van Keulen J W, van Prehn J, Prokop M, Moll F L, van Herwaarden J A
Department of Vascular Surgery, University Medical Center, Utrecht, The Netherlands.
Eur J Vasc Endovasc Surg. 2009 Nov;38(5):586-96. doi: 10.1016/j.ejvs.2009.06.018. Epub 2009 Aug 3.
An overview of the knowledge of thoracic (TAA), and abdominal aortic aneurysm (AAA) dynamics, before and after endovascular repair, is given.
Medline, EMBASE and the Cochrane database were searched for relevant articles. After inclusion and exclusion, 25 relevant articles reporting on aneurysm dynamics remained, allowing for comparison. Results provided in the included studies were assumed (statistically) significant if they were larger than the repeatability of the used method.
The sample size of dynamic studies is limited and translational studies are missing. Magnetic resonance angiography (MRA) and computed tomographic angiography (CTA) were shown to have lower inter-observer variabilities than ultrasonography (US). The distension of several relevant stent-graft-landing zones during the cardiac cycle in both the abdominal and thoracic aorta are significant (mean diameter change of the AAA neck in the included studies ranged from 0.9 mm to 2.4 mm; mean area change of the thoracic aorta ranged from 4.8% to 12.7% at various levels). This distension remained preserved after stent-graft placement. Preoperatively, the renal arteries displace per heartbeat. Significant movement of the aorta in the anteroposterior (AP) and lateral direction, during the cardiac cycle, was observed.
The aorta exhibits a wide variety of morphologic changes throughout the cardiac cycle. CTA and MRA are reliable modalities to investigate aortic shape changes during the cardiac cycle. Significant changes per heartbeat are reported in the AAA neck and thoracic aorta. The renal artery displaces per heartbeat. The clinical relevance of dynamic imaging has not been proven yet, but dynamic changes of the aorta have to be taken into account in stent-graft selection and future stent-graft design.
对胸主动脉瘤（TAA）和腹主动脉瘤（AAA）血管腔内修复术前和术后的动力学知识进行综述。
检索Medline、EMBASE和Cochrane数据库中的相关文章。经过纳入和排除后，保留了25篇关于动脉瘤动力学的相关文章，以便进行比较。如果纳入研究中提供的结果大于所用方法的可重复性，则假定（统计学上）具有显著性。
动力学研究的样本量有限，且缺乏转化研究。磁共振血管造影（MRA）和计算机断层血管造影（CTA）的观察者间变异性低于超声检查（US）。腹主动脉和胸主动脉在心动周期中几个相关支架移植物着陆区的扩张是显著的（纳入研究中AAA颈部的平均直径变化范围为0.9毫米至2.4毫米；胸主动脉在不同水平的平均面积变化范围为4.8%至12.7%）。支架移植物放置后，这种扩张仍然存在。术前，肾动脉随每次心跳移位。观察到主动脉在心动周期中在前后（AP）和侧向方向有显著移动。
主动脉在整个心动周期中表现出多种形态学变化。CTA和MRA是研究心动周期中主动脉形状变化的可靠方法。AAA颈部和胸主动脉报告了每次心跳的显著变化。肾动脉随每次心跳移位。动态成像的临床相关性尚未得到证实，但在支架移植物选择和未来支架移植物设计中必须考虑主动脉的动态变化。
