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B型胸主动脉夹层动脉瘤的治疗策略聪明出于勤奋,天才在于积累B型胸主动脉夹层动脉瘤的治疗策略B型胸主动脉夹层动脉瘤的治疗策略聪明出于勤奋,天才在于积累TheTherapeuticStrategyforTypeBThoracicAorticDissectionPeople’sHospital,PekingUniversity北京大学人民医院XieJiyan(解基严),etal,TheTherapyforTypeBThoracicAorticDissectionMedicalSurgicalEndovascularB型胸主动脉夹层动脉瘤的治疗策略聪明出于勤奋,天才在于积累B1B型胸主动脉夹层动脉瘤的治疗策略课件整理2B型胸主动脉夹层动脉瘤的治疗策略课件整理3B型胸主动脉夹层动脉瘤的治疗策略课件整理4B型胸主动脉夹层动脉瘤的治疗策略课件整理5ChestPainHeart\renal\lungSymptoms

(ShortBreath)Pulse:Decreased(60%)BP:NormalorHighSymptoms&SignsChestPainHeart\renal\lungSym6DiagnosisMethodsEchocardiogram(TTE&TEE)CTMRIAngiographyDiagnosisMethodsEchocardiogr7SurgicalTherapy(48)MedicalTherapy(30)Localresection&patch2Prostheticvesselreplacement3EndovascularStent15Actue(17)Chronica(31)Prostheticvesselreplacement14EndovascularStent14SurgicalTherapy(48)Medic848Localresection&patch00/2Prostheticvesselreplacement32/14EndovascularStent0/140/15EmergencySelectiveAMIBleedingResults:operativemortality

48Localresection&patch9Onestent21Twostents6Results:NooperativedeathComplications:Leak2Threestents1Onestent21Twostents6Re10

Rupture:4/6

Trachea:1Esophagus:1Chest:2Latetermdeath:8Results:MedicalTherapymortality(30)Results:MedicalTherapym11Results:Long-termProstheticvesselreplacement12(1~7years):Hoarse3/5Death2EndovascularStent29

(3mon.~4years):Nocomplications&deathResults:Long-termProsthetic12OneyearafterimplantStentOneyearafterimplantStent13DiscussionDiscussion14Medicalvs

Surgical?TheTimeofSurgery:EmergencyvsSelective?OperativeMethods:ConventionalvsEndo?TheTherapyforTypeBThoracicAorticDissectionMedicalvsSurgical?TheTimeo15COBPTheTherapyforTypeBThoracicAorticDissectionMedicalTherapyVascularDilatorCalciumantagonistß—BlockerCOBPTheTherapyforTypeBMedi16TheComplicationsofSurgeryTraumaAnesthesiaBleedingSpinalinjuryBrainRenalLungsAMITheComplicationsofSurgeryTr17EndovascularGraftMethods

1.Byfemoralartery

2.ByAorticArchEndovascularGraftMeth18TheExcellencesofEndovasculartherapyInvasive&safetherapyReducetheoperativemorbidity&mortalitySaveBloodItisanewandeffectivetherapyTheExcellencesofInvasive19LocalAnatomyConditionAgeImportantOrgansFunctionsTheTherapyforTypeBThoracicAorticDissectionThelengthoftheneckTheShapeofthetrue&falselumenThearterybranchTheperipheralarteriesThegeneralcondition

LocalAnatomyConditionAgeImpo20leakNeckthetrueconditionArteriesbranchTheReasonsoftheleakSurgeon11%~44%11%~44%Prosthetic

leakNeckthetrueconditionAr21DiagnosisMildAngiographyCTPrevent&TreatmentLeak(I)TreatmentSeverere-do-stentSurgicalObservationDiagnosisMildAngiographyCTPre22Prevent&TreatmentLeak(II)PatientsStentsAnatomySurgicalSkillPrevent&TreatmentLeak(II)P23Multiplelaceration&SegmentsHugefalselumenTruelumen:small,neck,cylinderImportanceorgansperfusion?

(bythefalselumen)TheperipheralarteriesLongtermoftheeffects?ChronicTypeBPath-physiologicalMultiplelaceration&Segments24Makingsurediagnosis(ClinicalDiagnosis)TheDiagnosisofAorticDissectionConclusion(I)Complications?(Pathologic&PhysiologicDiagnosis)Thelocation&range(PathologicDiagnosis)MakingsurediagnosisTheDiagn25Multi-expertiseCooperation:Surgeon,Physician、Radiology、AnesthesiaMulti-therapy:Medicinal、Surgical、EndovascularConsideration:

Pathology&physiology(CT,MRI,Angiography)Conclusion(II)Multi-expertiseCooperation:Mu26Conclusion(III)MedicalEndovascularSurgicalSub-acuteBChronicBAcutephase

PostOPFirstchoice?!Conclusion(III)MedicalEndov27Acute

RepeatPainHypertensionDiameterexpandquicklyRuptureMal-perfusionSub-acuteorChronicDiameter>5cmWhthinoneyear>1cmTheTherapyforTypeBThoracicAorticDissectionSurgicalIndicationsAcuteSub-acute28Thanks2005.Nov.BeijingThanks2005.Nov.Beijing29

1、最灵繁的人也看不见自己的背脊。——非洲

2、最困难的事情就是认识自己。——希腊

3、有勇气承担命运这才是英雄好汉。——黑塞

4、与肝胆人共事,无字句处读书。——周恩来

5、阅读使人充实,会谈使人敏捷,写作使人精确。——培根

1、最灵繁的人也看不见自己的背脊。——非洲

2、最困30B型胸主动脉夹层动脉瘤的治疗策略聪明出于勤奋,天才在于积累B型胸主动脉夹层动脉瘤的治疗策略B型胸主动脉夹层动脉瘤的治疗策略聪明出于勤奋,天才在于积累TheTherapeuticStrategyforTypeBThoracicAorticDissectionPeople’sHospital,PekingUniversity北京大学人民医院XieJiyan(解基严),etal,TheTherapyforTypeBThoracicAorticDissectionMedicalSurgicalEndovascularB型胸主动脉夹层动脉瘤的治疗策略聪明出于勤奋,天才在于积累B31B型胸主动脉夹层动脉瘤的治疗策略课件整理32B型胸主动脉夹层动脉瘤的治疗策略课件整理33B型胸主动脉夹层动脉瘤的治疗策略课件整理34B型胸主动脉夹层动脉瘤的治疗策略课件整理35ChestPainHeart\renal\lungSymptoms

(ShortBreath)Pulse:Decreased(60%)BP:NormalorHighSymptoms&SignsChestPainHeart\renal\lungSym36DiagnosisMethodsEchocardiogram(TTE&TEE)CTMRIAngiographyDiagnosisMethodsEchocardiogr37SurgicalTherapy(48)MedicalTherapy(30)Localresection&patch2Prostheticvesselreplacement3EndovascularStent15Actue(17)Chronica(31)Prostheticvesselreplacement14EndovascularStent14SurgicalTherapy(48)Medic3848Localresection&patch00/2Prostheticvesselreplacement32/14EndovascularStent0/140/15EmergencySelectiveAMIBleedingResults:operativemortality

48Localresection&patch39Onestent21Twostents6Results:NooperativedeathComplications:Leak2Threestents1Onestent21Twostents6Re40

Rupture:4/6

Trachea:1Esophagus:1Chest:2Latetermdeath:8Results:MedicalTherapymortality(30)Results:MedicalTherapym41Results:Long-termProstheticvesselreplacement12(1~7years):Hoarse3/5Death2EndovascularStent29

(3mon.~4years):Nocomplications&deathResults:Long-termProsthetic42OneyearafterimplantStentOneyearafterimplantStent43DiscussionDiscussion44Medicalvs

Surgical?TheTimeofSurgery:EmergencyvsSelective?OperativeMethods:ConventionalvsEndo?TheTherapyforTypeBThoracicAorticDissectionMedicalvsSurgical?TheTimeo45COBPTheTherapyforTypeBThoracicAorticDissectionMedicalTherapyVascularDilatorCalciumantagonistß—BlockerCOBPTheTherapyforTypeBMedi46TheComplicationsofSurgeryTraumaAnesthesiaBleedingSpinalinjuryBrainRenalLungsAMITheComplicationsofSurgeryTr47EndovascularGraftMethods

1.Byfemoralartery

2.ByAorticArchEndovascularGraftMeth48TheExcellencesofEndovasculartherapyInvasive&safetherapyReducetheoperativemorbidity&mortalitySaveBloodItisanewandeffectivetherapyTheExcellencesofInvasive49LocalAnatomyConditionAgeImportantOrgansFunctionsTheTherapyforTypeBThoracicAorticDissectionThelengthoftheneckTheShapeofthetrue&falselumenThearterybranchTheperipheralarteriesThegeneralcondition

LocalAnatomyConditionAgeImpo50leakNeckthetrueconditionArteriesbranchTheReasonsoftheleakSurgeon11%~44%11%~44%Prosthetic

leakNeckthetrueconditionAr51DiagnosisMildAngiographyCTPrevent&TreatmentLeak(I)TreatmentSeverere-do-stentSurgicalObservationDiagnosisMildAngiographyCTPre52Prevent&TreatmentLeak(II)PatientsStentsAnatomySurgicalSkillPrevent&TreatmentLeak(II)P53Multiplelaceration&SegmentsHugefalselumenTruelumen:small,neck,cylinderImportanceorgansperfusion?

(bythefalselumen)TheperipheralarteriesLongtermoftheeffects?ChronicTypeBPath-physiologicalMultiplelaceration&Segments54Makingsurediagnosis(ClinicalDiagnosis)TheDiagnosisofAorticDissectionConclusion(I)Complications?(Pathologic&PhysiologicDiagnosis)Thelocation&range(Patho

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