Lawton James, Touma Joseph, Sénémaud Jean, de Boissieu Paul, Brossier Julien, Kobeiter Hicham, Desgranges Pascal
Department of Vascular Surgery, Henri Mondor University Hospital, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France.
Department of Research and Innovation, Robert Debré Hospital, Reims University Hospitals, rue du Général Koenig, 51100, Reims, France.
Surg Radiol Anat. 2017 Feb;39(2):149-160. doi: 10.1007/s00276-016-1718-6. Epub 2016 Jun 25.
Endovascular navigation in aortic, renal and visceral procedures are based on precise knowledge of arterial anatomy. Our aim was to define the anatomical localization of the ostia of renovisceral arteries and their distribution to establish anatomical landmarks for endovascular catheterization.
Computer-assisted measurements performed on 55 CT scans and patients features (age, sex, aortic diameter) were analyzed. p values <0.05 were considered statistically significant.
The mean axial angulation of CeT and the SMA origin was 21.8° ± 10.1° and 9.9° ± 10.5°, respectively. The ostia were located on the left anterior edge of the aorta in 96 % of cases for the CeT and 73 % for the SMA. CeT and SMA angles followed Gaussian distribution. Left renal artery (LRA) rose at 96° ± 15° and in 67 % of cases on the left posterior edge. The right renal artery (RRA) rose at -62° ± 16.5° and in 98 % of cases on the right anterior edge of the aorta. RRA angle measurements and cranio-caudal RRA-LRA distance measurements did not follow Gaussian distribution. The mean distances between the CeT and the SMA, LRA, and RRA were 16.7 ± 5.0, 30.7 ± 7.9 and 30.5 ± 7.7 mm, respectively. CeT-SMA distance showed correlation with age and aortic diameter (p = 0.03). CeT-LRA distance showed correlation with age (p = 0.04). The mean distance between the renal ostia was 3.75 ± 0.21 mm. The RRA ostium was higher than the LRA ostium in 52 % of cases. RRA and LRA origins were located at the same level in 7 % of cases.
Our results illustrate aortic elongation with ageing and high anatomical variability of renal arteries. Our findings are complementary to anatomical features previously published and might contribute to enhance endovascular procedures safety and efficacy for vascular surgeons and interventional radiologists.
主动脉、肾和内脏手术中的血管内导航基于对动脉解剖结构的精确了解。我们的目的是确定肾内脏动脉开口的解剖定位及其分布，以建立血管内导管插入术的解剖标志。
对55例CT扫描进行计算机辅助测量，并分析患者特征（年龄、性别、主动脉直径）。p值<0.05被认为具有统计学意义。
腹腔干（CeT）和肠系膜上动脉（SMA）起始部的平均轴向角度分别为21.8°±10.1°和9.9°±10.5°。在96%的病例中，CeT开口位于主动脉左前缘，73%的SMA开口位于此。CeT和SMA角度呈高斯分布。左肾动脉（LRA）起始角度为96°±15°，67%的病例位于左后缘。右肾动脉（RRA）起始角度为-62°±16.5°，98%的病例位于主动脉右前缘。RRA角度测量值和RRA-LRA头尾距离测量值不呈高斯分布。CeT与SMA、LRA和RRA之间的平均距离分别为16.7±5.0、30.7±7.9和30.5±7.7mm。CeT-SMA距离与年龄和主动脉直径相关（p=0.03）。CeT-LRA距离与年龄相关（p=0.04）。肾开口之间的平均距离为3.75±0.21mm。52%的病例中，RRA开口高于LRA开口。7%的病例中，RRA和LRA起始部位于同一水平。
我们的结果表明随着年龄增长主动脉伸长以及肾动脉存在高度解剖变异。我们的发现补充了先前发表的解剖特征，可能有助于提高血管外科医生和介入放射科医生进行血管内手术的安全性和有效性。
