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

doi:10.3969/j.issn.1006-7795.2015.03.004

Abstract

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

CLC Number:

R543.1

Yao Peng, Pan Xudong, Qiao Huanyu, Liu Ningning, Xue Jinrong, Bai Tao, Liu Yongmin. Anatomic data and clinical significance of aortic arch with type A aortic dissection in China: single center experience[J]. Journal of Capital Medical University, 2015, 36(3): 354-359.

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URL: https://journal03.magtech.org.cn/Jweb_sdykdxxb/EN/10.3969/j.issn.1006-7795.2015.03.004

https://journal03.magtech.org.cn/Jweb_sdykdxxb/EN/Y2015/V36/I3/354

References

[1] Sun L Z, Qi R D, Chang Q, et al. Surgery for acute type A dissection using total arch replacement combined with stented elephant trunk implantation: experience with 107 patients[J]. J Thorac Cardiovasc Surg, 2009, 138(6): 1358-1362.
[2] Sun L, Zhao X, Chang Q, et al. Repair of chronic type B dissection with aortic arch involvement using a stented elephant trunk procedure[J]. Ann Thorac Surg,2010,90(1):95-100.
[3] Zhao H P, Zhu J M, Ma W G, et al. Total arch replacement with stented elephant trunk technique for acute type B aortic dissection involving the aortic arch[J]. Ann Thorac Surg,2012,93(5):1517-1522.
[4] Sun L, Qi R, Zhu J, et al. Total arch replacement combined with stented elephant trunk implantation: a new "standard" therapy for type a dissection involving repair of the aortic arch?[J]. Circulation,2011,123(9):971-978.
[5] Chen L W, Dai X F, Lu L, et al. Extensive primary repair of the thoracic aorta in acute type a aortic dissection by means of ascending aorta replacement combined with open placement of triple-branched stent graft: early results[J]. Circulation,2010,122(14):1373-1378.
[6] Shimamura K, Kuratani T, Matsumiya G, et al. Hybrid endovascular aortic arch repair using branched endoprosthesis: the second-generation "branched" open stent-grafting technique[J]. J Thorac Cardiovasc Surg,2009,138(1):46-52, 52-53.
[7] Dumfarth J, Plaikner M, Krapf C, et al. Bovine aortic arch: predictor of entry site and risk factor for neurologic injury in acute type a dissection[J]. Ann Thorac Surg,2014,98(4):1339-1346.
[8] Hannuksela M, Lundqvist S, Carlberg B. Thoracic aorta—dilated or not? [J].Scand Cardiovasc J,2006,40(3):175-178.
[9] Hager A, Kaemmerer H, Rapp-Bernhardt U, et al. Diameters of the thoracic aorta throughout life as measured with helical computed tomography[J]. J Thorac Cardiovasc Surg,2002,123(6):1060-1066.
[10] Wolak A, Gransar H, Thomson L E, et al. Aortic size assessment by noncontrast cardiac computed tomography: normal limits by age, gender, and body surface area[J]. JACC Cardiovasc Imaging,2008,1(2):200-209.
[11] Vasan R S, Larson M G, Levy D. Determinants of echocardiographic aortic root size. The Framingham Heart Study[J]. Circulation,1995,91(3):734-740.
[12] Roman M J, Devereux R B, Kramer-Fox R, et al. Two-dimensional echocardiographic aortic root dimensions in normal children and adults[J]. Am J Cardiol,1989,64(8):507-512.
[13] Rylski B, Desjardins B, Moser W, et al. Gender-related changes in aortic geometry throughout life[J]. Eur J Cardiothorac Surg,2014,45(5):805-811.
[14] Nienaber C A, Kische S, Rousseau H, et al. Endovascular repair of type B aortic dissection: long-term results of the randomized investigation of stent grafts in aortic dissection trial[J]. Circ Cardiovasc Interv,2013,6(4):407-416.
[15] Nienaber C A, Rousseau H, Eggebrecht H, et al. Randomized comparison of strategies for type B aortic dissection: the investigation of Stent Grafts in Aortic Dissection (INSTEAD) trial[J]. Circulation,2009,120(25):2519-2528.
[16] Guo W, Liu X, Liang F, et al. Transcarotid artery endovascular reconstruction of the aortic arch by modified bifurcated stent graft for Stanford type A dissection[J]. Asian J Surg,2007,30(4):290-295.
[17] Finlay A, Johnson M, Forbes T L. Surgically relevant aortic arch mapping using computed tomography[J]. Ann Vasc Surg,2012,26(4):483-490.
[18] 张敏宏,郭伟,刘小平,等. 国人升主动脉及主动脉弓的CT解剖研究[J]. 中华普通外科杂志,2009,24(1):42-44.
[19] Shin I Y, Chung Y G, Shin W H, et al. A morphometric study on cadaveric aortic arch and its major branches in 25 korean adults: the perspective of endovascular surgery[J]. J Korean Neurosurg Soc,2008,44(2):78-83.
[20] Zamir M, Sinclair P. Origin of the brachiocephalic trunk, left carotid, and left subclavian arteries from the arch of the human aorta[J]. Invest Radiol, 1991, 26(2):128-133.