腹盆腔血管数字化三维模型指导血管内介入插管方式选择研究

Application of digital three-dimensional model of abdominal and pelvic vessels in selecting intravascular catheterization method

目的利用腹盆腔血管及腰骶椎数字化三维模型,探讨左右髂总动脉分叉角度及分叉开口位置与髂总动脉长度的关系,从而指导血管内介入插管方式的选择。方法选取2011年9月至2013年5月在我科接受腹盆腔CTA检查患者439例,采用数字化三维重建技术构建患者腹盆腔血管及腰骶椎数字化三维模型,Mimics软件联合Geomagic软件对左右髂总动脉间分叉角度和左右髂总动脉长度进行测量,观察并记录左右髂总动脉分叉角度所对应椎体。通过统计学软件对左右髂总动脉分叉角度与其对应椎体位置及左右髂总动脉长度进行相关性分析。结果成功构建439例患者腹盆腔血管和腰骶椎三维模型,均清楚显示左右髂总动脉分叉角度及分叉开口位置。439例患者中左右髂总动脉分叉角度为平均（49.1±12.4）°,分叉开口位于L3-4有38例,L4上1/3有63例,L4中1/3有89例,L4下1/3有135例,L4-5有114例。左右髂总动脉平均长度分别为（45.6±15.6）mm和（43.3±15.4）mm。Pearson相关分析显示,左右髂总动脉分叉角度与其分叉开口位置高度存在负相关关系（r=-0.172,P〈0.05）,该分叉角度与左右髂总动脉长度也存在负相关关系（左侧：r=-0.171,P〈0.05;右侧：r=-0.164,P〈0.05）。结论左右髂总动脉分叉开口位置越低,其角度越大,相应髂总动脉长度越短,经股动脉行对侧髂内动脉直接插管距离短、易操作,成功率高;反之,插管路径就延长,直接插管难度增加,需用成襻插管技术,或进一步结合髂内外动脉分叉角度,评估是选择对侧还是同侧髂内动脉插管。

Objective By using digital three-dimensional（3D） model of abdominal and pelvic vessels to investigate the relationship between the angle/position of the bifurcation of bilateral common iliac arteries and the length of the common iliac artery,thus to guide the endovascular interventional catheterization manipulation.Methods A total of 439 patients,who received abdominal and pelvic CTA at authors＇ department during the period from Sep.2011 to May 2013,were included in this study.By using digital 3D reformation technique,the 3D model of the abdominal and pelvic vessels as well as the lumbosacral vertebrae was established in all patients.With the help of mimics and geomagic software the angles between the left and right common iliac arteries and the lengths of common iliac arteries were determined,and the lumbar vertebra corresponding to the bifurcation of common iliac arteries was recorded.Using statistical software,the relationship between the bifurcation angle of bilateral common iliac arteries and the corresponding lumbar vertebra as well as the length of common iliac arteries was analyzed.Results The digital 3D model of the abdominal and pelvic vessels as well as the lumbosacral vertebrae was successfully reconstructed in all 439 patients.Both the angle between the left and right common iliac arteries and the corresponding lumbosacral level of bifurcation angle were clearly demonstrated on the model.The average angle was 49.1° ± 12.4°.The bifurcation was located at L3-L4 level in 38 cases,at upper one-third level of L4 in 63 cases,at middle one third level of L4 in 89 cases,at lower one-third level of L4 in 135 cases and at L4-L5 level in 114 cases.The average length of the left and right common iliac artery was（45.6 ± 15.6） mm and（43.3 ± 15.4）mm respectively.Pearson correlation analysis indicated that a negative correlation existed between the angle and the position level of the left and the right common iliac artery（r =-0.172,P〈0.05）,and a negative correlation also existed between the angle and the length of the common iliac artery（left：r =-0.171,P〈0.05; right：r =-0.164,P〈0.05）.Conclusion The lower the opening position of the left and right common iliac artery is,and the bigger the intersection angle is,the shorter the length of corresponding common iliac artery will be.In this case,catheterization via femoral artery to contralateral iliac artery is a short path,and the catheterization procedure is easy to manipulate with higher success rate.On the contrary,the catheterization will be difficult,and the use of loop-technique will be needed.The digital 3D model of the abdominal and pelvic vessels as well as the lumbosacral vertebrae can help select the optimal catheterization path.