Research About The Size-Design Of The Modular Branched Stent-Graft

As the rapid development of endovascualr technology and instrument,more and more aortic diseas can be treated by EVR.However,commercially available devices which design for ascending aorta and aortic arch are still limited.Our reseach-team designed the"modular branched stent-graft system"to reconstruction ascending aorta and arch,and have finished animal-experiment already.But lack of the human thoracic vascular anatomical datas.Because CTA has already considered as a standard way to evaluate aortic pathological changes,so we get and record the anatomical datas that related with endovascular technic all by CTA,especially by the three-dimensional reconstruction and the vessel-analysis soft-ware,etc.Our aim is to design the "modular branched stent-graft system"which suitable for most part of the chinese population,and to provid datas for future production.Objective:Record and statistical analysis the endo-technology related datas about ascending aorta,aortic arch,supra-aortic vessels,respectively.To design the "size of modular branched stent-graft system"which suitable for most part of the chinese population,and to provid datas for future production.Methods:A retrospective reviw of the 388 CTA explorations of the thoracic aorta carried out between Sep.2006and Sep.2007 at our institution,these patients were free of current known aortic pathology and free of previous aortic pathology,too.We measured the length and diameter of ascending aorta(AA),aortic arch,and branch vessels of aortic arch respectively in AW4.2 work station.Set up data base about all the measurements,we use the CHESS statistical software to analysis datas.Results:1,The aortic diameter above Coronary Artery(CA)(D₁),the level at origin of BrachioCephalic Trunk(BCT)(D₃),the halfway of the AA(D₂),the level at origin of Left Common Carotid Artery(LCCA)(D₄),the level at origin of Left Subclavian Artery (LSA)(D₅)and the level at distal of origin of LSA(D₆)respectivly are:33.461±4.758mm;32.571±3.858 mm;34.247±4.936 mm;29.992±3.625 mm;27.831±3.209 mm;26.194±3.075 mm.The diameters of two level between the origin of BCT and RSA are 13.121±1.944mm,12.752±2.273mm,respectivly.Diameters of two level at LCCA are 8.716±1.538mm and 7.894±1.042mm.The diameters of two level between the origin of LSA and L-vertebral artery are 10.707±1.666mm,9.285±1.309mm,respectivly.The aortic lumina length between the origin of CA and BCT(L₁) are 5.348±1.220cm;aortic lumina length between the origin of BCT and LCCA(L₂) are 1.322±0.430cm;aortic lumina length between the origin of CA and 6cm distal to the LSA(L₃)are 15.294±1.702cm;the lumen length between origin of BCT and RSA(l₁)are 4.053±0.823cm;the lumen length between origin of LSA and L-vertebral artery(l₂)are 3.834±0.787cm.The distance between the wall of BCT and LCCA(l₃)are 0.388±0.229cm;the distance between the wall of LCCA and LSA(l₄) are 0.714±0.497cm.2,In this sample,there are 4 type of vasal abnormality:BCT and LCCA are originate from one trunk(37patients,9.5%);L- vertebral artery are originate from arch directly(23patients,5.9%);thyreoid aretery originate from arch(2patients,0.5%);mixture of all above(1patient,0.2%).And aortic diameters and lengths are definitly have differences between female and male.3,The diameter-size of modular-one that fit for above 90%sample are(A-B): 32-10 32-14 32-18;36-10 36-14 36-18;40-14 40-18 40-20;44-14 44-18 44-20;48 48-18 44-20;the diameter-size that fit for above 70%sample are:36-14 36-16 36-18;40-14 40-16 40-18;44-14 44-16 44-18;48-16 48-18.The length-size of modular-one that fit for above 50%sample are(a7-a5):4.5-5;5.5-5;6.5-5;and length-size that fit for above 85%sample are:4.5-4.5;5.5-4.5;6.5-4.5.The diameter-size of modular-two that fit for above 90%sample are(A'-B'): 26-8,26-10,26-12;32-8,32-10,32-12;36-8,36-10,36-12;46-8,46-10,46-12;the diameter-size that fit for above 70%sample are:32-8,32-10,32-12;36-8,36-10,36-12; 46-8,46-10,46-12.The length-size of modular-two is(b2-b5-b7):2-5-4.The size of modular-three that fit for above 90%sample are(A"-B"-c4):26-28-15 26-30-15 26-32-15;30-30-15 30-32-15 30-34-15;34-34-15 34-36-15 34-38-15; 40-38-15.Conclusion:By these retrospective research on a big sample,we know about the ascending aorta and arch much more,and the modular branched stent-graft system is suitable for the most part of chinses population.On this basic,we get the size serious that fit for human.