全脑血管造影术中主动脉弓形态学的分析

Analysis of the morphology of aortic arch in the cerebral angiography

目的分析全脑血管造影术中主动脉弓分支的变异、畸形情况及不同年龄患者主动脉弓的变化情况。方法连续纳入774例行脑血管造影术的患者,均经股动脉置管,行主动脉弓造影及其分支动脉的超选择造影,分析主动脉弓分支的变异和畸形情况。分析年龄因素对Myla分型、主动脉弓上各分支呈锐角、头臂干发自主动脉弓上升段以及主动脉弓分支辽曲情况的影响。结果①共发现异常主动脉弓78例,占10.08%(78/774)。其中主动脉弓变异68例,占8.79%(68/774);主动脉弓畸形10例,占1.29%(10/774)。②随年龄的增长,Myla Ⅰ型主动脉弓的比例降低,Myla Ⅱ型和Myla Ⅲ型主动脉弓的比例增加。③随年龄的增长,头臂干、左侧颈总动脉和左侧锁骨下动脉的锐角发生率逐渐增加,头臂干发自主动脉弓上升段的比例升高。④随年龄的增长,主动脉弓上分支尢迂曲的发生率逐渐降低,轻、中、重度迂曲的发生率逐渐升高。⑤该组患者主动脉弓上各分支造影成功751例,失败23例,其中因主动脉弓变异5例,因主动脉弓畸形1例,因高龄、弓上分支角度小或血管严重迂曲17例。结论应充分掌握异常复杂主动脉弓的解剖学和影像学表现,结合其他三维血管成像技术,使脑血管造影术及介入治疗更加安全有效。

Objective To analyze the variations and malformations of the aortic arch branches in the cerebral angiography and the changes of aortic arch in patients with different ages. Methods The cere- bral angiography of 774 consecutive patients were included in the study. Angiography of aortic arch and the superselective angiography of its branch arteries were performed via femoral artery catheterization. The vari- ations and malformations of aortic arch branches were analyzed. The effects of age on the Myla type, the sharp angles of each aortic arch branches, the brachiocephalic trunk arising from the ascending segment of aortic arch, as well as the vascular tortuos conditions of the aortic arch branches were analyzed. Results ①Aortic arch anomalies were found in 78 cases （ 10.08% ）. Of which 68 cases （ 8.79% ） had aortic arch variations ; 10 cases（ 1.29% ） had aortic arch. ②With the increase of age, the proportion of Myla type I aortic arch decreased ; the proportions of Myla type II and III aortic arch increased. ③With the increase of age, the incidences of the sharp angles of brachiocephalie trunk, left common carotid artery and left subclavian artery increased gradually, and the proportion of braehioeephalic trunk arising from the ascending segment of aortic arch increased. ④With the increase of age, the incidence of non-tortuosity in aortic arch branches decreased gradually, and the incidences of mild, moderate and severe tortuosities increased gradually. ⑤Angiography on each aortic arch branch of 751 cases in this group was successful, and 23 cases failed, in which 5 because of variations of aortic arch, 1 because of aortic arch malformation, and 17 because of advanced age, sharp singles on aortic arch branches, and severe vascular tortuosity. Conclusion We should fully master the exceptionally complex anatomy and imaging findings of aortic arch and make the cerebral angiography and interventional treatment to be more safe and effective in combination with other 3-D vascular imaging technology.