Department of Vascular and Endovascular Surgery, Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy.
Department of Experimental Medicine, University of Genoa, Genoa, Italy.
Eur J Cardiothorac Surg. 2019 Jun 1;55(6):1045-1053. doi: 10.1093/ejcts/ezy397.
The aim of this study was to measure the morphological remodelling of the ascending aorta, aortic arch and thoracic aorta after aortic arch hybrid treatment including debranching and stent graft implantation.
Preoperative, 1-month and 1-year follow-up of computed tomography angiography scans of 22 patients were analysed to compute the lumen centreline from the aortic root to the coeliac trunk, and the following measurements were derived: the total centreline length, distance from the aortic root to the left subclavian artery, distance from the left subclavian artery to the distal landing zone. For both pre- and postoperative centrelines, the pointwise curvature was measured at the proximal and the distal landing zones. The mean curvature values of the whole aortic segment and the endografting region of the ascending and the descending aorta were measured. Surface outerline was computed as well, and curvature values at the endograft landing points were extracted.
At the 1-month follow-up, centreline length were already significantly increased (382.66 ± 48.69 to 388.1 ± 50.75 mm; P = 0.01). Centreline pointwise curvature increased in the proximal (+29%, P = 0.011) and the distal zones (+63%, P = 0.004). Similarly, pointwise curvature of the outerline significantly increased in the proximal (+77%, P = 0.01) and the distal landing zones (+100%, P = 0.04). The centreline mean curvature increased in the ascending aorta (+7%, P = 0.02) and decreased in the endografting region (-3.3%, P = 0.004). No evidence of a relationship of such a remodelling with the type of endograft and the type of pathology was observed. This remodelling trend was confirmed by the analysis of 1-year computed tomography angiographies.
Hybrid arch repair was associated with a significant elongation of the vessel and a significant increase in the curvature on the ascending aorta and the descending aorta and on the endograft proximal and the distal landing zones.
本研究旨在测量主动脉弓杂交治疗（包括分支血管重建和支架移植物植入）后升主动脉、主动脉弓和胸主动脉的形态重塑。
分析 22 例患者的术前、术后 1 个月和 1 年的计算机断层血管造影扫描，计算从主动脉根部到腹腔干的管腔中心线，并得出以下测量值：总中心线长度、主动脉根部到左锁骨下动脉的距离、左锁骨下动脉到远端着陆区的距离。对于术前和术后的中心线，在近端和远端着陆区测量逐点曲率。测量整个主动脉节段和升主动脉及降主动脉移植物区域的平均曲率值。还计算了表面外轮廓，并提取了移植物着陆点的曲率值。
在术后 1 个月的随访中，中心线长度显著增加（382.66±48.69mm 至 388.1±50.75mm；P=0.01）。近端（+29%，P=0.011）和远端区域（+63%，P=0.004）的中心线逐点曲率增加。同样，近端（+77%，P=0.01）和远端着陆区（+100%，P=0.04）的外轮廓逐点曲率显著增加。升主动脉的中心线平均曲率增加（+7%，P=0.02），而移植物区域的平均曲率减少（-3.3%，P=0.004）。未观察到这种重塑与移植物类型和病变类型之间存在相关性。通过对术后 1 年的计算机断层血管造影分析证实了这种重塑趋势。
主动脉弓杂交修复与血管显著延长以及升主动脉和降主动脉以及移植物近端和远端着陆区的曲率显著增加相关。
