Ioannou Christos V, Kontopodis Nikolaos, Peteinarakis Ioannis, Tsetis Dimitrios
Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University of Crete Medical School, Heraklion, Crete, Greece.
Interventional Radiology Unit, Radiology Department, University of Crete Medical School, Heraklion, Crete, Greece.
J Endovasc Ther. 2016 Aug;23(4):606-13. doi: 10.1177/1526602816645524. Epub 2016 Apr 20.
To establish the feasibility of indirectly estimating aneurysm sac pressurization from recordings of aortic pulsatile wall motion (PWM) using M-mode ultrasonography before and after endovascular aneurysm repair (EVAR).
Twenty consecutive patients (mean age 72 years; 19 men) scheduled for EVAR in a single institution underwent M-mode ultrasonography 1 day before EVAR to record PWM of the abdominal aortic aneurysm wall during the cardiac cycle, along with simultaneous blood pressure measurements. The recording was repeated the first postoperative day. Pressure-strain elastic modulus (Ep) was calculated from the preoperative displacement and pressure data. This value and the postoperative PWM were used to inverse estimate pulse pressure in the abdominal aortic aneurysm sac post EVAR. Immediate pressure reduction post EVAR was compared between groups of endoleak vs no endoleak and expansion vs no expansion during 6-month follow-up.
Intraobserver variability of the method presented a mean value of 0.04 mm with a 1.2-mm coefficient of variation (95% limits of agreement -1.16 to 1.24 mm). PWM was significantly reduced postoperatively (1.2 vs 0.3 mm, p<0.001) as was pulse pressure exerted on the aneurysm sac (67 vs 16 mm Hg, p<0.001). The pressure reduction was similar between the endoleak vs no endoleak groups (79% vs 75%, p=0.65), but it was significantly greater in the no expansion group (79.5%) vs the group with aneurysm expansion (50%, p=0.008).
M-mode ultrasonography may provide a useful adjunct during EVAR surveillance to noninvasively estimate sac pressurization and identify aneurysms at risk of enlargement.
探讨在血管内动脉瘤修复术（EVAR）前后，通过M型超声记录主动脉搏动性壁运动（PWM）间接估计动脉瘤囊压力升高的可行性。
在单一机构中，连续20例计划接受EVAR的患者（平均年龄72岁；19例男性）在EVAR前1天接受M型超声检查，记录心动周期中腹主动脉瘤壁的PWM，并同时测量血压。术后第一天重复记录。根据术前位移和压力数据计算压力应变弹性模量（Ep）。该值和术后PWM用于反向估计EVAR后腹主动脉瘤囊内的脉压。比较6个月随访期间内漏组与无内漏组以及扩张组与无扩张组EVAR后即刻的压力降低情况。
该方法的观察者内变异性平均值为0.04 mm，变异系数为1.2 mm（95%一致性界限为-1.16至1.24 mm）。术后PWM显著降低（1.2 vs 0.3 mm，p<0.001），施加在动脉瘤囊上的脉压也显著降低（67 vs 16 mmHg，p<0.001）。内漏组与无内漏组之间的压力降低相似（79% vs 75%，p=0.65），但无扩张组（79.5%）的压力降低明显大于动脉瘤扩张组（50%，p=0.008）。
M型超声检查可在EVAR监测期间提供有用的辅助手段，以无创方式估计囊内压力并识别有扩大风险的动脉瘤。
