Construction Of Digital Fallopian Tube-ovarian Arterial Vascular Network Model And The Significance On PPH-UAE

Postpartum hemorrhage (PPH) which is the main cause of maternal mortality is a serious obstetric complications, its incidence rate is about 5% to 10%, and accounting for 49.9% of maternal deaths in China. Over the years, inorder to improve outcomes obstetric workers have made a lot of their tireless efforts, such as eliminate the causes, medication, physical therapy,uterine packing and so on. But there are still many refractory PPH patients who have to undergo bilateral internal iliac artery ligation or subtotal hysterectomy or even total hysterectomy to save their lives. But as we all know, internal iliac artery ligation surgery is not only difficult, technically demanding, risky, and there is only 42% efficiency. Although hysterectomy can stop the bleeding effectively, patients are losing their uterus and fertility, and the resulting series of physiological and psychological changes, will seriously affect the patient’s postoperative quality of life. In addition, individual patients or still can not achieve effective hemostasis. The development of interventional radiology provide new options in the diagnosis and treatment of postpartum hemorrhage, because of hemostasis quickly and effectively, the operation time is short, relatively simple operation with few complications and can reserve uterus, uterine artery embolization (UAE) is more and more widely used in PPH. A large number of studies have confirmed the effectiveness of UAE treatment of PPH, but at the same time many found showed that PPH-UAE also has certain surgical failure rate. Further research shows that the collateral supply of the uterus, such as the ovarian artery, round ligament artery, inferior epigastric artery and ureter artery, is the main reason, and ovarian artery of which is most common. Therefore, the detailed anatomic research of the fallopian tube-ovarian arterial vascular network especially the ovarian artery-to-uterine artery anastomoses is the key to solve the above problems. However, due to normal ovarian artery vascular network is very small and secluded within the pelvic cavity, subject to technical limitations, there is little study about the fallopian tube-ovarian arterial vascular network, led us know very little about it, which limited the successful resolution of these issues and more clinically relevant technology outreach.Traditional vascular casting technology is a common anatomic method to study human vascular network. It choose the human vascular as mold, according vascular characteristics choose different formulations and concentrations of fillers for vascular perfusion casting thus realize the detailed anatomic study of the internal vascular network in perfused organs. But because it is only a static model, and can not do any further functional study, its can not meet modern research and clinical requirements now. While as a new human vascular network research technology, CT thin-layer scanning reconstruction technique has already successful used in many organs research. As a research focus, it is not only convenient, but also can combine traditional anatomy with computer technology thereby to achieve further functional study. But because of vascular anatomic differences and hemodynamics factors, the results are still some differences in different organs. Specific to female pelvic, due to its complex vein and flow affect, current CTA technique can only show 2-3 level branch of iliac artery. Therefore there is no research report about construction of female pelvic arterial vascular network by CTA, not to say the construction of fallopian tube-ovarian arterial vascular network.Therefore, in order to find a better study technique for construction the 3D visual model of the female pelvic arterial vascular network, we improved traditional CPVC filler in our early experiment, which combined vascular casting technology and CT thin-layer scanning reconstruction technique successfully. Forthermore, base on the animal experiment, we successfully constructed a 3D visual model of human normal uterine artery vascular network. The model can not only study the uterine artery vascular network easily, but also can get some physical functions through computer softwares. So in order to provide corresponding anatomic basis for relevant new technologies and methods, we intend further our study on the preliminary experimental work basis and construct an ideal 3D visual model of human fallopian tube-ovarian arterial vascular network.But there is no research report about construct 3D visual model of fallopian tube-ovarian arterial vascular network, we have no direct experiences. Therefore we intend first apply vascular casting technique joint CT thin-layer scanning reconstruction technique to construct 3D visual model of female pig normal fallopian tube-ovarian arterial vascular network. So as to explore the feasibility of using different concentrations of CPVC fillers, through only ovarian arterial pure construct 3D visual model of fallopian tube-ovarian arterial vascular network, and to provide technical guidance and theoretical support for the construction of 3D visual model of human fallopian tube-ovarian arterial vascular network. Base on this, we will apply vascular casting technique joint CT thin-layer scanning reconstruction technique to construct 3D visual model of human fallopian tube-ovarian arterial vascular network using different concentrations of CPVC fillers and through only ovarian arterial perfusion. Finally, we will ues all of the constructed models to study the detailed anatomic morphology of the normal human allopian tube-ovarian arterial vascular network and explore its significance on PPH-UAE.This study divided into three parts:Part One Construction of 3D visual model of female pig normal fallopian tube-ovarian arterial vascular network[Purpose]Apply vascular casting technique joint CT thin-layer scanning reconstruction technique to construct 3D visual model of female pig normal fallopian tube-ovarian arterial vascular network. So as to explore the feasibility of using different concentrations of CPVC fillers, through only ovarian arterial pure construct 3D visual model of fallopian tube-ovarian arterial vascular network, and to provide technical guidance and theoretical support for the construction of 3D visual model of human fallopian tube-ovarian arterial vascular network.[Method]Collected 6 cases of female pig’s urogenital system specimens (uterus, adnexa, vagina, bladder and urethra), divided into group A, B, and C (each 2 cases) randomly. Adopt previous experiment screened best CPVC filler [perchlorethylene as solute, ethyl dibutyl phthalate as solvent, adding CT contrast agent lead oxide (8:100) and red/blue pigment] perfusing bilateral ovarian arteies (red) and bilateral urogential arteries (blue) respectivrly. Group A, B, and C adopt 20%,15% and 10% CPVC fillers respectivrly. Scanning and reconstructing the specimen with 64 slice spiral CT after perfusion immediately. Reconstruction methods content maximum intensity projection (MIP) and volume rendering technical (VR). Finally obtain vascular casting specimens through acid corrosion. Analyze the arterial vascular network characteristics of different models construted by different concentrations CPVC fillers through casting specimens and CT reconstruction models.[Results]All of the adopted 6 cases felamle pig urogenital system specimens were successfully completed bilateral ovarian arteries (red) and bilateral urogenital arteries (blue) perfusion. CT scanning reconstruction models and casting specimens can all display the vascular network clearly. Contrast and analyze 3 different concentrations of CPVC fillers constructed casting specimens and CT reconstruction models we can find that, each group of 3D visual model of female pig normal fallopian tube-ovarian arterial vascular network are different.(1) Through bilateral ovarian arteries and bilateral urogenital arterial perfusion can constructed complete 3D visual model of female pig normal fallopian tube ovarian arterial vascular network.(2) The casting speciens and CT reconstruction models of female pig normal fallopian tube-ovarian arterial vascular network constructed by different concentrations CPVC fillers are not only complete but also have some differences.(3) Those CT reconstruction models are not only have above characteristics but also can obtain some physical functions turough computer softwares.(4) The casting speciens and CT reconstruction models of female pig normal fallopian tube-ovarian arterial vascular network have good consistency.[Conclusion]Using previous experiment screened best CPVC filler, apply vascular casting technique joint CT thin-layer scanning reconstruction technique, through bilateral ovarian arteries and bilateral urogenital arteries perfusion can construct complete 3D visual model of female pig normal fallopian tube-ovarian arterial vascular network. So it provided technical guidance and theoretical support for the construction of 3D visual model of human fallopian tube-ovarian arterial vascular network.Part Two Construction of 3D visual model of human normal fallopian tube-ovarian arterial vascular network[Purpose]Apply vascular casting technique joint CT thin-layer scanning reconstruction technique to construct 3D visual model of human fallopian tube-ovarian arterial vascular network using different concentrations of CPVC fillers and through only ovarian arterial perfusion.[Method]Collected 5 cases of uterus, vagina and adnexa from normal fresh adult females, divided into group A (2 cases), B (2 cases), and C (1 cases) randomly. Adopt previous experiment screened best CPVC filler [perchlorethylene as solute, ethyl dibutyl phthalate as solvent, adding CT contrast agent lead oxide (8:100) and red pigment] perfusing ovarian arteies respectivrly. Group A, B, and C adopt 15%,10% and 15% CPVC fillers respectivrly. Group A and group B are perfused through bilateral ovarian arteies, group C is perfused through unilateral ovarian arteies. Scanning and reconstructing the specimen with 64 slice spiral CT just before and after perfusion. Reconstruction methods content maximum intensity projection (MIP) and volume rendering technical (VR). Finally obtain vascular casting specimens through acid corrosion. Analyze the arterial vascular network characteristics of different models construted by different concentrations CPVC fillers through casting specimens and CT reconstruction models.[Results]In this study, all of the specimens were successfully completed bilateral ovarian arteries and uterine arteries catheterization and the expected arteries (bilateral/ unilateral ovarian artery) perfusion. CT scanning reconstruction models and casting specimens can all display the vascular network clearly. Contrast and analyze different groups of casting specimens and CT reconstruction models have different characteristics.(1) Using different concentrations of CPVC fillers (10%,15%) and perfusion manner can construct complete 3D visual model of human normal fallopian tube-ovarian arterial vascular network.(2) The casting speciens and CT reconstruction models of human normal fallopian tube-ovarian arterial vascular network constructed by different concentrations CPVC fillers are not only complete but also have some differences.①the model constructed by 15% CPVC can not only show the trunk and main branches of bilateral uterine arteries and ovarian arteries, but also can clearly show the communication branches of bilateral spiral arteries and bilateral ovarian arterial vascular network.②the model constructed by 10% CPVC can be further clear indication on the small branches of uterine arteries and ovarian arteries.(3) Those CT reconstruction models are not only have above characteristics but also can obtain some physical functions turough computer softwares.(4) The casting speciens and CT reconstruction models of human normal fallopian tube-ovarian arterial vascular network have good consistency.[Conclusion]Using previous experiment screened best CPVC filler, apply vascular casting technique joint CT thin-layer scanning reconstruction technique, through bilateral/unilateral ovarian arteries perfusion can construct complete 3D visual model of fhuman normal fallopian tube-ovarian arterial vascular network. Part Three The significance of constructed 3D visual model of human normal fallopian tube-ovarian arterial vascular network on PPH-UAE[Purpose]Use all of the constructed casting specimens and CT reconstruction models to study the detailed anatomic morphology of the normal human fallopian tube-ovarian arterial vascular network and explore its significance on PPH-UAE.[Method]Observe and analyse all of the constructed 5 casting specimens and CT reconstruction models of the normal human allopian tube-ovarian arterial vascular network carefully. Mainly focuse on the anntomic characteristic of ovarian artery-to-uterine artery anastomoses, so as to explore its significance on PPH-UAE.[Results]All of the 5 cases (10 sides) of constructed complete arterial vascular casting specimens and CT reconstruction models can show fallopian tube-ovarian arterial vascular network clearly. The ovarian artery-to-uterine artery anastomoses are constituted by the ovarian branch of uterine artery and ovarian branch of ovarian artery. All of the branches are communicated directly.[Conclusion]Vascular casting technique joint CT thin-layer scanning reconstruction technique is a good way to study the detailed anatomic morphology of the normal human fallopian tube-ovarian arterial vascular network. The uterine artery and ovarian artery is communicated directly by ovarian artery-to-uterine artery anastomoses. From the purely anatomical point of view ovarian artery-to-uterine artery anastomoses could not be fully explained the impact of on PPH-UAE, a further functional study are needed.