涉及主动脉重建中弓上血管的扭曲角度与相关解剖参数分析  

Tortuosity and anatomy of supra-aortic trunks in aortic reconstruction

作　　者：范伟健 王博 陈波 林学广 谭晋韵 童进东 汤敬东 史伟浩 余波 Fan Weijian;Wang Bo;Chen Bo;Lin Xueguang;Tan Jinyun;Tong Jindong;Tang Jingdong;Shi Weihao;Yu Bo(Department of Vascular Surgery,Shanghai Pudong Hospital,Fudan University Pudong Medical Center,Shanghai 201300,China;Department of Vascular Surgery,Huashan Hospital of Fudan University,Shanghai 200040,China)

机构地区：[1]复旦大学附属浦东医院血管外科,上海201300 [2]复旦大学附属华山医院血管外科,上海200040

出　　处：《中华血管外科杂志》2022年第1期30-35,共6页Chinese Journal of Vascular Surgery

基　　金：上海市科委医学创新研究专项(20Y11909700);上海市浦东新区卫健委临床高原学科项目(PWYgy2021-03);上海市浦东新区重点亚专科建设项目-颈动脉外科(PWZY-2020-13)。

摘　　要：目的通过多排螺旋CT血管成像对主动脉弓及弓上分支血管解剖基线数据的测量,为主动脉弓部疾病及分支重建的腔内治疗策略选择和器具研发提供数据参考。方法回顾性分析复旦大学附属浦东医院及复旦大学附属华山医院2021年8月至2021年11月连续收集的500例非合并主动脉弓部疾病患者基线及完整的CTA影像学资料,通过Mimics 10.0软件重建图像并记录和分析主动脉弓及弓上分支血管的解剖参数。结果主动脉弓分型,Ⅰ型269例(53.8%),Ⅱ型149例(29.8%),Ⅲ型82例(16.4%)。主动脉弓分支类型,标准型454例(91.8%),牛角弓41例(8.2%),孤立性左侧椎动脉5例(1.0%)。弓上分支无名动脉(IA)、左颈总动脉(LCCA)及左锁骨下动脉(LSCA)直径分别为(15.28±4.84)mm、(9.69±3.13)mm及(11.86±3.54)mm。弓上分支IA-LCCA、LCCA-LSCA及LSCA-LVA间距分别为(5.69±3.64)mm、(10.56±6.30)mm及(39.40±16.80)mm。LCCA及LSCA与主动脉切线位夹角分别为(52.98±21.29)°和(59.83±25.49)°;LCCA及LSCA与主动脉矢状位中线夹角分别为(13.89±9.52)°和(13.30±8.88)°。69例(13.8%)患者LCCA-LSCA间距<5 mm;33例(6.6%)LSCA-LVA间距<25 mm;6例(1.2%)患者LSCA与主动脉弓矢状位中线夹角≥45°以及129例(25.8%)患者LSCA与主动脉弓切线位夹角≤45°。根据年龄及性别的亚组分析结果显示,弓上分支的直径和间距与年龄的增高无明显相关性,而男性弓上分支的解剖数据明显高于女性[IA直径:(15.39±4.66)mm比(13.98±4.51)mm;LCCA直径:(9.97±3.27)mm比(8.55±2.69)mm;LSCA直径:(12.26±3.35)mm比(10.66±3.16)mm;IA-LCCA间距:(6.15±3.95)mm比(5.11±3.45)mm;LCCA-LSCA间距:(10.58±5.80)mm比(9.63±6.28)mm],其直径和间距的差异均具有统计学意义(P均<0.05)。结论获得基于CTA结果的主动脉弓及弓上分支血管各参数范围,能更好地了解弓上分支血管的异质性及其与年龄、性别的相关性,为主动脉腔内修复弓上分支重建的策略选择及分支型支架移植物Objective To provide data reference for endovascular treatment strategy selection and device development for aortic arch disease and branches reconstruction through measuring anatomical baseline data of aorta arch and supra-aortic trunks(SATs)by multi-detector row spiral CT angiography(CTA).Methods The baseline and complete CTA image data of 500 patients without aortic arch disease were consecutively collected from Pudong Hospital of Fudan University and Huashan Hospital of Fudan University from August 2021 to November 2021.The images were reconstructed by Mimics 10.0 software,and the anatomical parameters of aorta arch and SATs were recorded and analyzed.Results The types of aorta arch were 53.8%(269/500)for typeⅠ,29.8%(149/500)for typeⅡ,and 16.4%(82/500)for typeⅢ.SATs types included 454 cases(91.8%)of standard type,41(8.2%)bovine arch and 5(1.0%)isolated left vertebral artery(ILVA).Diameter of innominate artery(IA),left common carotid artery(LCCA),and left subclavian artery(LSCA)were(15.28±4.84)mm,(9.69±3.13)mm and(11.86±3.54)mm,respectively.Distances between IA-LCCA,LCCA-LSCA and LSCA-left vertebral artery(LVA)were(5.69±3.64)mm,(10.56±6.30)mm and(39.40±16.80)mm,respectively.Angle between LCCA,LSCA and tangent line of aorta arch were(52.98±21.29)°and(59.83±25.49)°,respectively.Angle between LCCA,LSCA and sagittal midline of aorta arch were(13.89±9.52)°and(13.30±8.88)°,respectively.Among them,69 patients(13.8%)had distances between LCCA-LSCA<5mm;33 patients(6.6%)had distances between LSCA-LVA<25mm;6 patients(1.2%)showed angle between LSCA and sagittal midline of aorta arch≥45°,and 129 patients(25.8%)showed angle between LSCA and tangent line of aorta arch≤45°.According to the subgroup analysis of age and gender,no significant correlation was found between age and diameter and distance of SATs,while anatomical data of SATs in males were significantly higher than those in females,and the differences in diameter[IA:(15.39±4.66)mm vs(13.98±4.51)mm;LCCA:(9.97±3.27)mm vs(8.55±2.69)mm;LSCA

关 键 词：主动脉弓 弓上分支 主动脉血管腔内修复术 计算机断层扫描血管造影 解剖参数 

分 类 号：R654.3[医药卫生—外科学]