Department of Vascular Surgery, Brest University Hospital, Brest, France; INSERM UMR 1101, Laboratoire de traitement de l'imagerie médicale (LaTIM), Brest, France.
Department of Cardiology, Brest University Hospital, Brest, France.
Ann Vasc Surg. 2021 Apr;72:57-65. doi: 10.1016/j.avsg.2020.12.002. Epub 2020 Dec 24.
Stenting of common femoral artery (CFA) bifurcation lesions is complex due to harmonious asymmetric geometry between the CFA and deep or superficial femoral artery. In order to ensure an optimal flow, the stents must be implanted according to the diameter of the CFA and the diameter of the daughter vessels. The aim of this study was to validate a mathematical formula for the CFA bifurcation in order to optimize the implantation of stents in this bifurcation with a fast and efficient method.
MATERIALS/METHODS: We retrospectively included all patients who underwent transcatheter aortic valve implantation and who had a healthy CFA bifurcation on the CT-scan. Diameters of the mother vessel (D), daughter vessels (D: larger vessel; D: smaller vessel), and the ratio between the two were calculated. According to the latter, the following linear model was proposed: [D = (D/D + D) × (D + D)] and was compared to the four existing models (Murray, HK, Flow, Finet). Finally, we calculated the relative error between the prediction of the four models and the measurements.
Overall, 110 CFA bifurcations were included. Mean CFA diameter was 7.75 ± 1.67 mm. Mean D diameter was 5.79 ± 1.21 mm and mean D diameter was 5.23 ± 1.09 mm. A reduction of 25 % was seen between the CFA and the larger daughter-vessel. The mean ratio between the CFA and the daughter vessels was 0.71. Our model [D = 0.71× (D + D)] and the flow law were the most accurate (relative difference of 1.59 ± 11.97% and 1.01 ± 11.94%, respectively). However, Murray's law had a statistically significant deviation from the real mother-vessel diameter (P < 0.001).
We developed a simple fractal ratio between CFA and daughter vessels, which could be easily used in daily practice during CFA percutaneous reconstruction to identify the optimal diameters of the diseased vessels.
股总动脉（CFA）分叉病变的支架置入较为复杂，因为 CFA 与股深或股浅动脉之间存在协调的不对称几何结构。为了确保最佳血流，支架必须根据 CFA 的直径和子血管的直径进行植入。本研究的目的是验证一种 CFA 分叉的数学公式，以便通过一种快速有效的方法优化该分叉处的支架植入。
材料/方法：我们回顾性纳入了所有接受经导管主动脉瓣植入术且 CT 扫描显示 CFA 分叉健康的患者。测量母血管（D）、子血管（D：较大的血管；D：较小的血管）的直径，并计算两者之间的比值。根据后者，提出了以下线性模型：[D=（D/D+D）×（D+D）]，并与现有的四个模型（Murray、HK、Flow、Finet）进行比较。最后，我们计算了四个模型的预测值与测量值之间的相对误差。
共有 110 个 CFA 分叉纳入研究。CFA 的平均直径为 7.75±1.67mm。D 直径的平均值为 5.79±1.21mm，D 直径的平均值为 5.23±1.09mm。CFA 与较大的子血管之间的直径缩小了 25%。CFA 与子血管之间的平均比值为 0.71。我们的模型[D=0.71×（D+D）]和流量定律最为准确（相对差值分别为 1.59±11.97%和 1.01±11.94%）。然而，Murray 定律与真实母血管直径存在统计学显著偏差（P<0.001）。
我们提出了一种简单的 CFA 与子血管之间的分形比，在 CFA 经皮重建过程中，可在日常实践中轻松用于确定病变血管的最佳直径。
