Abdominal aortic aneurysm morphology in candidates for endovascular repair evaluated with spiral computed tomography and digital subtraction angiography.
Timothy Resch, K. Ivancev, M. Lindh, N. Nirhov, Ulf Nyman, Bengt Lindblad
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引用次数: 40
Abstract
PURPOSE
To analyze the morphology of abdominal aortic aneurysms (AAAs) and to study the usefulness of spiral computed tomography (CT) versus digital subtraction angiography (DSA) in the evaluation of patients for endovascular repair.
METHODS
Of 133 AAA patients (120 men, mean age 67 years, range 52 to 84) evaluated preoperatively with CT imaging, 77 endograft candidates (68 men) were also assessed with intra-arterial DSA. Arterial parameters were measured on axial CT scans and angiographic films for comparison.
RESULTS
Mean maximum AAA diameter was 58 +/- 11 mm (range 39 to 95). Aneurysmal neck diameter was consistently smaller on DSA than on CT (20.7 +/- 3.6 mm versus 23.0 +/ 3.5 mm, p < 0.0001). The distance from the most distal renal artery to the aortic bifurcation was longer on angiography than on CT (mean difference 10.0 mm, p < 0.0001). There was a positive correlation between the maximum AAA diameter and the AAA length (r = 0.49, p < 0.0001) and an inverse relationship between the neck length and the neck diameter (r = -0.36, p < 0.0001). No correlation was found between the maximum AAA diameter and maximum iliac diameter, angulation, or length.
CONCLUSIONS
AAA anatomy varies widely and independently of the aneurysm size. Therefore, the maximum size of the aneurysm is a poor predictor of whether or not an aneurysm is suitable for endovascular repair. The discrepancy between angiographic and axial CT measurements suggests that neither alone is sufficient as a preoperative imaging technique when evaluating a patient for an endovascular graft procedure.
目的分析腹主动脉瘤(AAAs)的形态,探讨螺旋CT (CT)与数字减影血管造影(DSA)在血管内修复患者评价中的价值。方法对133例AAA患者(男性120例,平均年龄67岁,52 ~ 84岁)进行术前CT评估,同时对77例(男性68例)进行动脉内DSA评估。动脉参数测量轴向CT扫描和血管造影片进行比较。结果平均最大AAA直径为58±11 mm(范围39 ~ 95)。DSA上动脉瘤颈直径始终小于CT (20.7 +/- 3.6 mm vs 23.0 +/ 3.5 mm, p < 0.0001)。血管造影显示肾动脉最远端到主动脉分叉的距离比CT长(平均差10.0 mm, p < 0.0001)。最大AAA直径与AAA长度呈正相关(r = 0.49, p < 0.0001),颈长与颈直径呈负相关(r = -0.36, p < 0.0001)。最大AAA直径与最大髂直径、成角或长度之间没有相关性。结论saaa的解剖结构变化广泛,且与动脉瘤大小无关。因此,动脉瘤的最大尺寸并不能很好地预测动脉瘤是否适合进行血管内修复。血管造影和轴向CT测量之间的差异表明,在评估患者是否接受血管内移植手术时,单独作为术前成像技术是不够的。