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目的对A型夹层状态下的头臂血管进行解剖学测量,为人工血管的制作和完善提供数据支持,为主动脉腔内治疗和头颈部介入操作提供参考。方法对331例A型主动脉夹层的患者行回顾性CTA三维重建,并对其分别进行形态描述,径线和角度测量。结果共计331例,标准型主动脉弓91.5%(303例),变异型主动脉弓8.5%(28例)。25.4%(77例)3分支开口均低于主动脉弓最高点。3分支开口分布中,IA多见于后位,而LCCA和LSA则多见于中位。IA最易被夹层累及。由IA到LSA,3分支在开口处的直径分别为(16.2±3.6)、(11.0±3.3)、(12.9±3.6)mm。3分支在距离开口2 cm处直径分别为:(12.0±3.0)、(9.0±1.9)、(9.8±2.1)mm。IA-LCCA间距平均为(10.1±5.5)mm(2.0~20.0mm)。LCCA-LSA间距平均为(14.1±5.9)mm(2.0~27.0mm)。在主动脉弓冠状面,头臂血管与主动脉弓所成角分别为(62.5±26.5)°,(57.8±23.4)°,(64.9±23.5)°。在主动脉弓横截面,头臂血管与主动脉弓所成角分别为(121.1±24.7)°,(107.3±19.4)°,(100.5±16.1)°。结论通过本研究得到了A型夹层状态下的头臂血管详细解剖数据,且和目前流行的人工血管设计数据并不一致,这为人工血管进一步完善提供了数据支持。
Objective To dissect the brachiocephalic vessels under type A dissection, provide data support for the production and improvement of artificial blood vessels, and provide reference for endovascular treatment of aorta and interventional operation of the head and neck. Methods Three hundred and thirty - one patients with type A aortic dissection were retrospectively retrospectively reconstructed by CTA, and their morphology, diameter and angle were measured. Results A total of 331 cases, the standard aortic arch 91.5% (303 cases), variant aortic arch 8.5% (28 cases). 25.4% (77 cases) 3 branch openings were lower than the highest point of aortic arch. 3 branch opening distribution, IA more common in the posterior, and LCCA and LSA are more common in the median. IA most easily affected by dissection. From IA to LSA, the diameters of the 3 branches at the opening were (16.2 ± 3.6), (11.0 ± 3.3) and (12.9 ± 3.6) mm, respectively. The diameters of 3 branches at 2 cm from the opening were (12.0 ± 3.0), (9.0 ± 1.9) and (9.8 ± 2.1) mm, respectively. The average IA-LCCA spacing was (10.1 ± 5.5) mm (2.0-20.0mm). The mean LCCA-LSA distance was (14.1 ± 5.9) mm (2.0-27.0 mm). In the coronal plane of the aortic arch, the angle between the arm artery and aortic arch was (62.5 ± 26.5) °, (57.8 ± 23.4) ° and (64.9 ± 23.5) °, respectively. In the cross section of the aortic arch, the angle between the arm artery and the aortic arch was (121.1 ± 24.7) °, (107.3 ± 19.4) ° and (100.5 ± 16.1) °, respectively. Conclusions The anatomical data of the brachiocephalic vessels in Type A dissection were obtained through this study. The data were not consistent with the current design data of artificial vessels, which provided data support for the further improvement of artificial blood vessels.