Chuter T A, Green R M, Ouriel K, DeWeese J A
Section of Vascular Surgery, University of Rochester, NY 10032.
J Vasc Surg. 1994 Jul;20(1):44-9; discussion 49-50. doi: 10.1016/0741-5214(94)90174-0.
The structure of infrarenal aortic aneurysm was studied as a basis for design of a transfemoral system of aneurysm repair. This information was particularly important because endovascular techniques, unlike conventional techniques, afford little opportunity for intraoperative adjustments.
Three-dimensional computer reconstructions of the distal aorta, the renal arteries, the aneurysm and the iliac arteries were generated from computed tomography scanning data in 22 patients with aortic aneurysms.
The proximal neck of the aneurysm was longer than 20 mm in 14 patients, and the mean length (of all 22) was 26.7 +/- 4.1 mm. In contrast, only one patient had a distal cuff longer than 20 mm and 14 of the others had no measurable distal cuff. The mean distal cuff length (of all 22) was 4.2 +/- 1.6 mm. There was no significant difference between mean aneurysm diameter in the anteroposterior direction (58.0 +/- 3.2 mm) and the transverse direction (56.4 +/- 3.3 mm), although corresponding values in individual patients were often different. Aneurysm diameter correlated with aneurysm length (r = 0.79, p < 0.001). The proximal right common iliac artery deviated from the axis of the distal aorta by 40.0 +/- 5.8 degrees, whereas the left deviated by 47.8 +/- 5.4 degrees. One of the iliac arteries deviated by more than 45 degrees in 12 cases. Eleven common iliac arteries in seven patients were aneurysmal. Fifteen patients had no aneurysm of the common iliac arteries, and another three had segments of nondilated common iliac artery distal to iliac aneurysms on both sides.
Computerized three-dimensional reconstruction facilitated interpretation of anatomic information from computed tomography scans, particularly the length of the aneurysm neck and shape of the iliac arteries. On the basis of this information, we expect that few patients will have too short an aneurysm neck for endovascular aneurysm repair, but many will require a bifurcated graft for secure, hemostatic implantation distally.
研究肾下腹主动脉瘤的结构，为经股动脉动脉瘤修复系统的设计提供依据。该信息尤为重要，因为与传统技术不同，血管内技术在术中几乎没有调整的机会。
利用22例主动脉瘤患者的计算机断层扫描数据，生成远端主动脉、肾动脉、动脉瘤和髂动脉的三维计算机重建图像。
14例患者动脉瘤近端颈部长度超过20mm，所有22例患者的平均长度为26.7±4.1mm。相比之下，只有1例患者的远端袖口长度超过20mm，其他14例患者没有可测量的远端袖口。所有22例患者的平均远端袖口长度为4.2±1.6mm。动脉瘤前后径平均直径（58.0±3.2mm）与横径（56.4±3.3mm）之间无显著差异，尽管个别患者的相应数值往往不同。动脉瘤直径与动脉瘤长度相关（r = 0.79，p < 0.001）。右侧髂总动脉近端与远端主动脉轴线的夹角为40.0±5.8度，而左侧为47.8±5.4度。12例患者中有1例髂动脉夹角超过45度。7例患者的11条髂总动脉呈瘤样改变。15例患者髂总动脉无动脉瘤，另外3例患者双侧髂动脉瘤远端有未扩张的髂总动脉节段。
计算机三维重建有助于解读计算机断层扫描的解剖信息，尤其是动脉瘤颈部的长度和髂动脉的形态。基于这些信息，我们预计很少有患者的动脉瘤颈部过短而无法进行血管内动脉瘤修复，但许多患者将需要分叉移植物以在远端进行安全、止血的植入。
