1 Department of Vascular Surgery, University Medical Center Utrecht, The Netherlands ; 2 Thoracic Aortic Research Center, Policlinico San Donato IRCCS, University of Milan, Italy ; 3 Department of Civil Engineering and Architecture, Structural Mechanics Division, University of Pavia, Italy.
Ann Cardiothorac Surg. 2014 May;3(3):300-6. doi: 10.3978/j.issn.2225-319X.2014.04.05.
Dynamic aortic evaluation in planning thoracic endovascular aortic repair (TEVAR) is important to provide optimal stent graft sizing. Static imaging protocols do not consider normal aortic dynamics and may lead to stent graft to aorta mismatch, causing stent graft related complications, such as type I endoleak and stent graft migration. Dynamic imaging can assist in accurate stent graft selection and sizing preoperatively, and evaluate stent graft performance during follow-up. To create new imaging technologies, integration of knowledge between diverse scientific fields is essential (i.e., engineering, informatics and medicine). Different dynamic imaging modalities, such as electrocardiographic-gated computed tomography angiography (ECG-gated CTA) and four-dimensional phase-contrast MRI (4D PC-MRI), are progressively investigated and implemented into clinical practice as important instruments in preoperative planning for TEVAR. In time, further application of dynamic imaging tools for preoperative screening and follow-up after TEVAR might lead to better outcomes for patients. The advances in dynamic imaging for evaluation of the thoracic aorta using new imaging modalities and their future perspectives are addressed in this manuscript.
在规划胸主动脉腔内修复术 (TEVAR) 时，进行主动脉动态评估很重要，这有助于提供最佳的支架移植物尺寸。静态成像方案没有考虑到正常的主动脉动力学，可能导致支架移植物与主动脉不匹配，从而导致支架移植物相关并发症，如 I 型内漏和支架移植物迁移。动态成像可以帮助术前准确选择和确定支架移植物的尺寸，并在随访期间评估支架移植物的性能。为了开发新的成像技术，需要整合不同科学领域的知识（即工程、信息学和医学）。不同的动态成像方式，如心电图门控计算机断层血管造影（ECG-gated CTA）和四维相位对比磁共振成像（4D PC-MRI），正逐步被研究并应用于临床实践，成为 TEVAR 术前规划的重要工具。随着时间的推移，动态成像工具在 TEVAR 术前筛查和随访中的进一步应用，可能会为患者带来更好的结果。本文讨论了使用新成像方式评估胸主动脉的动态成像技术的进展及其未来前景。
