Department of Surgery, Hamamatsu University School of Medicine, Japan; Division of Vascular Surgery, Hamamatsu University School of Medicine, Japan.
Department of Surgery, Hamamatsu University School of Medicine, Japan; Division of Vascular Surgery, Hamamatsu University School of Medicine, Japan.
Eur J Vasc Endovasc Surg. 2023 Jul;66(1):17-26. doi: 10.1016/j.ejvs.2023.01.042. Epub 2023 Jan 31.
To predict sac enlargement with type II endoleak (ELII) before endovascular aneurysm repair (EVAR) using four dimensional flow sensitive magnetic resonance imaging (4D flow MRI).
A single centre retrospective analysis of prospectively collected data was conducted. Patients with an abdominal aortic aneurysm (AAA) who underwent EVAR between 2013 and 2019 were included. Aortic branches occluded pre-EVAR, and patients with endoleaks other than ELII were excluded. The aortic branch diameter, peak flow velocity (PFVe), and amplitude of the dynamics of flow volume (AFV) were measured in each aortic branch pre-EVAR. Total flow volume per minute (TFV/min), defined as the sum of AFV/min, was calculated in each case. According to computed tomography findings one year post-EVAR, the aortic branches and patients were divided into patent vessel and occluded vessel groups and sac expanding and non-expanding groups. PFVe, AFV/min, and TFV/min were analysed via receiver operating characteristic curve analysis.
The patent aortic branches pre-EVAR (69 inferior mesenteric arteries [IMAs]; 249 lumbar arteries [LAs]) of 100 patients were included. Patent IMAs (n = 14) and occluded IMAs (n = 55), patent LAs (n = 23) and occluded LAs (n = 226), and expanding (n = 9) and non-expanding (n = 91) groups were compared, respectively. No statistically significant difference was observed in branch diameters (IMA; patent, 2.5 ± 0.8 mm, occluded, 2.5 ± 0.8 mm, p < .78 and LA; patent, 1.5 ± 0.3 mm, occluded, 1.5 ± 0.4 mm, p < .35). PFVe (IMA; patent, 262.6 mm/sec, occluded, 183.4 mm/sec and LA; patent, 142.6 mm/sec, occluded, 47.7 mm/sec) and AFV/min (IMA; patent, 8.4 mL, occluded, 5.2 mL and LA; patent, 4.2 mL, occluded, 1.4 mL) were higher in the patent vessel group (p < .050). TFV/min was statistically significantly higher in the expanding group (24.1 mL/min) than in the non-expanding group (7.0 mL/min) (p < .010).
Pre-EVAR haemodynamic analyses using 4D flow MRI were useful to detect aortic branches responsible for ELII and to predict AAA cases with sac enlargement. This analysis suggests a new strategy for pre-EVAR aortic branch embolisation.
使用四维血流敏感磁共振成像（4D flow MRI）在血管内动脉瘤修复（EVAR）前预测 II 型内漏（ELII）所致的瘤囊增大。
对前瞻性收集的数据进行单中心回顾性分析。纳入 2013 年至 2019 年间接受 EVAR 的腹主动脉瘤（AAA）患者。EVAR 前闭塞主动脉分支，排除除 ELII 以外的内漏患者。在 EVAR 前测量每个主动脉分支的直径、峰值血流速度（PFVe）和血流容积动力学幅度（AFV）。在每个病例中计算每分钟总流量（TFV/min），定义为 AFV/min 的总和。根据 EVAR 后 1 年的 CT 检查结果，将主动脉分支和患者分为通畅血管组和闭塞血管组、瘤囊扩张组和非扩张组。通过受试者工作特征曲线分析，对 PFVe、AFV/min 和 TFV/min 进行分析。
纳入了 100 名患者的 69 支（69 支肠系膜下动脉[IMA]；249 支腰动脉[LA]）通畅的主动脉分支。比较了通畅 IMA（n=14）和闭塞 IMA（n=55）、通畅 LA（n=23）和闭塞 LA（n=226）以及扩张（n=9）和非扩张（n=91）组。分支直径无统计学差异（IMA；通畅，2.5±0.8mm，闭塞，2.5±0.8mm，p<0.78 和 LA；通畅，1.5±0.3mm，闭塞，1.5±0.4mm，p<0.35）。PFVe（IMA；通畅，262.6mm/sec，闭塞，183.4mm/sec 和 LA；通畅，142.6mm/sec，闭塞，47.7mm/sec）和 AFV/min（IMA；通畅，8.4mL，闭塞，5.2mL 和 LA；通畅，4.2mL，闭塞，1.4mL）在通畅血管组中更高（p<0.050）。TFV/min 在扩张组（24.1mL/min）显著高于非扩张组（7.0mL/min）（p<0.010）。
使用 4D flow MRI 进行 EVAR 前血流动力学分析有助于发现导致 ELII 的主动脉分支，并预测 AAA 病例瘤囊增大。该分析提示了一种新的 EVAR 前主动脉分支栓塞策略。
