A型主动脉夹层头臂血管的解剖学研究及临床意义
Anatomical study of brachiocephalic vessels in type A aortic dissection and its clinical significance
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 The study is to provide data support for the production and improvement of artificial blood vessels and to provide reference for aortic endovascular treatment by determining the dimension of the brachiocephalic vessels in the setting of type A aortic dissection. Methods 331 cases with type A aortic dissection were reviewed by CTA, and the shape, diameter and angle were studied. Results In a total of 331 cases, 91.5%(303 cases) are with a normal aortic arch and 8.5%(28 cases) with a variant aortic arch. In 25.4%(77 cases), the opening of the three branches is lower than that of the aortic arch. In the distribution of the three branches, IA is more common in the posterior position, while LCCA and LSA are more common in the middle. IA is most likely to be involved in the dissection. From IA to LSA, the diameter of the three branches at the opening is (16.2±3.6), (11.0±3.3), and (12.9±3.6)mm respectively. The diameter of the three branches 2 cm distal to the opening is (12.0±3.0), (9.0±1.9), and (9.8± 2.1) mm, respectively. The average IA-LCCA distance is (10.1±5.5)mm(2~20 mm). The average LCCA-LSA distance is (14.1±5.9)mm(2~27 mm). In the coronal plane of aortic arch, the angles of the brachiocephalic artery and the aortic arch are (62.5± 26.5)°, (57.8±23.4)°, and (64.9±23.5)°, respectively. In the aortic cross section, the angles of the brachiocephalic artery and the aortic arch are (121.1±24.7)°, (107.3±19.4)°, and (100.5±16.1)°, respectively. Conclusion This research obtained the detailed anatomical data of brachiocephalic vessels in the setting of type A dissection, which is not consistent with the existing artificial blood vessel. The study can provide data support for the further improvement of artificial blood vessels.
Morphology of aortic arch / Aortic arch dissection / Anatomy
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