适用于血流动力学和腔内支架修复研究的猪主动脉夹层模型

A swine aortic dissection model applying to the hemodynamic and endovascular aortic repair study

目的建立一种适用于研究血流动力学和腔内支架修复研究的猪主动脉夹层模型。方法全身麻醉下经开胸在猪降主动脉段机械性制造夹层破口,共制作10例主动脉夹层动物模型。建模前后分别通过血管造影对主动脉或夹层病变进行评估,术后造影随访并行血流动力学监测。通过计算机断层扫描随访夹层进展情况,并对夹层管壁行组织病理学检测。选择3例动物模型行腔内支架修复术。应用SPSS20.0统计软件分析,计量资料以均值±标准差(Mean±SD)或中位数及四分位间距表示;计数资料采用例数和百分数表示。结果动物夹层建模即刻成功率为100%。开胸建模平均手术时间为44.1min(27.4~65.0min);术中主动脉平均阻断时间为21.2min(14.3~34.5min)。术后30d内猪死亡2例,分别为麻醉相关死亡和夹层破裂。平均随访8.4个月,夹层破口处主动脉平均直径为18.9mm,夹层撕裂总长度为147.6mm,夹层受累平均最大径为24.1mm。夹层远端破口位置多位于主动脉分支动脉开口处。病理提示夹层撕裂位于动脉中膜层,假腔外侧壁纤维较内侧壁显著拉伸。夹层模型行血流动力学监测的信号满意,经腹入路行腔内支架修复术后无并发症。结论该主动脉夹层模型是适合血流动力学监测和腔内支架修复研究的有较大价值的大动物模型。

Objective To construct an aortic dissection (AD) model in swine applying to the hemodynamic and endovascular aortic repair study. Methods Ten swine of AD were created using open surgical procedures under general anesthesia. The healthy aorta and dissection propagation were evaluated using digital subtraction angiography (DSA) before and after the procedure. The hemodynamic measurements were performed during the follow up. Animals were scanned with computed tomography scan during the 12 months of follow-up and subjected to post-experimental autopsy. Three models underwent endovascular stent-graft implantation through abdominal aorta access. Results All models were successfully created. The mean time for establishing the model was 44.1 min (range 27.4-65.0 min), while the duration of total aortic occlusion was 21.2 min (range 14.3-34.5 min). At the first day post-procedures, two animals died of anesthesia related complications and aortic rupture, respectively. The average follow-up was 8.4 months. The mean diameter of the aorta at the primary entry tear was 18.9 mm. The total propagation length was observed in the models during the follow-up was 147.6 mm, with the maximum diameter of the dissection aorta of 24.1 mm. Most of the distal tears were found around the branches fed by the aorta according to the CT images and autopsy. Histopathological examination demonstrated the fibers were stretched linearly at the outside of the false lumen. The signals of Doppler measurements of velocity and pressure in the models were acceptable. No complication was observed after stent-graft repair in the three models. Conclusion This model in swine can be applied in hemodynamic and endovascular aortic repair study for AD.