CT血管成像在胸主动脉腔内修复术后主动脉移置物感染中的临床诊断价值  

Clinical value of CT angiography in the diagnosis of aortic graft infection after thoracic endovascular aortic repair

作　　者：彭明亮 刘浩 程赛明 张道琴 黄连军 PENG Mingliang;LIU Hao;CHENG Saiming;ZHANG Daoqin;HUANG Lianjun(Department of Interventional Therapy,Deltahealth Hospital Shanghai,Shanghai 201702,China)

机构地区：[1]上海德达医院介入治疗科,210702

出　　处：《心肺血管病杂志》2022年第11期1174-1178,共5页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的:探讨CT血管成像(CTA)在胸主动脉腔内治疗术后主动脉移置物感染中的临床诊断价值。方法:对2018年8月至2022年3月期间,我院确诊的22例,胸主动脉腔内修复术(TEVAR)术后主动脉移置物感染患者的临床及CT资料进行回顾性分析,总结分析主动脉移置物感染CTA影像表现、感染范围及相关并发症的诊断等。结果:年龄范围39~75岁,男性20例,女性2例,CTA影像表现为支架外管腔内多发气泡15例,支架段主动脉脉周围模糊、形态不规则增厚并周围低密度影、主动脉弓水平纵隔区模糊并多发淋巴结影5例,支架段假性动脉瘤形成并周围模糊影2例。CTA确定的移置物感染范围与16例术中所见或PET-CT确定感染范围基本一致。主动脉移置物感染合并主动脉食管瘘14例,其中12例可见主动脉周围积气与食管相通的直接征象,2例通过口服对比剂CT食管成像诊断。结论:CTA能够明确TEVAR术后主动脉移置物感染的诊断并确定移置物感染的范围、是否存在主动脉食管瘘或主动脉气管瘘及其他主动脉相关的急症,是TEVAR术后主动脉移置物感染临床评价的首选影像检查方法。Objective:To evaluate the clinical value of CT angiography(CTA) in the diagnosis of aortic graft infection after thoracic aortic endovascular treatment.Methods:the clinical and CT data of 22 patients with aortic graft infection after TEVAR in our hospital from August 2018 to March 2022 were retrospectively analyzed,and the CTA imaging manifestations,infection scope and diagnosis of related complications of aortic graft infection were summarized and analyzed.Results:the age range was 39-75years old,including 20 males and 2 females.CTA images showed multiple bubbles in the lumen outside the stent in 15 cases,fuzzy,irregular thickening and low-density shadow around the active pulse of the stent segment,fuzzy and multiple lymph node shadow in the horizontal mediastinum of the aortic arch in 5 cases,and false aneurysm formation and fuzzy shadow around the stent segment in 2 cases.The graft infection range determined by CTA was basically consistent with that seen in 16 cases or determined by PET-CT.There were 14 cases of AgI complicated with aortoesophageal fistula,of which 12 cases showed the direct sign of gas accumulation around the aorta communicating with the esophagus,and 2 cases were diagnosed by oral contrast CT esophageal imaging.Conclusions:CTA can make clear the diagnosis of aortic graft infection after TEVAR,and determine the scope of graft infection,whether there is aortoesophageal fistula or aortotracheal fistula and other aortic related emergencies.CTA is the preferred imaging method for the clinical evaluation of aortic graft infection after TEVAR.

关 键 词：主动脉腔内治疗 主动脉移置物感染 主动脉食管瘘 CT血管成像 

分 类 号：R54[医药卫生—心血管疾病]