Arch-Bypass-in-Hybrid-Operation-for-Aortic-Dissection：对主动脉夹层的杂交手术弓旁路课件

夹层动脉瘤杂交手术

弓上分支转流方式探讨

AorticArchBypass

inHybridOperationforAorticDissectionAneurysm哈尔滨医科大学附属第二医院血管外科姜维良WEILIANGJIANGDept.ofVascularSurgery,2ndTeachingHosp.HarbinMedicalUniversity,Harbin,Heilongjiang,China150086夹层动脉瘤杂交手术

弓上分支转流方式探讨

AorticAr夹层动脉瘤杂交手术弓上分支转流

AorticDissectionHybridOperationwithArchBypass

涉及主动脉弓分支的夹层动脉瘤，通过外科手术改变供血位置，可以创造出腔内修复的条件，使得腔内修复手术可以进行。

AorticDissectioninvolvingarchbrachescanberepairedwiththeassistanceofthesurgicaloperationsalternatingthevesselanatomyandcreatingoptimalsettingsforendovascularrepair.夹层动脉瘤杂交手术弓上分支转流

AorticDissect病例资料Cases我科共完成主动脉夹层EVAR112例弓上分支转流6例5.3%（6/112）Totally112casesofTEVARforaorticdissectionwereperformedinourunit,6(5.3%)ofwhichwithauxiliaryarchbypass病例资料Cases我科共完成主动脉夹层EVAR112例病例资料 Cases

转流原因Causeofbypass

同侧转流

Ipsilateralbypass

对侧转流Contralateralbypass弓上分支转位Archbranchtranslocation2－左侧优势椎动脉Leftsidepredominantvertebralartery2－

瘘口位于主动脉弓Archentry－1左颈动脉动脉瘤Aneurysmonleftcarotidartery－1Total642病例资料 Cases转流原因同侧转流对弓上分支转流方式分类

Typeofaorticarchbypass1.同侧转位颈动脉-锁骨下动脉目的：重建左侧优势椎动脉血流2.对侧转位颈-颈-锁骨下动脉目的：重建左颈动脉\左锁骨下动脉3.升主动脉转流

目的：重建弓上血运1.Ipsilateral：CarotidA.-SCA.

aim：toreconstructthedominantvertebralA.2.Contralateral：

Carotid-Carotid–SCA.

aim：toreconstructLCA.\L.SCA.3.Bypassofarch:

aim：toreconstructthearchbranches

弓上分支转流方式分类

Typeofaorticarc1.同侧转位颈动脉-锁骨下动脉

Ipsilateralbypass:CarotidA.-SCA.1.锁骨下动脉-颈动脉端侧吻合（SCA-CA:end-to-side）2.颈动脉-锁骨下动脉人造血管转流（CA-SCA:artificialgraftbypass）1.同侧转位颈动脉-锁骨下动脉

Ipsilatera2.对侧转位颈-颈-锁骨下动脉

ContralateralBypass:CA-CA-SCA合理的重建方法—尽量缩短颈动脉阻断时间Idealmethodsshouldshortenthecarotidblockingtime2.对侧转位颈-颈-锁骨下动脉

Contralater2.对侧转位颈-颈-锁骨下动脉

ContralateralBypass：CA-CA-SCA可能延长颈动脉阻断时间的重建方式Stylesthatmayprolongblockingtimeofcarotidartery.2.对侧转位颈-颈-锁骨下动脉

Contralater3.升主动脉转流3.Bypassinvolvingascendingaorta3.升主动脉转流3.Bypassinvolvingas弓上分支转位病例—同侧转流

Case1:archbranchtranslocation(Ipsilateralbypass)

弓上分支转位病例—同侧转流

Case1:archbraBYPASSCase1BYPASSCase1BYPASSCase1BYPASSCase1BYPASSCase1BYPASSCase1BYPASSCase1BYPASSCase1BYPASSCase1BYPASSCase1锁骨下动脉-颈动脉转流前后对比

EffectofBypass←转流前BeforeBypass转流后→AfterBypass锁骨下动脉-颈动脉转流前后对比

EffectofBypaTEVAR手术后

AfterTEVARCase1TEVAR手术后

AfterTEVARCase1锁骨下动脉-颈动脉对端吻合(SCA-CA:end-to-end)

右位主动脉弓夹层动脉瘤

Case2:aorticdissectionwithrightsidedaorticarch锁骨下动脉-颈动脉对端吻合(SCA-CA:end-to-瘘口位于弓顶，食道受压，进食困难。Entryatthetopofthearch,esophaguscompressedanddysphasiadevelopedCase2瘘口位于弓顶，食道受压，进食困难。Entryatthe双侧锁骨下动脉发自降主动脉双侧颈动脉起自升主动脉BilateralSCAarisefromdescendingaorta,bilateralcarotidA.fromascendingaorta.Case2双侧锁骨下动脉发自降主动脉Case2锁骨下动脉-颈动脉同侧转流IpsilateralBypassfromSCAtoCACase2锁骨下动脉-颈动脉同侧转流Case2AngiographyofAfterEVARCase2AngiographyofAfterEVARCase术后1个月复查CTA术后CTACTAFollow-up@1mafterTEVARCase2术后1个月复查CTA术后CTACTAFollow-up对侧转位颈-颈-锁骨下动脉转流

Contralateralbypass：Carotid-Carotid–SCA.颈-颈-锁骨下动脉人造血管转流Carotid-Carotid–SCA：Artificialgraftbypass对侧转位颈-颈-锁骨下动脉转流

Contralater瘘口位于主动脉弓病例

Case3：entryonthearch瘘口位于主动脉弓病例

Case3：entryonth降主动脉多发瘘口左侧血胸

Multipleentryondescendingaorta

withleftsidehemothoraxCase3降主动脉多发瘘口左侧血胸

Multipleentry弓上瘘口位置

EntryonthearchCase3弓上瘘口位置

EntryonthearchCase3瘘口位于颈动脉开口附近

EntrynearLeftCarotidArteryCase3瘘口位于颈动脉开口附近

EntrynearLeftCaCase3BYPASSCase3BYPASS颈-颈动脉转流+左颈锁骨下动脉侧侧吻合

CA-CAbypass+L.CA-SCAside-sideanastomosis

颈-颈动脉转流+左颈锁骨下动脉侧侧吻合

CA-CAbypaCase3TEVARCase3TEVARCase3ClosedhemothoraxdrainageCase3Closedhemothoraxdraina主动脉夹层伴左侧颈动脉受累病例

Case4:aorticdissectionwithleftcarotidarteryinvolvement主动脉夹层伴左侧颈动脉受累病例

Case4:aortic瘘口位置

entrypositionCase4瘘口位置

entrypositionCase4Case4BYPASSCase4BYPASS颈颈转流+颈锁骨下对端吻合

CA-CAbypass+CA-SCAend-endanastomosis

Case4颈颈转流+颈锁骨下对端吻合

CA-CAbypass+C总结 summary1.颈部杂交手术可以对瘘口位于主动脉弓的夹层进行TEVAR手术2.手术并发症发生率相对较低3.转流方式可以根据患者情况个体化选择4.防止并发症发生的要点是尽量缩短颈动脉阻断时间

①CarotidhybridoperationsmakeTEVARproceduresafeandpossiblefortheaorticdissectionswitharchentries.②Withrelativelylowcomplicationrate,③theprocedurecanbecustomizedforindividualpatient.④Keypointforcomplicationpreventionistoreducethecarotidarteryblockingtimeasmuchaspossible.总结 summary1.颈部杂交手术可以对瘘口位于主动脉弓Thanksforyourattention！谢

谢！Dept.ofVascularSurgery,2ndTeachingHosp.HarbinMedicalUniversity,Harbin,Heilongjiang,China哈尔滨医科大学附属第二医院血管外科Thanksforyourattention！谢 谢夹层动脉瘤杂交手术

弓上分支转流方式探讨

AorticArchBypass

inHybridOperationforAorticDissectionAneurysm哈尔滨医科大学附属第二医院血管外科姜维良WEILIANGJIANGDept.ofVascularSurgery,2ndTeachingHosp.HarbinMedicalUniversity,Harbin,Heilongjiang,China150086夹层动脉瘤杂交手术

弓上分支转流方式探讨

AorticAr夹层动脉瘤杂交手术弓上分支转流

AorticDissectionHybridOperationwithArchBypass

涉及主动脉弓分支的夹层动脉瘤，通过外科手术改变供血位置，可以创造出腔内修复的条件，使得腔内修复手术可以进行。

AorticDissectioninvolvingarchbrachescanberepairedwiththeassistanceofthesurgicaloperationsalternatingthevesselanatomyandcreatingoptimalsettingsforendovascularrepair.夹层动脉瘤杂交手术弓上分支转流

AorticDissect病例资料Cases我科共完成主动脉夹层EVAR112例弓上分支转流6例5.3%（6/112）Totally112casesofTEVARforaorticdissectionwereperformedinourunit,6(5.3%)ofwhichwithauxiliaryarchbypass病例资料Cases我科共完成主动脉夹层EVAR112例病例资料 Cases

转流原因Causeofbypass

同侧转流

Ipsilateralbypass

对侧转流Contralateralbypass弓上分支转位Archbranchtranslocation2－左侧优势椎动脉Leftsidepredominantvertebralartery2－

瘘口位于主动脉弓Archentry－1左颈动脉动脉瘤Aneurysmonleftcarotidartery－1Total642病例资料 Cases转流原因同侧转流对弓上分支转流方式分类

Typeofaorticarchbypass1.同侧转位颈动脉-锁骨下动脉目的：重建左侧优势椎动脉血流2.对侧转位颈-颈-锁骨下动脉目的：重建左颈动脉\左锁骨下动脉3.升主动脉转流

目的：重建弓上血运1.Ipsilateral：CarotidA.-SCA.

aim：toreconstructthedominantvertebralA.2.Contralateral：

Carotid-Carotid–SCA.

aim：toreconstructLCA.\L.SCA.3.Bypassofarch:

aim：toreconstructthearchbranches

弓上分支转流方式分类

Typeofaorticarc1.同侧转位颈动脉-锁骨下动脉

Ipsilateralbypass:CarotidA.-SCA.1.锁骨下动脉-颈动脉端侧吻合（SCA-CA:end-to-side）2.颈动脉-锁骨下动脉人造血管转流（CA-SCA:artificialgraftbypass）1.同侧转位颈动脉-锁骨下动脉

Ipsilatera2.对侧转位颈-颈-锁骨下动脉

ContralateralBypass:CA-CA-SCA合理的重建方法—尽量缩短颈动脉阻断时间Idealmethodsshouldshortenthecarotidblockingtime2.对侧转位颈-颈-锁骨下动脉

Contralater2.对侧转位颈-颈-锁骨下动脉

ContralateralBypass：CA-CA-SCA可能延长颈动脉阻断时间的重建方式Stylesthatmayprolongblockingtimeofcarotidartery.2.对侧转位颈-颈-锁骨下动脉

Contralater3.升主动脉转流3.Bypassinvolvingascendingaorta3.升主动脉转流3.Bypassinvolvingas弓上分支转位病例—同侧转流

Case1:archbranchtranslocation(Ipsilateralbypass)

弓上分支转位病例—同侧转流

Case1:archbraBYPASSCase1BYPASSCase1BYPASSCase1BYPASSCase1BYPASSCase1BYPASSCase1BYPASSCase1BYPASSCase1BYPASSCase1BYPASSCase1锁骨下动脉-颈动脉转流前后对比

EffectofBypass←转流前BeforeBypass转流后→AfterBypass锁骨下动脉-颈动脉转流前后对比

EffectofBypaTEVAR手术后

AfterTEVARCase1TEVAR手术后

AfterTEVARCase1锁骨下动脉-颈动脉对端吻合(SCA-CA:end-to-end)

右位主动脉弓夹层动脉瘤

Case2:aorticdissectionwithrightsidedaorticarch锁骨下动脉-颈动脉对端吻合(SCA-CA:end-to-瘘口位于弓顶，食道受压，进食困难。Entryatthetopofthearch,esophaguscompressedanddysphasiadevelopedCase2瘘口位于弓顶，食道受压，进食困难。Entryatthe双侧锁骨下动脉发自降主动脉双侧颈动脉起自升主动脉BilateralSCAarisefromdescendingaorta,bilateralcarotidA.fromascendingaorta.Case2双侧锁骨下动脉发自降主动脉Case2锁骨下动脉-颈动脉同侧转流IpsilateralBypassfromSCAtoCACase2锁骨下动脉-颈动脉同侧转流Case2AngiographyofAfterEVARCase2AngiographyofAfterEVARCase术后1个月复查CTA术后CTACTAFollow-up@1mafterTEVARCase2术后1个月复查CTA术后CTACTAFollow-up对侧转位颈-颈-锁骨下动脉转流

Contralateralbypass：Carotid-Carotid–SCA.颈-颈-锁骨下动脉人造血管转流Carotid-Carotid–SCA：Artificialgraftbypass对侧转位颈-颈-锁骨下动脉转流

Contralater瘘口位于主动脉弓病例

Case3：entryonthearch瘘口位于主动脉弓病例

Case3：entryonth降主动脉多发瘘口左侧血胸

Multipleentryondescendingaorta

withleftsidehemothoraxCase3降主动脉多发瘘口左侧血胸

Multipleentry弓上瘘口位置

EntryonthearchCase3弓上瘘口位置

EntryonthearchCase3瘘口位于颈动脉开口附近

EntrynearLeftCarotidArteryCase3瘘口位于颈动脉开口附近

EntrynearLeftCaCase3BYPASSCase3BYPASS颈-颈动脉转流+左颈锁骨下动脉侧侧吻合

CA-CAbypass+L.CA-SCAside-sideanastomosis

颈-颈动脉转流+左颈锁骨下动脉侧侧吻合

CA-CAbypaCase3TEVARCase3TEVARCase3Closedhemothoraxdrain