Virgilio F, Maurel B, Davis M, Hamilton G, Mastracci T M
Royal Free London, London, UK.
Royal Free London, London, UK.
Eur J Vasc Endovasc Surg. 2017 Mar;53(3):425-430. doi: 10.1016/j.ejvs.2016.11.026. Epub 2017 Jan 5.
The vertebral tortuosity index (VTI) predicts increased risk of acute aortic events in patients with known genetic aortopathies. This study describes the VTI in a cohort of patients with non-connective tissue disorder-related large aneurysms.
Hospital imaging records from July 2012 to March 2016 were interrogated to identify patients with aneurysmal disease who had undergone computed tomographic angiography that included imaging of vertebral arteries. A control group of consecutive patients undergoing carotid and vertebral imaging was also assessed. VTI was calculated using the formula: [(centre-line distance) / (straight-line distance)-1] ×100 for all patients, and statistical analysis undertaken to determine whether measured VTI was statistically different in patients of younger age, with larger aneurysms, or an acute presentation. Comparison was made with patients who had no aneurysm disease.
Sixty-five patients were identified with adequate imaging to assess the entire aorta, including vertebral arteries. The majority of patients were male (71%, 46/65) and mean age at the time of the CT scan was 71 years (SD 11.1 years). There were 11 patients under the age of 60 years in this cohort. The mean VTI was 33.17 (SD 20.43). There was no statistically significant difference between different territories of presentation (proximal vs. distal aneurysm, p=.94), age of patient (>60 years vs. <60 years, p=.2), or size of aneurysm (>6 cm vs. <6 cm, p=.09). Acuity of presentation was not predicted by a higher VTI (p=.69). The VTI in patients with aneurysms was higher than in patients without aneurysm disease (VTI = 16.1, p<.005) CONCLUSIONS: An elevated VTI is consistently present in patients with degenerative aneurysms and has potential as a universally available predictive measurement. However, the increased VTI in the older cohort without connective tissue disease may not carry the same predictive value for acute presentations as has been demonstrated in younger patients with a known genetic basis for their aortopathy.
椎体迂曲指数（VTI）可预测已知遗传性主动脉病变患者发生急性主动脉事件的风险增加。本研究描述了一组非结缔组织病相关大动脉瘤患者的VTI。
查阅2012年7月至2016年3月的医院影像记录，以识别患有动脉瘤疾病且接受过包括椎动脉成像在内的计算机断层血管造影的患者。还评估了一组连续接受颈动脉和椎动脉成像的患者作为对照组。所有患者的VTI均使用公式计算：[（中心线距离）/（直线距离）-1]×100，并进行统计分析以确定在年龄较小、动脉瘤较大或急性发病的患者中，测得的VTI是否存在统计学差异。与无动脉瘤疾病的患者进行比较。
确定了65例有足够影像资料以评估整个主动脉（包括椎动脉）的患者。大多数患者为男性（71%，46/65），CT扫描时的平均年龄为71岁（标准差11.1岁）。该队列中有11例年龄在60岁以下的患者。平均VTI为33.17（标准差20.43）。不同发病部位（近端动脉瘤与远端动脉瘤，p = 0.94）、患者年龄（>60岁与<60岁，p = 0.2）或动脉瘤大小（>6 cm与<6 cm，p = 0.09）之间均无统计学显著差异。较高的VTI不能预测发病的急性程度（p = 0.69）。动脉瘤患者的VTI高于无动脉瘤疾病的患者（VTI = 16.1，p<0.005）。结论：退行性动脉瘤患者中VTI持续升高，具有作为普遍可用的预测指标的潜力。然而，在无结缔组织病的老年队列中，升高的VTI对急性发病的预测价值可能与已知有遗传性主动脉病变基础的年轻患者中所证实的不同。
