在识别和解释亚当基维奇动脉的肋间分支的挑战
Satoru Tomita1, Yoshimasa Seike1, Tatsuya Nishii2
1Departments of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
Annals of vascular diseases
|December 17, 2025
概括
在胸内血管大动脉修复 (TEVAR) 后,重新评估Adamkiewicz动脉 (AKA) 是非常重要的. 仔细解释计算机断层扫描血管学 (CTA) 是至关重要的,以避免错误识别内血管程序期间的AKA.
科学领域:
- 血管外科 血管外科
- 干预性放射学 干预性放射学
- 医疗成像医学成像
背景情况:
- 胸内血管大动脉修复 (TEVAR) 是一种常见的治疗下降大动脉动脉瘤.
- 经过TEVAR后,可能会出现诸如Ib型的内皮瘤,可能需要重新干预.
- 亚当基维奇动脉 (AKA) 是供给脊髓的关键动脉,在TEVAR期间其覆盖范围可能会导致并发症.
研究的目的:
- 强调在TEVAR后重新评估Adamkiewicz动脉 (ICA-AKA) 的肋间动脉分支的重要性.
- 强调需要仔细解释计算机断层扫描血管学 (CTA) 发现,以正确识别 AKA.
主要方法:
- 一位82岁的妇女的病例报告,她接受了两次TEVAR手术,治疗了下降性大动脉动脉瘤和Ib型内泄症.
- 对手术前和重新干预前CTA扫描的审查,以评估ICA-AKA的位置和过程.
- 对解剖学变化和识别AKA的潜在陷的分析.
主要成果:
- 最初,ICA-AKA在左侧第十个胸部水平上被识别出来,并在第一个TEVAR中被支架移植.
- 在第二次TEVAR之前,CTA揭示了来自左侧第一个腰椎动脉的ICA-AKA,表明其明显来源或可视化的变化.
- 这些发现强调了血管解剖学的动态性质和CTA误解的可能性.
结论:
- 重新评估ICA-AKA是必不可少的,特别是在支架移植覆盖之后,以确保准确的解剖评估.
- 外科医生在解释CTA时必须谨慎,因为其他动脉或静脉可以模仿AKA的外观.
- 仔细的CTA审查对于安全有效的内血管大动脉修复至关重要,最大限度地降低脊髓缺血的风险.
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