多排螺旋CT血管成像在急性主动脉综合征腔内修复术后随访中的应用价值

Application value of multi-detector spiral CT angiography in patients with acute aortic syndrome after endovascular aortic repair

目的探讨多排螺旋CT血管成像(CTA)对急性主动脉综合征(AAS)腔内修复术(EVAR)后随访的价值。方法回顾性分析2015年6月至2016年8月天津医科大学总医院收治的38例行EVAR治疗的AAS患者术前及术后的CT影像资料,评价支架的位置和形态、夹层真腔和假腔的变化、壁内血肿厚度的变化、溃疡深度的变化、受累分支血管及脏器情况、有无内漏及新发病变。结果 38例患者术后支架均无移位、形态良好;24例主动脉夹层患者术后真腔内径增大[(24.3±5.2)mm vs.(13.5±4.7)mm,t=7.892,P<0.05]、假腔内径减小[(8.4±7.8)mm vs.(18.6±5.1)mm,t=-6.744,P<0.05],差异具有统计学意义;15例(62.5%)支架覆盖区域假腔内完全血栓化,9例(37.5%)部分血栓化;壁内血肿患者血管壁厚度术后小于术前[(6.6±5.1)mm vs.(12.9±4.9)mm,t=-5.854,P<0.05];穿透性溃疡患者术后溃疡均未显影;57支分支血管受累,术后9支(15.8%)缓解,47支(82.5%)无变化,1支(1.7%)血栓形成;3例(7.9%)左肾灌注不同程度减低,术后2例缓解,1例无变化;术后5例(13.2%)出现Ⅰ型内漏,随访中1例消失,2例内漏量减少,2例内漏量无变化;术后随访中2例(5.3%)新发夹层、溃疡。结论多排螺旋CTA是一种无创、快速、准确的检查方法,对AAS的EVAR术后有较高的随访价值。

Objective To investigate the application value of multi-detector spiral computed tomography angiography （CTA） in patients with acute aortic syndrome （AAS） after endovascular aortic repair （EVAR）. Methods Thirty-eight patients from Tianjin Medical University General Hospital from June 2015 to August 2016 with A：AS were involved as the research subjects. All the patients were underwent EVAR. CTA was performed for both the preoperative and postoperative evaluation. The measurement and evaluation parameters were as follows： the position and shape of the stents, the size changes of the true lumen and false lumen of aortic dissection, the changes of the vessel wall thickness of intramural hematomas, the changes of the ulcers depth of penetrating aortic ulcer, the involvement of the artery branches and organs, whether or not with the endoleak and the new emerging lesions. Results For all 38 patients, the stents have good appearance without displacement and distortion. Of 24 patients with aortic dissection, ture lumen enlarged [（24.3±5.2）mm vs. （13.5±4.7）mm, t=7.892,P〈0.05] and false lumen shirked [（8.4±7.8）mm vs. （18.6±5.1）mm, t=-6.744, P〈0.05]. The false lumens were thrombosed completely in 15 patients （62.5%）, partially in 9 patients （37.5%）. The thickness of vessel wall in aortic intramural hematomas was decreased [（6.6±5.1）mm vs. （12.9±4.9）mm, t=-5.854, P〈0.05]. The penetrating aortic ulcers weren＇t shown after EVAR. There were 57 artery branches involved by AAS. After EVAR, 9 branches （15.8%） alleviated, 47 branches （82.5%） had no changes, and 1 branch （1.7%） formed thrombosis. In 3 cases （7.9%）, the perfusion of left kidney was decreased with different degrees. 2 cases relieved after EVAR and 1 case had no change. Type I endoleaks were found in 5 patients （13.2%）, 1 case＇s endoleak disappeared, 2 cases＇ endoleaks reduced during follow-up, and 2 cases＇ endoleaks had no change. 2 cases （5.3%）had new emerging aortic dissection and/or ulcer during follow-up. Conclusion CTA is non-invasive, rapid and accurate, and it is of high value to the postoperative follow-up of EVAR.