慢性胸主动脉夹层动脉瘤（病例讨论）课件

慢性胸主动脉夹层动脉瘤 (病例讨论) 李 松 奇 中山大学附属第一医院 血管外科 病例资料 男 72岁 2006年7月因胸闷及活动后气促于广医一附院检 查发现胸主动脉瘤 出院意见为定期复查 暂不予处理 2007年7月中山一院检查发现主动脉夹层动脉瘤 无明显胸背部疼痛病史 高血压病史12年 6年前曾有心绞痛发作一次 PROCEDURE 0.035 guidewire from left brachial artery Angiography confirm the position of primary tear Put guidewire to the right femoral artery from the true lumen Put Hunter-head catheter to the aortic arch and angiography again Change the super-stiff guidewire Deployment stent M e t r o Medtronic Talent 40-150 Follow-up data 1 week after TEVAR Half a year after TEVAR 1 WEEK AFTER TEVARHALF A YEAR AFTER TEVAR comparison 1 WEEK AFTER TEVARHALF A YEAR AFTER TEVAR 1 WEEK AFTER TEVARHALF A YEAR AFTER TEVAR 1 WEEK AFTER TEVAR HALF A YEAR AFTER TEVAR 1 WEEK AFTER TEVARHALF A YEAR AFTER TEVAR 讨 论 降主动脉扭曲的处理 继发性破口处理的指征及方法 Thanks! MALPERFUSION MICHIGAN CLASSIFICATION TREATING MALPERFUSION DYNAMIC OBSTRUCTION ENDOGRAFT ACROSS INTIMAL TEARS FENESTRATION STATIC OBSTRUCTION STENTS FOR UNCOMPLICATED STENOSIS WITH MECHANICAL THROMBECTOMY FOR STENOSIS COMPLICATED BY POST- OBSTRUCTIVE THROMBOSIS OF TRUE LUMEN OR EMBOLISM TO TRUE LUMEN Endografing vs. Fenetration Stenting for uncomplicated stenosis Endovascular Treatment (Non-endograft option) Static obstruction: uncovered stents in origin of branches Dynamic obstruction: percutaneous fenestration of the intimal flap WHAT FENESTRATION DOES CREATES HOLE IN THE FLAP SEPARATING FALSE AND TRUE LUMEN RAISES PRESSURE IN THE TRUE LUMEN PROMOTES FLOW IN THE FALSE LUMEN WHAT FENESTRATION DOES NOT DO DOES NOT REDUCE PRESSURE IN THE FALSE LUMEN DOES NOT “DECOMPRESS” THE FALSE LUMEN DOES NOT MODIFY THE RISK OF ACUTE AORTIC RUPTURE IN