Chassin-Trubert Lucien, Gandet Thomas, Ozdemir Baris Ata, Lounes Youcef, Alric Pierre, Canaud Ludovic
Department of Thoracic and Vascular Surgery, Arnaud de Villeneuve Hospital, Montpellier, France.
J Endovasc Ther. 2020 Oct;27(5):785-791. doi: 10.1177/1526602820931787. Epub 2020 Jun 4.
To analyze the structural variation of the aortic arch and the supra-aortic arteries and establish an average spatial configuration that would be a pattern for a "universal double fenestration" design for physician-modified endovascular grafts (PMEGs) used in total thoracic endovascular aortic repair (TEVAR). Aortic arch morphology was retrospectively analyzed by reviewing the preoperative thoracic computed tomography angiography scans in 33 consecutive patients (mean age 68 years; 27 men) treated between January 2017 and March 2019 using double-fenestrated PMEGs for zone 0 TEVAR. Image analysis was completed according to a standardized technique on a vascular workstation with center lumen line reconstruction for all measurements. Variations in branching pattern of the aortic arch were classified into 8 types. The arch trunk configuration was type I in 26 patients (79%), type II in 5 (15%), type III in 1, and type IV in 1. Mean aortic diameters at the level of mid ascending aorta, innominate artery (IA), left common carotid artery (LCCA), and left subclavian artery (LSA) were 35.7±3.7, 34.2±4.5, 33.3±6.7, and 33.7±4.7 mm, respectively. Mean diameters of the trunk were 12.2±1.7, 7.5±1.4, and 8.0±0.8 mm, respectively. Mean longitudinal center to center lengths were 15.9±2.5 mm between the LSA and LCCA and 12.1±3.0 mm between the LCCA and IA. Mean clock positions using the LSA as reference were 12:50 for the IA and 12:05 for the LCCA. In 32 patients (97%) all the supra-aortic branch vessels fit perfectly inside two delimited areas defined by a proximal common square area of 30×30 mm for the IA and LCCA and a second distal 8-mm-diameter circle for the LSA. Variations of the aortic arch anatomy are numerous and common. A general morphological pattern is described that delimits the aortic area where these variations occur. This information can be utilized for the design of an off-the-shelf double-fenestrated stent-graft for zone 0 TEVAR.
分析主动脉弓和主动脉弓上动脉的结构变异，并建立一种平均空间构型，该构型将作为用于全胸段主动脉腔内修复术（TEVAR）的医生改良型血管内移植物（PMEG）“通用双开窗”设计的模式。通过回顾2017年1月至2019年3月期间连续33例（平均年龄68岁；27例男性）使用双开窗PMEG进行0区TEVAR治疗的患者术前胸部计算机断层扫描血管造影扫描，对主动脉弓形态进行回顾性分析。在血管工作站上按照标准化技术完成图像分析，所有测量均进行中心腔线重建。主动脉弓分支模式的变异分为8种类型。26例患者（79%）的弓干构型为I型，5例（15%）为II型，1例为III型，1例为IV型。升主动脉中部、无名动脉（IA）、左颈总动脉（LCCA）和左锁骨下动脉（LSA）水平的平均主动脉直径分别为35.7±3.7、34.2±4.5、33.3±6.7和33.7±4.7mm。主干的平均直径分别为12.2±1.7、7.5±1.4和8.0±0.8mm。以LSA为参考，LSA与LCCA之间的平均纵向中心距为15.9±2.5mm，LCCA与IA之间的平均纵向中心距为12.1±3.0mm。以LSA为参考，IA的平均时钟位置为12:50，LCCA的平均时钟位置为12:05。在32例患者（97%）中，所有主动脉弓上分支血管都完美地位于两个划定区域内，这两个区域由IA和LCCA的近端30×30mm的共同方形区域以及LSA的第二个远端8mm直径的圆界定。主动脉弓解剖结构的变异众多且常见。描述了一种界定这些变异发生的主动脉区域的一般形态模式。该信息可用于设计用于0区TEVAR的现成双开窗支架型人工血管。
