腹主动脉瘤腔内修复术后再膨大的生物力学研究进展
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国家自然科学基金资助项目(11332003, 11102014, 11472031)


Biomechanical research progress on abdominal aortic aneurysm enlargement after endovascular aneurysm repair
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    摘要:

    在临床上,部分腹主动脉瘤(abdominal aortic aneurysm, AAA)行腔内修复术后由于内漏以及内张力的原因还会继续膨大(再生长),甚至破裂。内漏和内张力的存在会显著影响瘤体内的力学/血流动力学环境,从而改变动脉瘤管壁的应力、应变,同时更会影响瘤体内及管壁中物质输运,如低密度脂蛋白(LDL)、氧气、一氧化氮(NO)等,进而改变动脉管壁的生化环境和生理特性。综述引起AAA术后再膨大的生物力学原因及最新研究进展,并指出生物力学环境恶化(如管壁张应力升高)及生化环境异常(LDL沉积增加、氧气浓度变化等)引起的血管管壁强度下降可能是瘤体继续膨大的根源。在总结已有研究的基础上,提出从生物力学和力生物学角度系统研究AAA术后再膨大问题,将有助于更全面认识AAA术后再膨大的机制,同时也有助于腔内修复手术的改进及植介入器械的优化,具有重要的研究价值和临床意义。

    Abstract:

    Clinically, abdominal aortic aneurysm (AAA) may continue to expand or even rupture after endovascular aneurysm repair (EVAR) due to endoleak or endotension. The existence of endoleak and endotension can significantly affect the mechanical/hemodynamic environment in AAAs, thus changing the strain and stresses on aneurysm wall, further influencing the transportation of low density lipoprotein (LDL), oxygen and nitric oxide (NO) in AAAs and aneurysm wall, which might eventually alter the biochemical environment and physiological property of aneurysm wall. This review focused on biomechanical mechanism of AAA enlargement after EVAR and its recent research progress, which indicated that reduction of the aneurysm wall strength due to deterioration of biomechanical environment (such as increase of tensile stress on aneurysm wall) and abnormity of biochemical environment (such as increase of LDL deposition, change of oxygen concentration) might be the source leading to AAA enlargement after EVAR. Based on previous studies, the authors propose that comprehensive investigations on AAA enlargement after EVAR from the perspective of biomechanics and mechanobiology have great research values and clinical significance, which will help clarify the mechanism of AAA enlargement after EVAR, as well as optimize the strategies of aneurysm repair surgery and designs of interventional medical devices.

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张鹏,邓小燕,孙安强.腹主动脉瘤腔内修复术后再膨大的生物力学研究进展[J].医用生物力学,2015,30(4):380-384

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  • 收稿日期:2014-10-18
  • 最后修改日期:2014-11-25
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  • 在线发布日期: 2015-08-27
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