El Batti Salma, Casciaro Mariano E, Alsac Jean-Marc, Latremouille Christian, Julia Pierre, Mousseaux Elie, Craiem Damian
Department of Cardiovascular Surgery, Hôpital Européen Georges Pompidou, 20 Rue Leblanc, 75015, Paris, France.
Unité de Recherche en Développement, Imagerie et Anatomie (URDIA) EA 4465 Université Paris Descartes, Paris, France.
Cardiovasc Eng Technol. 2019 Mar;10(1):22-31. doi: 10.1007/s13239-018-00380-4. Epub 2018 Oct 4.
To analyze the volumetric evolution of abdominal aortic aneurysms after endovascular sealing (EVAS) with the Nellix™ device during follow-up.
Patients who underwent elective EVAS in our institution in 2014 and 2015 were retrospectively reviewed. Preoperative, postoperative and 1-year scans were processed. A custom software was conceived to assess semi-automated measurements of the aneurysm sac and the endograft sizes including volume, maximum diameter, sectional area and perimeter. Thrombus volume, aneurysm length, mean distance between the stents inside the polymer-filled sacs and endograft migration were also estimated. Manual maximum diameters were measured for comparison. Inter and intra-observer variability of the proposed semi-automated method was evaluated.
Pre-EVAS, post-EVAS and last follow-up scans of 12 patients were finally analyzed during a mean follow-up of 17 ± 5 months. No endograft migration or endoleak were detected. During follow-up, aneurysm volume and perimeter slightly increased compared to post-EVAS scans (+ 1 and + 5%, respectively, p < 0.05). A systematic 6% enlargement of the endobag volume was also observed (range 1-15 mL, p < 0.001). Endobag maximum diameter, area and perimeter increased 4, 8, and 8%, respectively (all p < 0.01). Mean plane-by-plane distance between stents increased 4% (p < 0.05). Mean thrombus volume did not change during follow-up, although a high variability was observed. Aneurysm and thrombus volume changes were highly correlated (r = 0.93, p < 0.001). No associations were observed between aneurysm and endobag volume changes. Intra- and inter-observer variability was below 1.7 and 2.4% for diameter and volume measurements, respectively. The automated measurements of post-EVAS aneurysm diameter and volume were higher than preoperative (p < 0.05). Maximum diameters measured manually did not differ between scans.
Small aneurysm volume enlargement detected during a mid-term follow-up was associated with thrombus size change, whereas systematic endograft expansion resulted independent from the aortic growth. Volumetric measurements using a semi-automated method could quantify small changes in aneurysm, endograft and thrombus sizes not detected by manually defined maximal diameters.
分析采用Nellix™装置进行血管腔内封闭术（EVAS）后腹主动脉瘤在随访期间的体积变化。
回顾性分析2014年和2015年在本机构接受择期EVAS的患者。对术前、术后及1年时的扫描图像进行处理。设计了一款定制软件，用于评估对动脉瘤囊和腔内移植物大小的半自动测量，包括体积、最大直径、截面积和周长。还估计了血栓体积、动脉瘤长度、聚合物填充囊内支架之间的平均距离以及腔内移植物移位情况。测量手动最大直径以作比较。评估了所提出的半自动方法在观察者间和观察者内的变异性。
最终分析了12例患者在平均17±5个月随访期间的EVAS术前、术后及末次随访扫描图像。未检测到腔内移植物移位或内漏。随访期间，与EVAS术后扫描相比，动脉瘤体积和周长略有增加（分别增加1%和5%，p<0.05）。还观察到腔内袋体积系统性增大6%（范围为1 - 15 mL，p<0.001）。腔内袋最大直径、面积和周长分别增加4%、8%和8%（均p<0.01）。支架间的平均逐平面距离增加4%（p<0.05）。随访期间平均血栓体积未改变，尽管观察到高度变异性。动脉瘤和血栓体积变化高度相关（r = 0.93，p<0.001）。未观察到动脉瘤和腔内袋体积变化之间的关联。对于直径和体积测量，观察者内和观察者间变异性分别低于1.7%和2.4%。EVAS术后动脉瘤直径和体积的自动测量值高于术前（p<0.05）。各次扫描间手动测量的最大直径无差异。
中期随访期间检测到的小动脉瘤体积增大与血栓大小变化有关，而腔内移植物的系统性扩张与主动脉生长无关。使用半自动方法进行的体积测量可量化手动定义的最大直径未检测到的动脉瘤、腔内移植物和血栓大小的微小变化。
