped aneurysms were similar with well continuous flow in the tumor cavity, stoma, while the flow pattern was in eddy current in the tumor cavity after being wrapped with autogenous vein. The blood velocity varied in different parts of the aneurysm wrapped with different materials. Conclusion Artificial biofilm and e-PTFE were superior as wrapping material for wrapping to autogenous EJV and dacron film. HFUS may clearly reveal the size, morphology, walls, changes in the wrappings, as well as the hemodynamic changes in stoma, cavity and parent artery, so it could be chosen as a satisfactory method in evaluating the changes in fusiform aneurysm after being wrapped with different materials.