复杂腹主动脉瘤颈的CT血管成像在腹主动脉瘤腔内修复术中的价值

The clinical value of multi slice computer tomography angiography reconstruction methods in the preoperative of complicated abdominal aortic aneurysms

目的：探讨CT血管成像（CTA）在复杂型腹主动脉瘤腔内修复术前评估中的临床应用价值。方法：回顾性分析2014年1月至2015年12月间,于我中心经腔内修复的58例复杂型腹主动脉瘤患者,男性42例,年龄57-80岁,平均年龄（71.3±6.6）岁,术前CTA影像资料,对瘤颈的直径变化、角度、长度进行分析测量,并与术中造影结果（DSA）比较。结果：（1）CT证实单因素复杂瘤颈7例,占12.1%,多因素复杂瘤颈51例,占87.9%,其中短瘤颈合并锥形瘤颈14例,占24.1%,锥形瘤颈合并瘤颈夹角〉60°的37例,占63.8%。（2）CTA与DSA测量值比较：瘤体最大直径平均[（53.2±7.3）vs.（45±5.6）mm,t=4.022,P〈0.001;肾下腹主动脉直径平均[（20.1±3.3）vs.（20.7±3.8）mm,t=0.793,P〉0.05],瘤体入口处腹主动脉直径平均[（19.2±2.8）vs（18.7±3.1）mm,t=0.728,P〉0.05）,差值平均[（1.9±0.8）vs.（0.9±0.5）mm,t=1.047,P〉0.05];瘤颈与瘤体成角平均[（49.3o±17.2o）vs.（36.4o±16.3o）,t=5.416,P〈0.001;瘤颈长度平均[（27.7±5.1）vs.（25.7±6.5）mm,t=1.873,P〉0.05）。（3）手术成功率100%,术中造影发现即刻I型内漏18例,占31.0%,17例经球囊扩张内漏消失,1例通过近端补CUFF内漏消失;随访3个月支架稳定,未见移位,无I型内漏,各分支血管通畅。结论：腹主动脉瘤腔内修复术前应用CTA评估复杂瘤颈形态,对手术成功有决定性意义。对于瘤体最大径和瘤颈夹角应参考CTA的测量结果,瘤颈长度及直径变化与术中DSA无显著性差异。

Objective：To assess the clinical value of MSCTA and multiple reconstruction methods in pre-operative complicated abdominal aortic aneurysms. Methods： The MSCTA data of 58 complicated abdominal aortic aneurysms from Jan. 2014 to Dec. 2015 were analyzed retrospectively. The parameters including diameters, angle and length of aneurysms＇ neck, the diameter of aneurysms which EVAR required were measured in MSCTA and compared with DSA measurements during EVAR. Results： 1. One index complicated neck were detected in 7 cases （ 12. 1% ）, multi-index complicated neck were detected in 51 cases （87.9%）. Short com bined with coned neck in 14 cases （24. 1% ）, coned combined with large angle （ 〉 60°） neck in 37 cases （63.8%）. 2. The comparation of CTA and DSA measurements： The mean of max diameter of aneurysm is [ （53.2 ±7. 3） vs. （ 45 ±5.6mm, t = 4. 022, P 〈 0. 001 ; the mean aortic diamenter of lower renal ostia level is [ （20. 1 ± 3.3 ） vs. （20. 7± 3.8 ） mm, t = 0. 793,P 〉 0. 05 ], the mean aortic diameter of entrance of aneurysm is [ （ 19. 2± 2. 8 ） vs. （ 18.7 ± 3.1 ） mm, t = 0. 728, P 〉 0. 05 ], the mean difference of diameter of renal ostia level minus aneurysm entrance is [ （1.91 ±0. 8） vs. （0. 87 ±0. 5）mm,t = 1. 047,P 〉0. 05） ;the mean angle between aneurysm neck and body is [ （49. 3 ±17. 2 ） ° vs. （ 36.4 ± 16. 3 ） °, t = 5.416, P 〈 0. 001 ; the mean length of aneurysm neck is [ （ 27.7 ±5.1 ） vs. （ 25.7± 6. 5 ） mm, t = 1. 873, P 〉 0.05 ]. 3. The procedure were successful in all cases, type I endoleak at post-procedure angiography were detected in 18 cases （31.0%）, 17 of them were disappeared after balloon dialation, and implanted another cuff at proximal neck in 1 case, after the procedure, no endoleak was detected. In 58 cases, no graft mal-position, no endoleak and no branch vessels occlusion detected at 3 month follow-up. Conclusion： For the complicated AAA, using MSCTA to evaluate the detail information of aneurysm neck is important before EVAR. The CT measurements of max di- ameter of aneurysm and the angle of aneurysm neck should be considered to select suitable endograft, no significant differences between the CTA and DSA measurements of the length and diameters of aneurysm neck.