Department of Surgery, University of California San Francisco (UCSF) and San Francisco VA Medical Center, San Francisco, CA, USA.
Department of Radiology, University of California San Francisco (UCSF) and San Francisco VA Medical Center, San Francisco, CA, USA.
Eur J Cardiothorac Surg. 2023 Jun 1;63(6). doi: 10.1093/ejcts/ezad241.
Rapid diameter growth is a criterion for ascending thoracic aortic aneurysm repair; however, there are sparse data on aneurysm elongation rate. The purpose of this study was to assess aortic elongation rates in nonsyndromic, nonsurgical aneurysms to understand length dynamics and correlate with aortic diameter over time.
Patients with <5.5-cm aneurysms and computed tomography angiography imaging at baseline and 3-5 years follow-up underwent patient-specific three-dimensional aneurysm reconstruction using MeVisLab. Aortic length was measured along the vessel centreline between the annulus and aortic arch. Maximum aneurysm diameter was determined from imaging in a plane normal to the vessel centreline. Average rates of aneurysm growth were evaluated using the longest available follow-up.
Over the follow-up period, the mean aortic length for 67 identified patients increased from 118.2 (95% confidence interval: 115.4-121.1) mm to 120.2 (117.3-123.0) mm (P = 0.02) and 15 patients (22%) experienced a change in length of ≥5% from baseline. The mean annual growth rate for length [0.38 (95% confidence interval: 0.11-0.65) mm/year] was correlated with annual growth rate for diameter [0.1 (0.03-0.2) mm/year] (rho = 0.30, P = 0.01). Additionally, annual percentage change in length [0.3 (0.1-0.5)%/year] was similar to percentage change in diameter [0.2 (0.007-0.4)%/year, P = 0.95].
Aortic length increases in parallel with aortic diameter at a similar percentage rate. Further work is needed to identify whether elongation rate is associated with dissection risk. Such studies may provide insight into why patients with aortic diameters smaller than surgical guidelines continue to experience dissection events.
升主动脉瘤修复的标准是直径快速增长；然而，关于瘤体伸长率的数据很少。本研究的目的是评估非综合征、非手术性动脉瘤的主动脉伸长率，以了解长度动态变化，并与随时间推移的主动脉直径相关联。
对基线和 3-5 年随访时接受 CT 血管造影成像且瘤体直径<5.5cm 的患者进行特定患者的三维动脉瘤重建，使用 MeVisLab 软件。在与血管中心线垂直的平面上测量瘤体最大直径。使用最长的随访数据评估瘤体生长的平均速度。
在随访期间，67 例患者的主动脉长度平均值从 118.2（95%置信区间：115.4-121.1）mm增加到 120.2（117.3-123.0）mm（P=0.02），15 例（22%）患者的长度变化≥5%。长度的年增长率[0.38（95%置信区间：0.11-0.65）mm/年]与直径的年增长率[0.1（0.03-0.2）mm/年]相关（rho=0.30，P=0.01）。此外，长度的年变化百分比[0.3（0.1-0.5）%/年]与直径的变化百分比[0.2（0.007-0.4）%/年]相似（P=0.95）。
主动脉长度与主动脉直径以相似的百分比率增加。需要进一步研究以确定伸长率是否与夹层风险相关。此类研究可以深入了解为什么直径小于手术指南的患者仍会发生夹层事件。
