Nguyen Tammy T, Simons Jessica P, Podder Sourav, Crawford Allison S, Judelson Dejah R, Arous Edward J, Aiello Francesco A, Schanzer Andres
1 Division of Vascular and Endovascular Surgery, UMass Memorial Center for Complex Aortic Disease, University of Massachusetts Medical School, Worcester, MA, USA.
Vasc Endovascular Surg. 2019 Oct;53(7):563-571. doi: 10.1177/1538574419864769. Epub 2019 Jul 30.
Patients referred for fenestrated/branched endovascular aortic repair (F/BEVAR) often present with a previous computed tomography angiogram (CTA), but it is unknown how recent the CTA must be to ensure accurate F/BEVAR planning. We sought to determine whether anatomic planning parameters change significantly between a CTA used for F/BEVAR planning and a CTA obtained 6 to 12 months prior.
Two blinded observers reviewed preoperative CTAs from 21 patients who underwent F/BEVAR. Each patient had a "recent" scan obtained 0 to 6 months before F/BEVAR planning and a "prior" scan obtained 6 to 12 months before the "recent" CTA. Standard measurements included (1) target vessel separation distances, (2) target vessel origin clock position, and (3) proximal F/BEVAR device diameter. Clinically significant differences for target vessel separation distance, target vessel origin clock position, and proximal F/BEVAR device diameter were predefined as >5 mm, >30 minutes, and >4 mm, respectively. Differences between "recent"/"prior" CTA scans were examined by paired test.
Mean time interval between paired "recent"/"prior" CTAs was 8.0 months (standard deviation: ±1.7). Mean difference in paired "recent"/"prior" target vessel distance (relative to celiac artery [CA]) was 2.6 mm for the superior mesenteric artery (SMA), 2.5 mm for the right renal artery (RRA), and 3.3 mm for the left renal artery (LRA). Of the 21 paired "recent"/"prior" CTAs, clinically significant differences were observed in 2, 4, and 2 patients for SMA, RRA, and LRA target vessel distance, respectively. Target vessel clock position (SMA reference at 12:00) varied by 12 minutes for the CA, 13 minutes for the RRA, and 15 minutes for the LRA. One paired "recent"/"prior" CTA was found to have a clinically significant difference for the LRA. No clinically significant differences were observed for proximal device diameter.
In patients who underwent successful F/BEVAR, measurement comparisons between CTAs obtained up to 1 year prior were minor and unlikely to yield clinically significant changes to F/BEVAR design.
接受开窗/分支型血管腔内主动脉修复术（F/BEVAR）的患者通常之前已进行过计算机断层扫描血管造影（CTA），但尚不清楚CTA必须多新才能确保准确的F/BEVAR规划。我们试图确定用于F/BEVAR规划的CTA与6至12个月前获得的CTA之间的解剖学规划参数是否有显著变化。
两名盲法观察者回顾了21例行F/BEVAR患者的术前CTA。每位患者在F/BEVAR规划前0至6个月有一次“近期”扫描，在“近期”CTA前6至12个月有一次“先前”扫描。标准测量包括：（1）目标血管分离距离，（2）目标血管起源时钟位置，（3）近端F/BEVAR装置直径。目标血管分离距离、目标血管起源时钟位置和近端F/BEVAR装置直径的临床显著差异分别预先定义为>5mm、>30分钟和>4mm。通过配对检验检查“近期”/“先前”CTA扫描之间的差异。
配对的“近期”/“先前”CTA之间的平均时间间隔为8.0个月（标准差：±1.7）。配对的“近期”/“先前”目标血管距离（相对于腹腔干[CA]）的平均差异，肠系膜上动脉（SMA）为2.6mm，右肾动脉（RRA）为2.5mm，左肾动脉（LRA）为3.3mm。在21对“近期”/“先前”CTA中，SMA、RRA和LRA目标血管距离分别有2例、4例和2例患者出现临床显著差异。目标血管时钟位置（以12:00的SMA为参考），CA相差12分钟，RRA相差13分钟，LRA相差15分钟。发现一对“近期”/“先前”CTA的LRA有临床显著差异。近端装置直径未观察到临床显著差异。
在成功进行F/BEVAR的患者中，1年内获得的CTA之间的测量比较差异较小，不太可能对F/BEVAR设计产生临床显著变化。
