解剖学变量对择期和急诊修复腹主动脉瘤患者血管内支架设计影响的形态计量学分析。

Morphometric analysis of anatomic variables affecting endovascular stent design in patients undergoing elective and emergency repair of endovascular abdominal aortic aneurysm.

机构信息

The Division of Vascular Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ont.

出版信息

Can J Surg. 2010 Feb;53(1):25-31.

PMID:20100409

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC2810015/

Abstract

BACKGROUND

Our objective was to identify morphologic trends in elective and emergency endovascular aneurysm repair (EVAR). This work will inform hospitals with endovascular programs about the diameters and lengths of endostents that should be available to efficiently care for patients with these conditions.

METHODS

We performed a retrospective review of patients undergoing elective (n = 127) and emergency (n = 17) EVAR. Using computed tomography and 3-dimensional reconstructions, we evaluated the following: diameters of the aneurysm (D3), the aorta at the superior mesenteric (D1) and renal (D2a,b,c; 3 levels) levels, the iliac arteries (D5a,b; right and left) and the aortic bifurcation (D4); lengths from the lowest renal artery to the distal aspect of the aortic neck (H1), to the aortic bifurcation (H3), to the right and left iliac bifurcations (H4a,b); and angles of the origin of the common iliac arteries on the transverse plane (A1). We used descriptive statistics of trends within groups and independent sample t tests.

RESULTS

In elective and emergency aneurysm repair, D2max (26, standard deviation [SD] 3, mm v. 30.7 [SD 3] mm), D5a (16 [SD 4.7] mm v. 19.3 [SD 5] mm), D5b (15.3 [SD 4] mm v. 18.1 [SD 3.6] mm), H1 (25.6 [SD 8.6] mm v. 18 [SD 2] mm), H4a (173 [SD 22] mm v. 189.5 [SD 22] mm) and H4b (174 [SD 25] mm v. 190 [SD 14] mm) were significantly different between the 2 groups (p = 0.001, p = 0.006, p = 0.007, p < 0.001, p = 0.05 and p = 0.01, respectively). H3 (118 [SD 17] mm v. 121.5 [SD 13.5] mm) was not significantly different (p = 0.40). In elective patients, A1 identified the right common iliac more frequently anterior relative to the left common iliac (mean 23 degrees , SD 16 degrees).

CONCLUSION

Significant anatomic differences between elective and emergency patients will require hospitals to stock separate endovascular devices to treat abdominal aortic aneurysms in both groups.

摘要

背景

我们的目的是确定择期和急诊血管内动脉瘤修复术（EVAR）中的形态趋势。这项工作将为有血管内项目的医院提供有关腔内支架直径和长度的信息，以便能够有效地为这些患者提供护理。

方法

我们对 127 例择期（n=127）和 17 例急诊（n=17）EVAR 患者进行了回顾性分析。通过计算机断层扫描和三维重建，我们评估了以下指标：动脉瘤直径（D3）、肠系膜上动脉（D1）和肾动脉（D2a、b、c；3 个水平）水平的主动脉直径、髂动脉（D5a、b；右侧和左侧）和主动脉分叉（D4）；从最低肾动脉到主动脉颈远端（H1）、主动脉分叉（H3）、右侧和左侧髂骨分叉（H4a、b）的长度；以及横向平面上髂总动脉起点的角度（A1）。我们对组内趋势进行了描述性统计和独立样本 t 检验。

结果

在择期和急诊动脉瘤修复中，D2max（26，标准差[SD]3，mm v. 30.7 [SD 3]mm）、D5a（16 [SD 4.7]mm v. 19.3 [SD 5]mm）、D5b（15.3 [SD 4]mm v. 18.1 [SD 3.6]mm）、H1（25.6 [SD 8.6]mm v. 18 [SD 2]mm）、H4a（173 [SD 22]mm v. 189.5 [SD 22]mm）和 H4b（174 [SD 25]mm v. 190 [SD 14]mm）在两组之间有显著差异（p=0.001，p=0.006，p=0.007，p＜0.001，p=0.05，p=0.01）。H3（118 [SD 17]mm v. 121.5 [SD 13.5]mm）无显著差异（p=0.40）。在择期患者中，A1 更频繁地确定右侧髂总动脉相对于左侧髂总动脉更靠前（平均 23°，SD 16°）。