The Aortic Remodeling Comparative Study Of Contrast Enhanced Ultrasound And CTA In Debakey Type ? Aortic Dissection After TEVAR

ObjectiveTo compare the different features of contrast enhanced ultrasound(CEUS)and CT angiography(CTA)in abdominal aortic remodeling after thoracic endovascular aortic repair(TEVAR)of DeBakey type ? aortic dissection(AD),to investigate the application value of CEUS in the follow-up of DeBakey type? aortic dissection after TEVAR.Methods36 patients with DeBakey type ? AD in our hospital from March 2015 to March 2016 in Dongguan kanghua hospital were enrolled in this study.All patients were treated with TEVAR in our hospital as the research object.Among them,8 patients were lost to follow-up,and the final sample was selected as the research object of the 28 cases.CEUS was performed in 28 patients with DeBakey type ? AD after TEVAR,which 8 cases type ?a(simple type)was not involved of abdominal aorta,20 cases ?b(complex type)is involved in the abdominal aorta,all patients were performed CTA examination of aorta.The functional and morphological changes of abdominal aortic remodeling were observed by two methods in DeBakey type ? AD after TEVAR.Results28 cases of DeBakey type ? AD after 3 months of follow-up,8 cases of type ?a with CEUS in the 3 test period were not found redissection and dissection,is consistent with the results of CTA examination(P>0.05),the difference was not statistically significant;20 cases of type ?b AD with the detection of the first and second test period,the difference between the two groups was statistically significant(P<0.05),in the third test period,the difference between the two groups was not statistically significant(P>0.05).CTA found 63 ruptures,an average of 3.15 cases in which the detection,section one 19(30.16%),section two 30(47.62%),section three 14(22.22%).35 ruptures were found by CEUS in which the detection,section one 5,section two 19,section three 11.CEUS was less than the CTA in check the rupture.20 cases of DeBakey type ?b AD postoperative long-term follow-up,which blood pressure controlled in good condition,with two methods of level Celiac trunk artery,superior mesenteric artery,renal artery and abdominal aortic bifurcation measuring diameter of the false and true lumen in the abdominal cavity for about 3 months,there were no significant differences(P>0.05).In the long-term follow-up,the false lumen was found to be gradually thrombosis,and the velocity of blood flow in the lumen decreased gradually.The true lumen gradually increased,the false lumen gradually reduced,and the abdominal aortic dissection decreased.ConclusionsThe study found that CEUS in the same level of measurement results the diameter of the true and false lumen with CTA were similar,but less than CTA in detect the number of rupture.The type ? endoleak(including proximal and distal endoleak)influence the presence or the original type ? endoleak and poor control of blood pressure,to further expand the living habits and other factors,the prognosis of type ?a AD may appear abdominal segment redissection and dissection,through the examination of CEUS found fleetly,timely,accurately and clearly,can provide the basis for further intervention.A long-term follow-up of 20 cases of type ? AD after TEVAR,by CEUS examination revealed abdominal segment dissection false lumen thrombosis with endometrial swing also gradually decreased,the true and false lumen pressure difference gradually narrowed,and the true lumen expands gradually,the false lumen narrowing.Static images of abdominal segment break and tear film and aortic thrombosis situation can not just look at CTA,because the CTA image resolution of intima is low,and the evaluation of false lumen thrombosis degree may be overestimated,CEUS image dynamic evolution of hemodynamics is more valuable.Because of the small number of cases,we can' t give a convincing conclusion,further research is needed.In summary,CEUS can not only display the anatomy and morphology of abdominal aorta and branch,and through the evaluation of the hemodynamic changes in the tear and false lumen,to compensate for the lack of aortic CTA in this area,so the comprehensive evaluation of DeBakey type ? AD aortic remodeling,provide a more comprehensive basis for further intervention and prognosis it is worthy of popularization and application.