The purpose of this study was to utilize dynamic computed tomographic angiography (CTA) on pre- and postoperative thoracic endovascular aneurysm repair (TEVAR) patients to characterize cardiac pulsatility-induced aortic motion on essential TEVAR proximal sealing zones and to study the influence of endograft placement. Six pre- and six postoperative dynamic CTA studies were obtained in six patients with thoracic aortic aneurysms (TAAs) undergoing TEVAR. Data were acquired using a retrospective electrocardiography-triggered dynamic CTA scan, with eight reconstructed phases over the cardiac cycle. Scans were acquired during a single breath hold. Multiplanar reconstructions were made perpendicular to the aorta at five surgically relevant anatomical thoracic landmarks: 1 cm proximal to the innominate trunk, 1 cm proximal and 1 cm distal to the left subclavian artery, and 1 cm proximal and 3 cm distal to the proximal end of the stent. After segmentation of the aortic lumen in the images, diameter change and area change over the cardiac cycle were measured. Diameter change was measured through the center of mass of the aortic lumen, and the average change over 180 axis is presented. We found significant distention of the thoracic aortic arch and descending thoracic aorta during the cardiac cycle before and after TEVAR. Distention ranged 3-12% in diameter and 2-20% in area. This distention was preserved after TEVAR. Patients with TAA experience aortic diameter and area changes during the cardiac cycle. The magnitude, and hence the clinical importance, of this aortic distention varies among patients. After stent-graft placement, aortic distention throughout the cardiac cycle is preserved. This may have major implications for correct sizing of the endograft as well as for stent-graft design and durability as the forces on the stents may be much larger after implantation than initially anticipated by stent manufacturers.

译文

:本研究的目的是对术前和术后胸腔内血管瘤修复(TEVAR)患者使用动态计算机断层血管造影(CTA),以表征心脏搏动诱发的主动脉运动对基本TEVAR近端密封区域的影响,并研究内移植的影响放置。在六名接受TEVAR的胸主动脉瘤(TAA)患者中进行了六项术前和六项动态CTA研究。使用回顾性心电图触发的动态CTA扫描获取数据,在整个心动周期中具有八个重建阶段。在一次屏气期间进行扫描。在五个与手术相关的解剖学胸部标志点垂直于主动脉进行多平面重建:距无名主干近1 cm,左锁骨下动脉近端1 cm和远端1 cm,近端1 cm和近端3 cm远处进行多平面重建。支架。在图像中分割主动脉腔后,测量整个心动周期的直径变化和面积变化。通过主动脉腔质心测量直径变化,并给出180轴的平均变化。我们发现在TEVAR之前和之后的心动周期中,胸主动脉弓和胸主动脉下降明显。肿胀的直径范围为3-12%,面积为2-20%。 TEVAR后保留了这种膨胀。 TAA患者在心动周期中会经历主动脉直径和面积的变化。这种主动脉扩张的程度以及因此的临床重要性在患者之间有所不同。植入支架后,可保留整个心动周期的主动脉扩张。这可能对正确设置内移植物的尺寸以及支架移植物的设计和耐用性具有重大意义,因为在植入后,支架上的作用力可能比支架制造商最初预期的要大得多。

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