主动脉几何构型对Stanford B型主动脉夹层腔内修复术后围手术期支架周围假腔残留的预测价值  

Aortic geometry in the prediction of peri-stent false lumen residue in perioperative period after thoracic endovascular aortic repair for Stanford type B aortic dissection

作　　者：代承忠 肖鹏[1] 王浩东[1] DAI Chengzhong;XIAO Peng;WANG Haodong(Department of Medical Imaging,Sichuan Orthopedic Hospital,Chengdu 610041,China.)

机构地区：[1]四川省骨科医院医学影像科,四川成都610041

出　　处：《中国中西医结合影像学杂志》2021年第5期413-417,共5页Chinese Imaging Journal of Integrated Traditional and Western Medicine

摘　　要：目的:通过分析Stanford B型主动脉夹层患者行胸主动脉腔内修复(TEVAR)术前的主动脉三维空间构型,以期找到预测术后假腔残留风险的指标。方法:收集经双源CTA(DSCTA)诊断为Stanford B型主动脉夹层94例患者的术前和术后影像学资料;依据TEVAR治疗后1周DSCTA示支架周围假腔是否闭合分为假腔残留组51例和假腔闭合组43例。评价TEVAR治疗前Stanford B型主动脉夹层真假腔直径、面积(降主动脉上段最大径层面、肺动脉分叉水平、膈肌水平)、体积及主动脉弓角度。对相关指标进行统计分析,找出可预测Stanford B型主动脉夹层TEVAR术后假腔残留风险的最佳指标。结果:2组术前3个测量平面假腔直径、面积、假腔体积及主动脉弓角度差异均有统计学意义(均P<0.05)。二元Logistic回归分析显示,降主动脉上段最大径层面面积和主动脉弓角度是TEVAR术后早期支架周围假腔残留的独立危险因素(OR=3.322,P=0.007;OR=1.136,P=0.005)。ROC曲线分析表明,降主动脉上段最大径层面面积对应ROC曲线的AUC为0.924,最佳截断值为2.69 cm2,敏感度和特异度分别为93.0%和76.5%;主动脉弓角度的AUC为0.766,最佳截断值为48°,敏感度和特异度分别为90.2%和51.2%。结论:通过Stanford B型主动脉夹层术前几何构型指标测量发现,降主动脉上段最大径层面面积和主动脉弓角度是Stanford B型主动脉夹层TEVAR术后支架周围假腔残留的独立危险因素;其中降主动脉上段最大径层面面积是良好的预测因素,其每增加1 cm2,TEVAR术后支架周围假腔残留风险概率增加232.2%;当降主动脉上段最大径层面面积>2.69 cm^(2),易出现TEVAR治疗后支架假腔残留,可同时增加裸支架,以改变假腔血流动力学特征,加速假腔血栓化,改善临床预后。Objective:To analyze the three-dimensional configuration of the aorta preoperatively in patients undergoing thoracic endovascular aortic repair(TEVAR)with Stanford type B aortic dissection in order to predict the risks of postoperative false cavity residue.Methods:Preoperative and postoperative imaging data of 94 patients with Stanford type B aortic dissection diagnosed by dual source CTA(DSCTA)were collected.The patients were divided into two groups according to whether the false lumen around the stent being closed or not by DSCTA 1 week after TEVAR treatment,the remaining false cavity group and the closed false cavity group.The diameter and area of true and false lumen in maxium diameter level of upper descending aorta,pulmonary artery bifurcation level and largest diaphragm level,the volume of true and false lumen and the degree of aortic arch of type B dissection before TEVAR treatment were evaluated.Statistical analysis were made to find out the best indicator to predict the risks of residual false cavity after TEVAR for Stanford type B dissection.Results:There were significant differences between the two groups in false lumen diameter and area in the three levels,false lumen volume,and the degree of aortic arch(all P<0.05).The binary logistic regression analysis showed that the false lumen area in maxium diameter level of upper descending aorta and the degree of the aortic arch were independent risk factors for peri-stent false lumen residue in early stage after TEVAR(OR=3.322,P=0.007;OR=1.136,P=0.005).Using ROC curve analysis,AUC of false lumen area in maxium diameter level of upper descending aorta was 0.924 with the best cut-off value of 2.69 cm2,and the sensitivity and specificity were 93.0% and 76.5%,respectively. AUC of the degree of the aortic arch was 0.766 with the best cut-off value of 48°,and the sensitivity and specificity were 90.2% and 51.2%,respectively. Conclusions:In this study,using the preoperative geometric configuration of Stanford type B aortic dissection,the false lumen area in maxim

关 键 词：动脉瘤 夹层 主动脉 胸 血管成形术 体层摄影术 X线计算机 

分 类 号：R654.3[医药卫生—外科学]