The Study On The Wrapping Treatment Of Canine Fursiform Aneurysm With High Frequency Ultrasound

Background:With the continuous development of new ultrasound technology, especially for peripheral vascular ultrasound in the diagnosis continuously improve, more scholars use noninvasive ultrasound technology to improve the diagnostic accuracy of early diagnosis of vascular disease and methods. Intracranial aneurysm formation, growth, stability has been broken, or is a controversial issue. fusiform aneurysms, also known as spindle which aneurysms unclear etiology, clinical treatment are more difficult. At present, because the ethical and moral and health insurance policies and other factors limit, parcels for the treatment of intracranial aneurysms spindle clinical study have not been reported. Aneurysms, wrapped it around the aneurysm thylakoid enveloping some material, the intensity of use of these substances. These substances or foreign body reaction to the aneurysm wall reinforced the strength to achieve expansionist wall of the aneurysm stress resistance. restrict further expansion of the aneurysm to prevent further bleeding aneurysm rupture purpose. Experimental study on the course of aneurysms, aneurysms must be built with similar aneurysms. Through this experimental canine carotid artery fusiform aneurysm model Research and fusiform aneurysms wrapped contrast to the treatment of high-frequency ultrasound and sonographic appearance. Some combination of multislice CT angiography and digital subtraction angiography and pathologic results. Evaluation of ultrasound technology fusiform aneurysm neck wrapped after dogs detected value Preliminary study of different materials dogs fusiform aneurysm neck wrapped in the short-and long-term effects of treatment.Objective1. To establish the canine fusiform carotid aneurysm model and evaluate with High Frequency Ultrasound (HFUS)2. To evaluate the characteristics of morphologic and the hemodynamic changes with High Frequency Ultrasound (HFUS) in the wrapping treatment of canine fusiform aneurysm, and to discuss the curative effect of different wrap material.3. Comparative analysis of artery enhanced ultrasonography with the color Doppler ultrasound sonographic features of aneurysms. AN arterial vascular contrast improve detection accuracy of the value of the parcel.4. Comparative analysis HFUS with multislice CT angiography characteristics of the images in carotid artery occlusion parcels AN, to explore the value of non-invasive imaging techniques in detection CCA wrapped AN vascular.Materials and Methods1. Research and model-making10 healthy dogs were selected, raning in weight from 12kg to 18kg. Microsurgery interception of a dog on the EJV and the CCA to establish the fusiform aneurysm model of bilateral end anastomosis CCA; After modeling into four teams, each comprising five AN, as the experimental group. using artificial biofilm, e-PTFE, autologous vein (EJV). polyester film material wrapped therapy, respectively. Five AN were selected from 20 model, randomly, as a control group2. Instrment and contrast agents HFUS and ICU examination: Application of General Motors Corporation GE LOGIQ BOOK computer digital audio-visual device, linear array probe. 5-10 MHz frequency. Narcotic drug: Sumianxin, luantong and atropine. The contrast agent was "Quanfuxian",microbubble diameter 2.0～5.0μm, concentration1.0×10~9～2.0×10~9/ml, pH value 6.4～7.4. Contrast dosage 0.03ml/kg. DSA using Germany's Siemens AXIOM-Arpisdta equipment and the General Motors Corporation figures GE9800 subtraction angiography instrument. Contrast agent: 38% meglumine diatrizoate. MSCTAequipment was the PHILIPS 190P machine. Intravenous injection "Dianbile" of non-ionic contrast agent 250ml, flow rate of 3ml/s.3. HFUS detection methodLocal amplification measure the systolic diameter and wall thickness of of near the distal anastomosis, the parent artery and aneurysm cavit of model and parcels AN vascular y. Pulsed Doppler color flow measure the peak velocity (PSV). diastolic velocity (EDV) and resistive index (RI) of the aneurysm site. Determination of three consecutive measurements of the cardiac cycle, the average time of less than 1 hour. Contrast: lumen conventional color Doppler flow position, the image will be changed to 3 cm depth exploration. After using 1 ml syringe peripherally "projectile" injection, repeated three times. immediately after each injection of 3 ml saline injection followed by washing the wall. be repeated injection of more than 10～15 minutes each time interval. After the contrast agent injection, color Doppler signals observed changes in the lumen, record Onset, and increase the delay time.4. Pathology and electron microscopic examinationSpecimens were collected: dogs, and the top and bottom body resection AN CCA 1 cm. AN under observation of the form filling and emptying model size. Images of the parcel after the end of a 3% sodium pentobarbital overdose death in dogs. CCA bilateral neck surgery to remove the dogs long, vertical incision, use saline wash blood and then wrapped vascular aneurysms general situation. CCA interception wrapped aneurysms of the parent artery connecting the proximal and distal stumps total of 4cm. HE red-Yihong (HE) staining and parcel of the aneurysm site changes5. Statistical anlysis:Statistical package for social sciences (SPSS10.0), The data to mean±standard deviation (x±s). Repeated measurement One-way analysis of variance (ANOVA) statistical methods. A P value of 0.05 or less was considered to indicate a statisticant significant.Results1. Ultrasound finding of the dog fusiform aneurysm model1.1 Model and the general features of aneurysms10 dogs, 20 AN models of bilateral CCA were created successfully, operation into a rate 100% (20/20). After an autopsy, filling and emptying state of the state, both are well-shaped spindle AN.1.2 HFUS finding:Two-dimensional ultrasound: Fusiform aneurysms, the wall thickness of tumors compare with the near and distal parent artery the difference was not statistically significant (P=0.417). Tumor cavity diameter and the diameter of the parent artery anastomosis control diameter, a significant difference (P=0.000). CDFI showed aneurysm cavity equal to the red and blue swirl.anastomotic color flow mixing bright, red laminar flow of the parent artery. Pulsed Doppler showed: near the tumor that the distal end of PSV, EDV, RI was high than in the past aneurysm of the distal. Proximal margin of the tumor, the top of the distal edge of the RI gradually increased, PSV, EDV decreased gradually, also lower than the distal of tumor.2. The performance of high-frequency ultrasound of parcels aneurysm 2.1 Morphological characteristics of the ANAneurysms: autogenous vein parcels with the basic model form, and the tumor cavity diameter of the parent artery anastomosis diameter control, a significant difference (P=0.000); Compared with the control group wrapped aneurysm cavity diameter higher. a significant difference (P=0.003); Anterior and posterior wall of their tumors. Compared with the parent artery wall thickness Drive significant difference (P=0.007, 0.002). : 80% polyester film wrapped aneurysm occlusion of tumor cavity. E-PEFT and artificial biological membrane morphology of the same parcel: aneurysms, wrapped aneurysm cavity. and the parent artery anastomosis diameter diameter is close; Compared with the control group the two parcels aneurysm cavity diameter is reduced, a significant difference (P=0.000, 0.000). 60% and 80% of the e-PTFE membrane coating biological artificial wall between the aneurysm and dissection gap. After two parcels aneurysms, and the proximal and distal stumps after parent artery wall thickness Drive around thickness Drive, No significant difference (P=0.580, 0.410, 0.180, 0.749, 0.525).2.2 AN parcels of hemodynamic changesCDFI show: e-PTFE membrane and artificial wrapped aneurysm cavity flow patterns change, tumor cavity. Endovascular artery anastomosis and as a single parent, a good continuation of the red laminar flow, But not good blood tumor cavity filling parcels, Close wall of the aneurysm. And not autogenous vein occlusion of the aneurysm site polyester film wrapped AN model with color Doppler imaging, tumor cavity still swirl pattern. Color image shows filling defect and blood. PW: comparison of four materials: artificial biofilm part of the group of tumor cavity, the parent artery anastomosis and the PSV, EDV, RI no significant difference. Autogenous vein group intraluminal PSV, EDV lower than the parent artery anastomosis and PSV, EDV, a significant difference (P=0.001, 0.007, 0.006, 0.002). AN e-PTFE group wrapped anastomosis compared with the tumor cavity PSV significant difference (P=0.002). Group polyester film wrapped EDV cavity below the aneurysm and parent artery anastomosis EDV a significant difference (P=0.002, 0.024). Four groups in the control group compared with Group: artificial biofilm in the tumor cavity, and the parent artery anastomosis PSV. EDV RI compared with the control group and no significant difference; autogenous vein group in the parent artery PSV. EDV a significant difference compared with the control group (P=0.039, 0.037); e-PTFE team PSV and the parent artery anastomosis is higher than any significant difference (P=0.000, 0.000, 0.007, 0.041). In polyester films parent artery PSV, EDV and significant difference compared with the control group (P=0.002. .000); PSV anastomosis in a significant difference between the control group (P=0.000). Comparison between the various parts of the four groups: Group artificial biofilm parent artery anastomosis and PSV tumor cavity. EDV than autologous vein group and polyester film group, a significant difference (P=0.001, 0.000, 0.002, 0.008, 0.026, 0.013, 0.035, 0.048, .043); EDV artificial biofilm group in the parent artery below the e-PTFE group and the location of the tumor cavity RI than e-PTFE group, a significant difference (P=0.010. 0.004, 0.047). E-PTFE group in the parent artery anastomosis and PSV, EDV than polyester film group a significant difference (P=0.003, 0.000); PSV in the tumor cavity. EDV difference was significant (P=0.011, 0.003); RI in the parent artery and the tumor cavity below the polyester film group, a significant difference (P=0.004, 0.026); PSV and the parent artery anastomosis in the tumor cavity EDV difference was significant (P=0.032, 0.000, 0.002, 0.005). Since the venous anastomosis group in the PSV and the parent artery EDV than polyester film group a significant difference (P=0.000, 0.017); PSV in the pseudoaneurysm. PSV PSV below the mouth and e-PTFE anastomosis group, a significant difference (P=0.005. 0.000, 0.015); PSV in the tumor cavity. EDV compared with the e-PTFE a significant difference (P=0.013, 0.004); RI than e-PTFE in the parent group, a significant difference (P=00.027)2.3 Contrast ultrasound findingContrast Agent for not blocking parcels, the echo effect in the wall of aneurysm, parent artery wall and tumor cavity has significantly enhanced, incomplete occlusion of the aneurysm can be seen sparse echo of contrast agent in wrapped AN cavity. There was marked improvement in the detection part of the velocity. Color pulse repetition frequency was increased, there was the bright blood filling the lumen and the spillover phenomenon. After repeated injection of contrast agent shows more clearly the wall. Parcels aneurysm occlusion of tumor cavity was no contrast agent enhancement. The color blood flow shows both vertebral artery and collateral vascular more clearly.3. HFUS and MSCTA in the diagnosis of occlusion parcels ANBlocking parcel AN of the show: The detection rates of HFUS and MSCTA were 100% to the occlusion vascular of parcels AN, the diagnosis rates were 100% and 80%, respectively. Both on the plaque, HFUS was better than angiography. To the degree of occlusion HFUS was not better than MSCTA; But HFUS for occlusive vascular aneurysms of the local judge also has an advantage over CT. Site assessment of the carotid artery occlusion: To the initial end, bifurcation and the collateral vascular HFUS can not better judge as angiography; But for all of vascular occlusive vascular, especially for the aneurysms HFUS can display MSCTA more clear.4. AN parcels of pathological findings4.1 Specimen observationBlocking parcel AN of the wall was smooth operation sculptured Department anastomotic connection suture clearly visible; Occlusion of the parcel AN, we can see plaque rupture and thrombosis, and thrombosis are all white plaque rupture thrombosis. AN close to the artery wall, some small parcels AN tumor cavity can be seen in the central space; ends with the parent artery anastomosis and blocks blood coagulation, osteoporosis and attachment wall of the aneurysm.4.2 HE staining resultsStaining various coated outer fibrous connective tissue most aneurysms. smooth muscle cells and collagen fibers in the middle shows different degrees of distribution; membrane with the membrane can be seen among a large number of heterogeneous red staining of collagen fibers hyperplasia, scar formation and lipid composition and retained foreign bodies can be seen; AN some smooth muscle cells disappear, the lack of elastic fibers and collagen fibers partial rupture, aneurysm vascular endothelial not consecutive, This shows foreign body giant cells and endothelial cell necrosis; lumen seen in large red structure with no necrosis and inflammatory cell degeneration.4.3 Electron microscopyEndovascular aneurysm inclusion of a small detachment of endothelial cells and erythrocytes can be seen; Endothelial cells are polygonal or slightly irregular in shape, oval nuclei, the cell cytoplasm rich; endothelial cells and the basement membrane is not continuous, falling into the lumen.5. Digital subtraction angiography (DSA)For 20 AN model showed fusiform aneurysm repair to swirl, Contrast Agent stranded obvious. After parcels AN of the performance: e-PTFE membrane and artificial parcels AN that the diameter can be seen of near the distal end of the basic and parent the distal artery diameter; Contrast Agent passed quickly, without staying. The parcels AN of autogenous vein increased, and contrast agent in the distal to proximal anastomosis, anastomotic axial extension of the tumor, along the side wall of the aneurysm and then return to their first tumor cavity which formed a small eddy and then converge into the swirl throughout the tumor cavity. Contrast Agent stranded obvious; intraluminal contrast agent disappeared in a wall of the aneurysm can be seen to extend and contrast agent filling defect. Polyester film wrapped AN aortic arch occlusion angiography: agent stem from the origin of total carotid artery flow rapidly to the subclavian vascular side artery and vertebral artery; Collateral vessels can be seen filling, the expansion of vascular showed. Confirmed the result of ultrasound.Conclusions1. It is practically feasible to establish common carotid artery fusiform aneurysms by graft external jugular vein. and success rate was higher than that of other little animals. The experimental aneurysms were stable and reliable which culd allow the catheter and surgical intervention easily. Canine fusiform aneurysms were similar to the ultrasound characteristics of neck aneurysm in human. It was an ideal animal model to study the imaging for encephalic aneurysm.2. Animal model of fusiform aneurysms in our experiments were ideal for the treatment of aneurysms external parcels.Using artificial biofilm and e-PTFE wraped aneurysms by microsurgical methods which could change the shape and the abnormal hemodynamics and terminate the action of aneurysm, in the same time which could prevent aneurysms expanded and rupture during short term. But their long-term effects need further observation. And the application results of terylene film material and autogenous wrapping were poor around the thylakoid AN model in the short and medium term, It is possible to expand and rupture except occlusion in both them. High-frequency ultrasound was not only able to detect the time change of AN dynamic after dogs fusiform aneurysms wrapped but also to detect the imaging characteristics effective to different wrapping materials, the effect could be judged.3. Contrast can make up for the shortfall, the low flow of parent artery and the segment of AN parceled could significantly enhance and extend the color Doppler imaging and to raise the pulse noise spectrum by contrast media, the success rate of Doppler spectrum sampling could increase; Meanwhile vascular contrast could be improved so that the vascular wall of CCA and the line shown more clearly. The features of vascular hemodynamics of AN wrapped could be reflected realy, and to help the diagnosis of endometrial hyperplasia, Plaque formation and a cavity filling defect in vascular wall and the blood4. To the occlusion or occlusive vascular insufficiency after parcels aneurysm, the area of the occlusion segment of AN wrapped, the damage of the vessel wall and the character of plaque intraluminal thrombus could be diagnosed clearly by HFUS, and the occlusion segment of the coating material of AN wrapped could be judged; MSCTA had a higher spatial resolution than HFUS, the whole process of AN wrapped vascular, branch and the relationship with surrounding structures could be shown clear. It was rapid and sensitive to diagnose the vascular occlusion of CCA. The accuracy of non-invasive imaging could be improved rapidly to detect the AN wrapped vascular combination HFUS and MSCTA.