首都医科大学学报 ›› 2015, Vol. 36 ›› Issue (3): 354-359.doi: 10.3969/j.issn.1006-7795.2015.03.004

• 心脏大血管外科领域前沿进展 • 上一篇    下一篇

A型主动脉夹层弓部血管解剖数据及其临床意义

姚鹏, 潘旭东, 乔环宇, 刘宁宁, 薛金熔, 白涛, 刘永民   

  1. 北京市心肺血管疾病研究所 首都医科大学附属北京安贞医院心脏外科, 北京 100029
  • 收稿日期:2015-03-18 出版日期:2015-06-21 发布日期:2015-06-15
  • 通讯作者: 刘永民 E-mail:liuyongmin100@sina.com
  • 基金资助:

    国家卫计委公益性行业科研专项项目(201402009), 北京市科委首都临床特色应用发展项目(Z14110700250000).

Anatomic data and clinical significance of aortic arch with type A aortic dissection in China: single center experience

Yao Peng, Pan Xudong, Qiao Huanyu, Liu Ningning, Xue Jinrong, Bai Tao, Liu Yongmin   

  1. Beijing Institute of Heart, Lung and Blood Vessel Disease, Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
  • Received:2015-03-18 Online:2015-06-21 Published:2015-06-15
  • Supported by:

    This study was supported by the National Health Planning Commission Nonprofit Industry Research Subject(201402009), Development of Clinical Medicine Application Characteristics Function of the Beijing Municipal Science & Technology Commission(Z14110700250000)

摘要:

目的 通过多排螺旋CT(multi-detector row spiral computed tomography, MDCT)血管成像对主动脉弓及其分支血管的相关数据进行测量,如直径、间距及角度等,为A型主动脉夹层弓部替换手术中选取人工植入物(人工四分支血管、术中分支支架)提供数据参考.方法 选择首都医科大学附属北京安贞医院心外科2009年2月至2014年5月连续收治的420例Stanford A型主动脉夹层患者的完整CT血管造影(CT angiography,CTA)影像学资料.通过医院MDCT室(Advanced Vessel Analysis. AVA软件)对CTA影像学资料DCIM格式图像进行三维重建,测量主动脉弓及其分支血管的直径、间距及角度.结果 1)主动脉弓分支类型,标准型96.5%(405/420),变异型3.5%(5/420);2)标准型主动脉弓直径(36.6±5.06)mm(95%CI: 36.11~37.09 mm);3)标准型主动脉弓各分支直径:无名动脉(IA)、左颈总动脉(LCCA)、左锁骨下动脉(LSA)直径分别为(16.20±3.44)mm(95%CI: 15.86~16.54 mm)、(10.90±2.03)mm(95%CI: 10.7~11.1 mm)、(12.53±2.50)mm(95%CI: 12.29~12.77 mm);夹层累及分支与否,对IA直径有统计学意义;对LCCA、LSA直径无统计学意义.4)标准型主动脉弓各分支间距:IA-LCCA、LCCA-LSA间距分别为(18.68±4.21)mm(95%CI: 18.27~19.09 mm)、(17.80±3.38)mm(95%CI: 17.47~18.13 mm);弓部是否扩张,对二者均无统计学意义.IA-右锁骨下动脉(RSA)、LSA-左椎动脉(LVA)间距分别为(38.59±5.16)mm(95%CI: 38.09~39.09 mm)、(38.57±7.91)mm(95%CI: 37.80~39.34 mm);夹层累及分支与否,对二者均无统计学意义;IA-RSA间距无1例<20 mm;99%病例LSA-LVA间距>20 mm.5)标准型弓部分支与弓主干夹角IA、LCCA、LSA分别为(44.43±14.83)°(95%CI :42.99°~45.87°)、(50.30±11.40)°(95%CI:49.19°~51.41°)、(52.62±15.04)°(95%CI:51.16°~54.08°);夹层累及分支与否,对三者角度均无统计学意义.结论 得到Stanford A型主动脉夹层弓部及其分支血管的各参数范围;为A型主动脉夹层弓部替换术中人工植入物,即目前常用的人工四分支血管、覆膜分支支架,尤其是分支支架型人工血管的设计提供了参考数据.

关键词: 主动脉夹层, 主动脉弓, 多排螺旋CT, 直径, 间距, 角度

Abstract:

Objective To provide basic data references of aortic arch and its branch vessels for selection of artificial implants (four branches aortic graft, branch stent graft) used in total aortic arch replacement procedure of acute aortic dissection through the method of measuring relevant parameters such as branch vessels' diameters, intervals and angles by multiple detector CT (MDCT) angiography. Methods MDCTA imaging data of continuous 420 patients with Stanford type A aortic dissection in our center from February 2009 to May 2014 were collected, and the diameters of the aortic arch and its branch vessels, intervals and angles in three-dimensional images were measured. Results 1The type of the aortic arch and its branches: standard 96.5% (405/420) and variant 3.5% (5/420);2Standard aortic arch inner diameter was (36.6±5.06) mm (95%CI: 36.11-37.09 mm); 3The standard inner diameters of aortic branch vessels: innominate artery(IA) (16.20±3.44) mm (95%CI: 15.86-16.54 mm), left common carotid artery(LCCA) (10.90±2.03) mm (95%CI: 10.7-11.1 mm) and left subclavian artery(LSA) (12.53±2.50) mm (95%CI: 12.29-12.77 mm); the difference of IA diameter according to whether IA was involved by aortic dissection was statistically significant, while which of LCCA and LSA were not statistically significant; 4The standard type of the aortic arch branch vessels' intervals: IA-LCCA interval was (18.68±4.21)mm (95%CI: 18.27-19.09 mm) and LCCA-LSA interval was (17.80±3.38)mm (95%CI: 17.47-18.13 mm); and these intervals were not statistically different whether aortic arch was expanded or not. IA-right subclavian artery(RSA) interval was (38.59±5.16)mm (95% CI: 38.09-39.09 mm) and LSA-left vertebral artery(LVA) was (38.57±7.91)mm (95%CI: 37.8-39.34 mm), these intervals were not significantly different whether the branch vessels were involved by aortic dissection or not; there was not a single case of IA-RSA interval was <20 mm; and LSA-LVA interval of 99% cases was >20 mm; 5The included angles between standard type of aortic arch trunk and branch vessels were IA (44.43±14.83)° (95% CI: 42.99°-45.87°), LCCA (50.30±11.40)° (95% CI: 49.19°-51.41°) and LSA (11.40±15.04)°(95% CI: 51.16°-54.08°) respectively; There were no statistically significant difference whether aortic arch branches was involved or not. Conclusion Our study published all the parameters of aortic arch and its branch vessels in type A dissection in China, providing data references for selection of artificial implants in total aortic arch replacement procedure in aortic dissection, such as four branches aortic graft、branch stent graft, especially branch stent-woven-graft.

Key words: aortic dissection, aortic arch, multi-detector row spiral computed tomography, diameters, intervals, angles

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