瘤颈角度对腹主动脉瘤腔内修复术后支架位移的影响
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1.四川大学建筑与环境学院 四川成都;2.四川大学华西医院血管外科 四川成都

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Effect of aneurysmal neck Angle on stent displacement after endovascular repair of abdominal aortic aneurysm
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    摘要:

    目的 腔内修复术(post-endovascular aneurysm repair,EVAR)是当前治疗腹主动脉瘤(Abdominal aortic aneurysm,AAA)的常用手段。但是临床发现,若患者的瘤颈严重成角,治疗后更容易发生支架位移。因此本研究旨在探索术前瘤颈角的大小对EVAR术后支架位移力及位移的影响。方法 本研究选用了28名AAA患者,并根据手术前瘤颈角度的大小分为:未严重成角组(n=14)和严重角度组(n=14)。根据患者真实CT图像,分别建立术前动脉瘤模型、术后两次随访的动脉瘤模型和覆膜支架模型。测量和对比术前瘤长度(Lsac)、瘤最大直径(Dmax)、术后两次瘤颈长度变化值、瘤体体积变化值和支架位移。通过计算流体力学的方法对术后第一次随访模型进行血流动力学分析。结果 研究发现:两组在瘤长度、Dmax、位移力、瘤颈长度变化和瘤体积变化上有明显差异;在支架的重心位移和近端位移无显著差异。此外,未严重成角组中发生2例内漏,而严重成角组中有4例。结论 严重的瘤颈成角可导致支架位移力显著增加以及近端锚固区减小,为此,在临床方面医生应加强对于严重瘤颈成角患者的术后随访,警惕远期内漏的发生。

    Abstract:

    Purpose : Endovascular repair (post-endovascular aneurysm repair, EVAR) is a common method for the treatment of abdominal aortic aneurysm (Abdominal aortic aneurysm, AAA). However, it is clinically found that if the tumor neck of the patient is seriously angled, the stent is more likely to be displaced after treatment. Therefore, the purpose of this study is to explore the effect of preoperative neck angle on stent displacement force and displacement after EVAR. Methods 28 patients with AAA were selected and divided into two groups according to the neck angle before operation: non-severe angle group (n = 14) and severe angle group (n = 14). According to the real CT images of the patients, the aneurysm model before operation, the aneurysm model followed up twice after operation and the stent graft model were established respectively. The preoperative tumor length (Lsac), maximum tumor diameter (Dmax), neck length, tumor volume and stent displacement were measured and compared. The hemodynamics of the first postoperative follow-up model was analyzed by the method of computational fluid dynamics. Results there were significant differences in tumor length, Dmax, displacement force, neck length and tumor volume between the two groups, but there was no significant difference in the center of gravity displacement and proximal displacement of the stent. In addition, there were 2 cases of internal leakage in the non-severe angular group and 4 cases in the severe angular group. Conclusion severe neck angulation can significantly increase the stent displacement force and decrease the proximal Anchorage zone. Therefore, doctors should strengthen the postoperative follow-up of patients with severe neck angulation and guard against the occurrence of long-term internal leakage.

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  • 收稿日期:2022-06-08
  • 最后修改日期:2022-08-03
  • 录用日期:2022-08-04
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