左锁骨下动脉的形态学：对单分支血管腔内主动脉弓修复的影响。

Morphology of the left subclavian artery: implications for single-branched endovascular aortic arch repair.

作者信息

Kondov Stoyan, Beyersdorf Friedhelm, Braun Nora, Höhn Rene, Schlett Christopher, Rylski Bartosz, Siepe Matthias, Kreibich Maximilian, Gottardi Roman, Czerny Martin

机构信息

Department of Cardiovascular Surgery, Medical Center, University of Freiburg, Freiburg, Germany.

Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany.

出版信息

Eur J Cardiothorac Surg. 2022 Jan 24;61(2):348-354. doi: 10.1093/ejcts/ezab482.

DOI:10.1093/ejcts/ezab482

PMID:34792129

Abstract

OBJECTIVES

Our goal was to evaluate the morphology of the aortic arch, focusing on the left subclavian artery (LSA), and to anticipate implications for single-branched endovascular aortic arch repair.

METHODS

We performed a morphological analysis of computed tomography angiography scans of 322 patients between January 2002 and December 2018. Arch type and distance between arch vessels on the convexity were evaluated. We defined 3 morphological types: U-type distance between the left common carotid artery (LCCA) and LSA offspring >10 mm; V-type distance between the LCCA and LSA offspring <10 mm and W-type isolated left vertebral artery offspring from the aortic arch.

RESULTS

Most patients presented a type III arch [50% (n = 161)]. The median distance from the brachiocephalic trunk offspring to the LCCA offspring measured 2.5 mm (2.0-3.0 mm) and that between the LCCA offspring and the LSA offspring was 6.5 mm (4.0-11.0 mm). We observed no significant difference based on the morphological type (V versus U versus W) in the brachiocephalic trunk-LCCA distance, but there were significant differences in the LCCA-LSA distance between types V and U (P < 0.001) and between types V and W (P < 0.001). Interestingly, we found no significant difference in the LCCA-LSA distance between types U and W. We noted a significant difference in the median diameter of the LSA according to U, V and W types: V type versus U type, 12.5 vs 13.5 mm (P = 0.033) as well as U type versus W type, 13.5 vs 10.5 mm (P < 0.001) and V type versus W type, 12.5 vs 10.5 mm (P < 0.002). The distances between the LSA offspring and left vertebral artery offspring between types U and V did not differ significantly.

CONCLUSIONS

Our categorization of the U, V and W types of the LSA can help us anticipate shapes and distances and thereby function as an initial evaluation tool for predicting single branched endovascular aortic arch repair involving the LSA.

摘要

目的

我们的目标是评估主动脉弓的形态，重点关注左锁骨下动脉（LSA），并预测其对单分支血管腔内主动脉弓修复的影响。

方法

我们对2002年1月至2018年12月期间322例患者的计算机断层扫描血管造影进行了形态学分析。评估了主动脉弓类型和弓凸面上血管之间的距离。我们定义了3种形态类型：U型，左颈总动脉（LCCA）与LSA分支之间的距离>10 mm；V型，LCCA与LSA分支之间的距离<10 mm；W型，左椎动脉从主动脉弓单独发出。

结果

大多数患者表现为III型主动脉弓[50%（n = 161）]。头臂干分支到LCCA分支的中位距离为2.5 mm（2.0 - 3.0 mm），LCCA分支与LSA分支之间的距离为6.5 mm（4.0 - 11.0 mm）。我们观察到，头臂干-LCCA距离在形态类型（V型与U型与W型）之间无显著差异，但V型与U型之间以及V型与W型之间的LCCA-LSA距离存在显著差异（P < 0.001）。有趣的是，我们发现U型与W型之间的LCCA-LSA距离无显著差异。我们注意到，根据U型、V型和W型，LSA的中位直径存在显著差异：V型与U型，分别为12.5 vs 13.5 mm（P = 0.033），U型与W型，分别为13.5 vs 10.5 mm（P < 0.001），V型与W型，分别为12.5 vs 10.5 mm（P < 0.002）。U型与V型之间LSA分支与左椎动脉分支之间的距离无显著差异。