Gawenda M, Knez P, Winter St, Jaschke G, Wassmer G, Schmitz-Rixen Th, Brunkwall J
Division of Vascular Surgery, Department of Visceral and Vascular Surgery, University of Cologne, Germany.
Eur J Vasc Endovasc Surg. 2004 Jan;27(1):45-50. doi: 10.1016/j.ejvs.2003.10.013.
Even though endovascular aneurysm repair (EVAR) creates a closed chamber except for patent branches, the intra-sac pressure is never zero. This study was designed to investigate whether, and to what extent, aneurysm wall compliance influences intra-sac pressure.
In vitro experimental study.
Aneurysm models with six and 12 latex layers were produced, resulting in elastic and stiff circumferential compliance (3.5 +/- 0.5 and 0.9 +/- 0.3%/100 mmHg, respectively). The models with an 18 mm internal neck and maximum aneurysm diameter of 60 mm were inserted into an in vitro circulation system. The systemic mean pressure (SPmean) was varied from 50 to 120 mmHg. After the aneurysm was excluded with a knitted polyethylene graft, aneurysm sac mean pressure (ASPmean) and aneurysm sac pulse pressure (ASPpulse) were measured. Data are presented as mean +/- SD. Statistics were performed using repeated measurements of variance; p<0.05 was considered significant.
In the model EVAR created a closed chamber without endoleak, but with an aneurysm sac pressure related to wall compliance. In the elastic aneurysm model with six latex coats the aneurysm sac mean pressure (ASPmean) and the aneurysm sac pulse pressure (ASPpulse) at all systemic pressures were significantly lower than they were in the stiffer model with 12 latex coats (p<0.05). At a SPmean of 90 mmHg, the ASPmean was 21.0 +/- 0.9 mmHg (six latex coats) and 26.0 +/- 0.2 mmHg (12 latex coats) (p<0.05), the ASPpulse was 5.7 +/- 0.2 mmHg (six latex coats) and 8.8 +/- 0.3 mmHg (12 latex coats) (p<0.05).
This in vitro model demonstrated that the aneurysm sac mean pressure (ASPmean) and the aneurysm sac pulse pressure (ASPpulse) were significantly influenced by the compliance of the aneurysm wall. These data highlight the need for further studies regarding endotension.
尽管血管内动脉瘤修复术（EVAR）除了开放分支外创造了一个封闭腔室，但瘤内压力从未为零。本研究旨在调查动脉瘤壁顺应性是否以及在何种程度上影响瘤内压力。
体外实验研究。
制作了具有6层和12层乳胶层的动脉瘤模型，分别产生弹性和僵硬的圆周顺应性（分别为3.5±0.5和0.9±0.3%/100 mmHg）。将具有18 mm内颈和最大动脉瘤直径60 mm的模型插入体外循环系统。全身平均压力（SPmean）在50至120 mmHg之间变化。用编织聚乙烯移植物排除动脉瘤后，测量瘤腔平均压力（ASPmean）和瘤腔脉压（ASPpulse）。数据以平均值±标准差表示。使用重复测量方差进行统计分析；p<0.05被认为具有统计学意义。
在模型中，EVAR创造了一个无内漏的封闭腔室，但瘤腔压力与壁顺应性相关。在具有6层乳胶涂层的弹性动脉瘤模型中，所有全身压力下的瘤腔平均压力（ASPmean）和瘤腔脉压（ASPpulse）均显著低于具有12层乳胶涂层的较硬模型（p<0.05）。在SPmean为90 mmHg时，ASPmean为21.0±0.9 mmHg（6层乳胶涂层）和26.0±0.2 mmHg（12层乳胶涂层）（p<0.05），ASPpulse为5.7±0.2 mmHg（6层乳胶涂层）和8.8±0.3 mmHg（12层乳胶涂层）（p<0.05）。
该体外模型表明，动脉瘤壁顺应性对瘤腔平均压力（ASPmean）和瘤腔脉压（ASPpulse）有显著影响。这些数据凸显了对内张力进行进一步研究的必要性。
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