利用术中锥形束 CT 对膝关节动脉解剖变异进行分类。
Classification of Genicular Artery Anatomic Variants Using Intraoperative Cone-Beam Computed Tomography.
机构信息
Division of Interventional Radiology, University of California, Los Angeles, Los Angeles, USA.
University of California, Los Angeles, Los Angeles, USA.
出版信息
Cardiovasc Intervent Radiol. 2023 May;46(5):628-634. doi: 10.1007/s00270-023-03411-3. Epub 2023 Mar 22.
PURPOSE
Genicular artery embolization (GAE) is a new treatment option for symptomatic knee osteoarthritis. Genicular arterial anatomy is complex with limited published reports. This study describes the genicular artery anatomy utilizing intraprocedural cone-beam computed tomography (CBCT) during GAE.
MATERIALS AND METHODS
This retrospective single-center study was approved by the institutional review board. All patients who underwent GAE between May 2018 and April 2022 were reviewed. Patients with a technically adequate CBCT were included in the analysis. CBCTs were analyzed to determine the presence, course, and branching patterns of the genicular arteries.
RESULTS
A total of 222 patients underwent GAE and 205 (92%) were included for analysis. The descending genicular artery was present in 197 (96%) CBCTs with two branches in 152 (77%). The superior medial genicular artery (SMGA) was present in 186 (91%), superior lateral genicular artery (SLGA) in 203 (99%), inferior medial genicular artery (IMGA) in 195 (95%), inferior lateral genicular artery (ILGA) in 196 (95%), and median genicular artery (MGA) in 200 (97%). Four unique branching patterns were identified: common origin of SLGA and MGA (115, 56%), unique origins (45, 22%), trifurcation of SLGA, SMGA, and MGA (32, 15.5%), and common origin of SMGA and MGA (12, 6%). The recurrent ascending tibial was identified in 156 (76%) CBCTs and superior patellar artery in 175 (85%) CBCTs.
CONCLUSION
Genicular artery anatomy is complex with numerous common variants. CBCT is a powerful adjunct in GAE to rapidly identify target vessels for embolization and potentially decrease the risk of nontarget embolization.
目的
关节内动脉栓塞术（GAE）是治疗症状性膝骨关节炎的一种新的治疗选择。关节内动脉解剖结构复杂，相关文献报道有限。本研究利用 GAE 过程中的术中锥形束计算机断层扫描（CBCT）描述了关节内动脉解剖结构。
材料和方法
这项回顾性单中心研究获得了机构审查委员会的批准。回顾了 2018 年 5 月至 2022 年 4 月期间接受 GAE 的所有患者。纳入了 CBCT 技术足够的患者进行分析。对 CBCT 进行分析，以确定关节内动脉的存在、走行和分支模式。
结果
共 222 例患者接受了 GAE，其中 205 例（92%）纳入分析。197 例（96%）CBCT 中存在降支关节内动脉，其中 152 例（77%）有两支分支。186 例（91%）存在膝上内侧动脉（SMGA），203 例（99%）存在膝上外侧动脉（SLGA），195 例（95%）存在膝下内侧动脉（IMGA），196 例（95%）存在膝下外侧动脉（ILGA），200 例（97%）存在正中关节内动脉（MGA）。共发现 4 种独特的分支模式：SLGA 和 MGA 有共同起源（115 例，56%），单独起源（45 例，22%），SLGA、SMGA 和 MGA 三分叉（32 例，15.5%），SMGA 和 MGA 有共同起源（12 例，6%）。在 156 例（76%）CBCT 中发现了再升胫骨动脉，在 175 例（85%）CBCT 中发现了膝上动脉。
结论
关节内动脉解剖结构复杂，存在多种常见变异。CBCT 是 GAE 的一种强大辅助手段，可快速识别栓塞目标血管，降低非目标栓塞的风险。
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