de Beaufort Hector W L, Coda Margherita, Conti Michele, van Bakel Theodorus M J, Nauta Foeke J H, Lanzarone Ettore, Moll Frans L, van Herwaarden Joost A, Auricchio Ferdinando, Trimarchi Santi
Thoracic Aortic Research Center, Policlinico San Donato IRCCS, University of Milan, San Donato Milanese, Italy.
Department of Civil Engineering and Architecture, University of Pavia, Pavia, Italy.
PLoS One. 2017 Oct 5;12(10):e0186080. doi: 10.1371/journal.pone.0186080. eCollection 2017.
Thoracic endovascular aortic repair (TEVAR) has been shown to lead to increased aortic stiffness. The aim of this study was to investigate the effect of stent graft type and stent graft length on aortic stiffness in a controlled, experimental setting.
Twenty porcine thoracic aortas were connected to a pulsatile mock loop system. Intraluminal pressure was recorded at two sites in order to measure pulse wave velocity (PWV) for each aorta: before stent graft deployment (t1); after deployment of a 100-mm long stent graft (t2); and after distal extension through deployment of a second 100-mm long stent graft (t3). Four different types of stent grafts (Conformable Gore® TAG® Device, Bolton Relay® Device, Cook Zenith Alpha™, and Medtronic Valiant®) were evaluated.
For the total cohort of 20 aortas, PWV increased by a mean 0.6 m/s or 8.9% of baseline PWV after deployment of a 100-mm proximal stent graft (P<0.001), and by a mean 1.4 m/s or 23.0% of baseline PWV after distal extension of the stent graft (P<0.001). Univariable regression analysis showed a significant correlation between aortic PWV and extent of stent graft coverage, (P<0.001), but no significant effect of baseline aortic length, baseline aortic PWV, or stent graft type on the percentual increase in PWV at t2 or at t3.
In this experimental set-up, aortic stiffness increased significantly after stent graft deployment with each of the four types of stent graft, with the increase in aortic stiffness depending on the extent of stent graft coverage.
胸主动脉腔内修复术（TEVAR）已被证明会导致主动脉僵硬度增加。本研究的目的是在可控的实验环境中，研究支架型人工血管类型和支架型人工血管长度对主动脉僵硬度的影响。
将20个猪胸主动脉连接到一个搏动性模拟循环系统。在两个部位记录腔内压力，以测量每个主动脉的脉搏波速度（PWV）：在植入支架型人工血管之前（t1）；在植入100毫米长的支架型人工血管之后（t2）；以及在通过植入第二个100毫米长的支架型人工血管进行远端延伸之后（t3）。评估了四种不同类型的支架型人工血管（顺应性戈尔TAG装置、博尔顿中继装置、库克齐尼斯阿尔法和美敦力勇士）。
对于20个主动脉的整个队列，在植入100毫米近端支架型人工血管后，PWV平均增加0.6米/秒或基线PWV的8.9%（P<0.001），在支架型人工血管远端延伸后，PWV平均增加1.4米/秒或基线PWV的23.0%（P<0.001）。单变量回归分析显示主动脉PWV与支架型人工血管覆盖范围之间存在显著相关性（P<0.001），但基线主动脉长度、基线主动脉PWV或支架型人工血管类型对t2或t3时PWV的百分比增加没有显著影响。
在本实验设置中，使用四种类型的支架型人工血管中的每一种进行植入后，主动脉僵硬度均显著增加，主动脉僵硬度的增加取决于支架型人工血管的覆盖范围。
