基于中国主动脉弓部病变人群的解剖特征分析

Anatomical characteristics of aortic arch lesions in Chinese population

目的分析中国主动脉弓部病变人群的解剖特征,为国产化腔内器械的研发提供解剖学依据。方法收集2021年6月1日至2024年1月1日全国17个中心开展的WeFlow-Arch支架系统首个前瞻性多中心研究中的83例主动脉弓部病变患者的数据。根据病变类型分为动脉瘤组67例和溃疡组16例。将术前CT血管造影数据导入专业图像处理软件进行三维重建,基于血管中心线测量并比较主动脉的相关解剖参数,评估Zenith支架和Relay支架在中国患者中的解剖适应性。结果Zenith支架和Relay支架在中国患者中的解剖适应性分别为39.8%和63.9%。动脉瘤组与溃疡组在主动脉弓分型、主动脉直径及距离、弓上分支血管直径及长度、时钟位置及角度、左右股动脉直径、近端主动脉及主动脉整体弯曲指数等解剖指标比较,差异无统计学意义(P>0.05)。动脉瘤组升主动脉弯曲指数明显低于溃疡组(1.17±0.06 vs 1.22±0.08,P=0.010),支架假体近似覆盖区域弯曲指数明显高于溃疡组(2.97±0.46 vs 2.66±0.36,P=0.020)。结论不同主动脉弓部病变在升主动脉和支架覆盖区域的弯曲程度上存在显著差异,需关注其对预后的潜在影响。国外相关器械在中国患者中的解剖适应性较差,研发适合中国患者的国产腔内器械具有重要意义。

Objective To investigate the anatomical features of aortic arch lesions in the Chinese population in order to provide anatomical reference for the development of domestic arch endografts.Methods Clinical data of 83 patients with aortic arch lesions were collected from a first prospective multi-center study of WeFlow-Arch stent system,which was carried out between June 1,2021 and January 1,2024 in 17 centers across China.According to their pathologic types,they were divided into an aneurysm group(67 patients)and an ulcer group(16 patients).Preoperative computed tomography angiography images were analyzed using three-dimensional reconstruction techniques to quantify the anatomical characteristics of the aorta.The resulting data were subsequently compared to assess the anatomical suitability of the Zenith and Relay stents for use in Chinese patients.Results The anatomical feasibility of Zenith stent and Relay stent was 39.8%and 63.9%,respectively in this investigation.No significant differences were observed between the two groups in terms of anatomical features,including arch type,aortic diameter and length,dimensions,orientation,and angulation of arch branch vessels,as well as diameters of the left and right femoral arteries,and proximal and total aortic tortuosity indices(P>0.05).The tortuosity index of the ascending aorta was lower in the aneurysm group than the ulcer group(1.17±0.06 vs 1.22±0.08,P=0.010),but the index within the coverage region of the stent was higher in the aneurysm group than the ulcer group(2.97±0.46 vs 2.66±0.36,P=0.020).Conclusion There are significant variations in the tortuosity indexes of the ascending aorta and the coverage region of the stent among the patients with different aortic arch lesions,and thus,attention should be paid to the variations due to their prognostic implications.The anatomical suitability of foreign devices is not good enough for Chinese patients,so it is of great significance for developing endografts specifically designed for the patients of our own country.