Doyle Matthew G, Crawford Sean A, Osman Elrasheed, Eisenberg Naomi, Tse Leonard W, Amon Cristina H, Forbes Thomas L
1 Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, Ontario, Canada.
2 Division of Vascular Surgery, Department of Surgery, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada.
Vasc Endovascular Surg. 2018 Apr;52(3):188-194. doi: 10.1177/1538574418754989. Epub 2018 Feb 7.
A complication of fenestrated endovascular aneurysm repair is the potential for stent graft rotation during deployment causing fenestration misalignment and branch artery occlusion. The objective of this study is to demonstrate that this rotation is caused by a buildup of rotational energy as the device is delivered through the iliac arteries and to quantify iliac artery geometric properties associated with device rotation.
A retrospective clinical study was undertaken in which iliac artery geometric properties were assessed from preoperative imaging for 42 cases divided into 2 groups: 27 in the nonrotation group and 15 in the rotation group. Preoperative computed tomography scans were segmented, and the iliac artery centerlines were determined. Iliac artery tortuosity, curvature, torsion, and diameter were calculated from the centerline and the segmented vessel geometry.
The total iliac artery net torsion was found to be higher in the rotation group compared to the nonrotation group (23.5 ± 14.7 vs 14.6 ± 12.8 mm; P = .05). No statistically significant differences were found for the mean values of tortuosity, curvature, torsion, or diameter between the 2 groups.
Stent graft rotation occurred in 36% of the cases considered in this study. Cases with high iliac artery total net torsion were found to be more likely to have stent graft rotation upon deployment. This retrospective study provides a framework for prospectively studying the influence of iliac artery geometric properties on fenestrated stent graft rotation.
开窗式血管内动脉瘤修复术的一个并发症是在支架移植物展开过程中存在旋转的可能性，这会导致开窗不对准和分支动脉闭塞。本研究的目的是证明这种旋转是由于装置通过髂动脉输送时旋转能量的积累所致，并量化与装置旋转相关的髂动脉几何特性。
进行了一项回顾性临床研究，从术前影像评估42例患者的髂动脉几何特性，这些患者分为2组：非旋转组27例，旋转组15例。对术前计算机断层扫描进行分割，并确定髂动脉中心线。根据中心线和分割后的血管几何形状计算髂动脉的迂曲度、曲率、扭转度和直径。
发现旋转组的髂动脉总净扭转度高于非旋转组（23.5±14.7对14.6±12.8毫米；P = 0.05）。两组之间在迂曲度、曲率、扭转度或直径的平均值上未发现统计学上的显著差异。
本研究中36%的病例发生了支架移植物旋转。发现髂动脉总净扭转度高的病例在展开时更有可能发生支架移植物旋转。这项回顾性研究为前瞻性研究髂动脉几何特性对开窗式支架移植物旋转的影响提供了一个框架。
