主动脉狭窄Winslow通路开放的CTA表现及分析  

CT angiography assessment of Winslow pathway in aortic stenosis

作　　者：赵莉 王浩力 黄梓平 陈楠 唐广磊 彭洋 彭林 ZHAO Li;WANG Haoli;HUANG Ziping;CHEN Nan;TANG Guanglei;PENG Yang;PENG Lin(Department of Radiology,Fujian Medical University Affiliated Sanming First Hospital,Fujian 365000,China)

机构地区：[1]福建医科大学附属三明第一医院放射科,福建三明365000 [2]中山大学附属第一医院医学影像科,广东广州510080

出　　处：《影像诊断与介入放射学》2024年第2期108-113,共6页Diagnostic Imaging & Interventional Radiology

基　　金：广东省医学科研基金(A2022008)。

摘　　要：目的分析主动脉狭窄性疾病中Winslow通路开放的特点,探讨其临床意义。方法回顾性收集中山大学附属第一医院2013年1月—2023年3月主动脉狭窄性疾病32例,包括先天性主动脉缩窄21例(胸主动脉段狭窄)和腹主动脉狭窄11例。32例均行胸主动脉-腹主动脉CTA扫描。观察Winslow通路的开放率,计算其扩张程度、吻合支开放数目,并记录主动脉狭窄部位及狭窄率,分析Winslow通路及主动脉狭窄的关系。结果本组主动脉狭窄性疾病患者Winslow通路的出现率为100%(32/32),均表现为双侧锁骨下动脉发出胸廓内动脉-腹壁上动脉,通过吻合支与腹壁下动脉吻合,向下连接双侧髂外动脉。21例主动脉缩窄患者Winslow通路中胸廓内动脉扩张明显,且扩张的胸廓内动脉直径和与主动脉狭窄率呈正相关(r=0.437,P<0.05),Winslow通路吻合支开放数目与主动脉的狭窄率亦呈正相关(r=0.519,P<0.05)。11例腹主动脉狭窄患者Winslow通路中胸廓内动脉、腹壁下动脉的扩张程度与主动脉狭窄率均无相关性(P>0.05),吻合支开放数目与主动脉狭窄率亦无相关性(P>0.05)。32例中20例接受了外科手术或介入治疗,复查Winslow通路侧支血管明显变细或消失,治疗前后胸廓内动脉及腹壁下动脉直径和[(9.3±4.1)mm比(4.1±2.0)mm、(6.4±2.4)mm比(2.6±1.5)mm]、吻合支数目(12.5±6.7比2.9±2.5)差异均有显著统计学意义(P<0.01)。结论正确识别和描述Winslow通路并进行CTA定量分析,有助于判断主动脉狭窄和代偿情况,为临床提供有价值的影像信息。Objective To analyze the characteristics of Winslow pathway in patients with aortic stenosis.Methods Thoracic and abdominal aortic CT angiography of 32 patients with aortic stenosis including coarctation of aorta(21)and abdominal aortic stenosis(11)from January 2013 to March 2023 was retrospectively analyzed.The opening rate of Winslow pathway,degree of collateral dilation,number of anastomotic branches,location and rate of aortic stenosis,and relationship between Winslow pathway and aortic stenosis were evaluated.Results The appearance rate of Winslow pathway in patients with aortic stenosis was 100%(32/32),which rerouted blood to the pelvis and lower extremities via the bilateral subclavian arteries to internal thoracic,superior epigastric,inferior epigastric,and external iliac arteries.Among 21 patients with coarctation of aorta,there was significant dilation of the internal thoracic artery with positive correlation between the internal thoracic artery diameter and rate of aortic stenosis(r=0.437,P<0.05)as well as positive correlation between the number of anastomotic branches and the rate of aortic stenosis(r=0.519,P<0.05).In the 11 patients with abdominal aortic stenosis,there was no correlation between the degree of internal thoracic and inferior epigastric artery dilatation and the rate of aortic stenosis(P>0.05),or between the number of anastomotic branches and the rate of aortic stenosis(P>0.05).Among the 32 patients,20 underwent surgical or interventional treatment with significant narrowing or disappearance of the collateral vessels on follow-up.The maximum diameters of the internal thoracic arteries[(9.3±4.1)mm]and inferior epigastric arteries[(6.4±2.4)mm]as well as the number of anastomotic branches(12.5±6.7)decreased significantly(P<0.01)to(4.1±2.0)mm,(2.6±1.5)mm,and 2.9±2.5,respectively after treatment.Conclusion The visualization and quantitative analysis of the Winslow pathway on CT angiography are valuable in assessing aortic stenosis.

关 键 词：Winslow通路 主动脉缩窄 腹主动脉狭窄 侧支动脉 CT血管造影 

分 类 号：R543.1[医药卫生—心血管疾病] R814.43[医药卫生—内科学]