{"title":"主动脉疾病患者主动脉直径的脉动变化可能与移植物大小无关。","authors":"Daniele Mariastefano Fontanini, Máté Huber, Milán Vecsey-Nagy, Sarolta Borzsák, Judit Csőre, Péter Sótonyi, Csaba Csobay-Novák","doi":"10.1177/15266028231172368","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>Endovascular aortic repair has become the preferred elective treatment of infrarenal aortic aneurysms. Aortic pulsatility may pose problems regarding endograft sizing. The aims of this study are to determine the aortic pulsatility in patients with aortic disease and to evaluate the effect of pulsatility on the growth of aneurysms.</p><p><strong>Materials and methods: </strong>In this retrospective study, analyses of computed tomography angiography (CTA) images of 31 patients under conservative treatment for small abdominal aortic aneurysms were performed. Reconstructions of the raw electrocardiography (ECG) gated dataset at 30% and 90% of the R-R cycle were used. After lumen segmentation, total aortic cross-sectional area was measured in diastole and systole in the following zones: Z0, Z3, Z5, Z6, Z8, and Z9. Effective diameters (EDs) were calculated from the systolic (ED<sub>sys</sub>) and diastolic (ED<sub>dia</sub>) cross-sectional areas to determine absolute (ED<sub>sys</sub> - ED<sub>dia</sub>, mm) and relative pulsatility [(ED<sub>sys</sub> - ED<sub>dia</sub>) / ED<sub>dia</sub>, %]. Diameter of the aneurysms was measured on baseline images and the last preoperative follow-up study of each patient.</p><p><strong>Results: </strong>A total of 806 measurements were completed, 24 pulsatility and 2 growth measurements per patient. The mean pulsatility values at each point were as follows: Z0: 0.7±0.8 mm, Z3: 1.0±0.6 mm, Z5: 1.0±0.6 mm, Z6: 0.8±0.7 mm, Z8: 0.7±1.0 mm, Z9: 0.9±0.9 mm. Follow-up time was 5.5±2.2 years during which a growth of 13.42±9.09 mm (2.54±1.55 mm yearly) was observed. No correlation was found between pulsatility values and growth rate of the aneurysms.</p><p><strong>Conclusion: </strong>The pulsatility of the aorta is in a submillimetric range for the vast majority of patients with aortic disease, thus probably not relevant regarding endograft sizing. Pulsatility of the ascending aorta is smaller than that of the descending segment, making an additional oversize of a Z0 implantation questionable.Clinical ImpactEndovascular aortic repair reqiures precise preoperative planning. Pulsatile changes of the aortic diameter may pose issues regarding endograft sizing. In our retrospective single-centre study, aortic pulsatility of patients with AAA was measured on ECG gated CTA images. Pulsatility values reached a maximum at the descending aorta, however absolute pulsatility values did not exceed 1 mm at any point along the aorta. Therefore, significance of aortic pulsatility regarding the sizing of EVAR prostheses is questionable. Correlation between pulsatility and AAA growth was not found.</p>","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"398-403"},"PeriodicalIF":1.7000,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Pulsatile Changes of the Aortic Diameter May Be Irrelevant Regarding Endograft Sizing in Patients With Aortic Disease.\",\"authors\":\"Daniele Mariastefano Fontanini, Máté Huber, Milán Vecsey-Nagy, Sarolta Borzsák, Judit Csőre, Péter Sótonyi, Csaba Csobay-Novák\",\"doi\":\"10.1177/15266028231172368\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>Endovascular aortic repair has become the preferred elective treatment of infrarenal aortic aneurysms. Aortic pulsatility may pose problems regarding endograft sizing. The aims of this study are to determine the aortic pulsatility in patients with aortic disease and to evaluate the effect of pulsatility on the growth of aneurysms.</p><p><strong>Materials and methods: </strong>In this retrospective study, analyses of computed tomography angiography (CTA) images of 31 patients under conservative treatment for small abdominal aortic aneurysms were performed. Reconstructions of the raw electrocardiography (ECG) gated dataset at 30% and 90% of the R-R cycle were used. After lumen segmentation, total aortic cross-sectional area was measured in diastole and systole in the following zones: Z0, Z3, Z5, Z6, Z8, and Z9. Effective diameters (EDs) were calculated from the systolic (ED<sub>sys</sub>) and diastolic (ED<sub>dia</sub>) cross-sectional areas to determine absolute (ED<sub>sys</sub> - ED<sub>dia</sub>, mm) and relative pulsatility [(ED<sub>sys</sub> - ED<sub>dia</sub>) / ED<sub>dia</sub>, %]. Diameter of the aneurysms was measured on baseline images and the last preoperative follow-up study of each patient.</p><p><strong>Results: </strong>A total of 806 measurements were completed, 24 pulsatility and 2 growth measurements per patient. The mean pulsatility values at each point were as follows: Z0: 0.7±0.8 mm, Z3: 1.0±0.6 mm, Z5: 1.0±0.6 mm, Z6: 0.8±0.7 mm, Z8: 0.7±1.0 mm, Z9: 0.9±0.9 mm. Follow-up time was 5.5±2.2 years during which a growth of 13.42±9.09 mm (2.54±1.55 mm yearly) was observed. No correlation was found between pulsatility values and growth rate of the aneurysms.</p><p><strong>Conclusion: </strong>The pulsatility of the aorta is in a submillimetric range for the vast majority of patients with aortic disease, thus probably not relevant regarding endograft sizing. Pulsatility of the ascending aorta is smaller than that of the descending segment, making an additional oversize of a Z0 implantation questionable.Clinical ImpactEndovascular aortic repair reqiures precise preoperative planning. Pulsatile changes of the aortic diameter may pose issues regarding endograft sizing. In our retrospective single-centre study, aortic pulsatility of patients with AAA was measured on ECG gated CTA images. Pulsatility values reached a maximum at the descending aorta, however absolute pulsatility values did not exceed 1 mm at any point along the aorta. Therefore, significance of aortic pulsatility regarding the sizing of EVAR prostheses is questionable. Correlation between pulsatility and AAA growth was not found.</p>\",\"PeriodicalId\":50210,\"journal\":{\"name\":\"Journal of Endovascular Therapy\",\"volume\":\" \",\"pages\":\"398-403\"},\"PeriodicalIF\":1.7000,\"publicationDate\":\"2025-04-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Endovascular Therapy\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1177/15266028231172368\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2023/5/8 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q3\",\"JCRName\":\"PERIPHERAL VASCULAR DISEASE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Endovascular Therapy","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1177/15266028231172368","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2023/5/8 0:00:00","PubModel":"Epub","JCR":"Q3","JCRName":"PERIPHERAL VASCULAR DISEASE","Score":null,"Total":0}
引用次数: 0
摘要
目的:血管内主动脉修复术已成为治疗肾下动脉瘤的首选方法。主动脉搏动可能会对移植物的大小造成影响。本研究的目的是确定主动脉疾病患者的主动脉搏动性,并评估搏动性对动脉瘤生长的影响。材料与方法:回顾性分析31例经保守治疗的小腹主动脉瘤的ct血管造影(CTA)图像。在R-R周期的30%和90%时,对原始心电图(ECG)门控数据集进行重建。管腔分割后,在Z0、Z3、Z5、Z6、Z8和Z9区域测量舒张期和收缩期主动脉总横截面积。根据收缩期(EDsys)和舒张期(EDdia)横截面积计算有效内径(EDs),以确定绝对(EDsys - EDdia, mm)和相对脉搏度[(EDsys - EDdia) / EDdia, %]。根据基线图像和每位患者的最后一次术前随访研究测量动脉瘤的直径。结果:共完成806次测量,每例患者24次脉搏测量和2次生长测量。各点脉搏率平均值为:Z0: 0.7±0.8 mm, Z3: 1.0±0.6 mm, Z5: 1.0±0.6 mm, Z6: 0.8±0.7 mm, Z8: 0.7±1.0 mm, Z9: 0.9±0.9 mm。随访5.5±2.2年,平均生长13.42±9.09 mm(每年2.54±1.55 mm)。脉搏值与动脉瘤生长速率无相关性。结论:绝大多数主动脉疾病患者的主动脉搏动在亚毫米范围内,因此可能与移植物的大小无关。升主动脉的搏动比降主动脉的搏动小,这使得额外的过大的Z0植入是值得怀疑的。临床影响:血管内主动脉修复需要精确的术前计划。主动脉直径的搏动性改变可能会对移植物的大小造成影响。在我们的回顾性单中心研究中,通过心电图门控CTA图像测量AAA患者的主动脉搏动。在降主动脉处脉搏值最大,但沿主动脉任何一点的绝对脉搏值均不超过1mm。因此,主动脉搏动对EVAR假体尺寸的意义值得怀疑。脉搏与心房动脉生长无相关性。
Pulsatile Changes of the Aortic Diameter May Be Irrelevant Regarding Endograft Sizing in Patients With Aortic Disease.
Purpose: Endovascular aortic repair has become the preferred elective treatment of infrarenal aortic aneurysms. Aortic pulsatility may pose problems regarding endograft sizing. The aims of this study are to determine the aortic pulsatility in patients with aortic disease and to evaluate the effect of pulsatility on the growth of aneurysms.
Materials and methods: In this retrospective study, analyses of computed tomography angiography (CTA) images of 31 patients under conservative treatment for small abdominal aortic aneurysms were performed. Reconstructions of the raw electrocardiography (ECG) gated dataset at 30% and 90% of the R-R cycle were used. After lumen segmentation, total aortic cross-sectional area was measured in diastole and systole in the following zones: Z0, Z3, Z5, Z6, Z8, and Z9. Effective diameters (EDs) were calculated from the systolic (EDsys) and diastolic (EDdia) cross-sectional areas to determine absolute (EDsys - EDdia, mm) and relative pulsatility [(EDsys - EDdia) / EDdia, %]. Diameter of the aneurysms was measured on baseline images and the last preoperative follow-up study of each patient.
Results: A total of 806 measurements were completed, 24 pulsatility and 2 growth measurements per patient. The mean pulsatility values at each point were as follows: Z0: 0.7±0.8 mm, Z3: 1.0±0.6 mm, Z5: 1.0±0.6 mm, Z6: 0.8±0.7 mm, Z8: 0.7±1.0 mm, Z9: 0.9±0.9 mm. Follow-up time was 5.5±2.2 years during which a growth of 13.42±9.09 mm (2.54±1.55 mm yearly) was observed. No correlation was found between pulsatility values and growth rate of the aneurysms.
Conclusion: The pulsatility of the aorta is in a submillimetric range for the vast majority of patients with aortic disease, thus probably not relevant regarding endograft sizing. Pulsatility of the ascending aorta is smaller than that of the descending segment, making an additional oversize of a Z0 implantation questionable.Clinical ImpactEndovascular aortic repair reqiures precise preoperative planning. Pulsatile changes of the aortic diameter may pose issues regarding endograft sizing. In our retrospective single-centre study, aortic pulsatility of patients with AAA was measured on ECG gated CTA images. Pulsatility values reached a maximum at the descending aorta, however absolute pulsatility values did not exceed 1 mm at any point along the aorta. Therefore, significance of aortic pulsatility regarding the sizing of EVAR prostheses is questionable. Correlation between pulsatility and AAA growth was not found.
期刊介绍:
The Journal of Endovascular Therapy (formerly the Journal of Endovascular Surgery) was established in 1994 as a forum for all physicians, scientists, and allied healthcare professionals who are engaged or interested in peripheral endovascular techniques and technology. An official publication of the International Society of Endovascular Specialists (ISEVS), the Journal of Endovascular Therapy publishes peer-reviewed articles of interest to clinicians and researchers in the field of peripheral endovascular interventions.