多排螺旋CT及数字减影血管造影对B型主动脉夹层评估的意义

目的探讨多排螺旋CT血管造影(CTA)和数字减影血管造影(DSA)诊断主动脉夹层(AD)的一致性及对主动脉夹层腔内修复术(TEVAR)的指导意义。方法回顾性分析资料完善的40例AD患者,比较两种方法显示的AD破口数、破口与左锁骨下动脉(LSA)的距离、左锁骨下动脉远端胸主动脉直径、主动脉夹层累及的范围及主动脉主要分支血管的累及情况、真假腔内血栓形成及钙化状况、行覆膜支架后内漏的发生率。结果两种检查方法在检测AD破口数、破口距LSA的距离、胸主动脉直径方面差异无统计学意义。CTA、DSA发现夹层累及左、右侧髂动脉平面的例数分别为16例(40.0%)、6例(15.0%)和15例(37.5%)、6例(15.0%),两种方法在检测夹层累及左、右侧髂动脉平面时的准确度差异均有统计学意义(P<0.05)。CTA可检测出夹层血栓、动脉壁钙化,而DSA无法显示。40例AD患者行TEVAR 34例,覆膜支架置入后DSA即刻检测发现内漏者11例(32.4%)。结论 CTA、DSA两者对诊断AD有较好的一致性,对TEVAR术前、后有指导价值。

Evaluation significance of the computed tomography angiography and digital subtraction angiography in diagnosis and treatment of aortic dissection

Objective To compare the computed tomography angiography（CTA） with digital subtraction angiography（DSA） in the diagnosis of aortic dissection and evaluate the value in thoratic endovascular aortic repair（TEVAR）.Methods Forty patients with aortic dissection,who were examined by both CTA and DSA,were analyzed,respectively.The following aspects were compared between CTA and DSA,including intimal tear,aortic diameter,true and false lumen area,the distance from proximal edge of the tear to the left subclavian artery（LSA）,thrombosis in the false lumen,calcified plaque,origin of artery branches as well as endoleaks after TEVAR.Results Forty patients who underwent CTA and DSA.TEVAR were performed in 34 cases.No statistical difference was found in the number of tearsand the distance from proximal edge of the tear to LSA and aortic diameter between CTA and DSA.Left iliac artery（LIA） and right iliac artery（RIA） involved in the dissection were discovered in 16（40.0%）,6（15.0%） cases by CTA and 15（37.5%）,6（15.0%） cases by DSA.There was significant difference in identifying LIA and RIA involved in the dissection between CTA and DSA（P0.05）.Thrombosis in the false lumen and calcified plaque was found by CTA and not by DSA.Type I endoleak was detected in 11（32.4%） cases.Conclusion The two methods of CTA and DSA show a good coincident result and have significant value for TEVAR.