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第1页/共28页ClinicalMaterialMale74Famale4Age:55~73yHypertension:51CAD:4Chronicrenalinsufficiency:4Diabetesmellitus41990~2005Chronicpulmonaryocclusiondisease:19第2页/共28页78casesAcute34Chronic44ClinicalMaterial第3页/共28页ChestPainHeart\renal\lungSymptoms

(ShortBreath)Pulse:Decreased（60%）BP:NormalorHighSymptoms&Signs第4页/共28页DiagnosisMethodsEchocardiogram(TTE&TEE)CTMRIAngiography第5页/共28页SurgicalTherapy（48）MedicalTherapy（30）Localresection&patch2Prostheticvesselreplacement3EndovascularStent15Actue（17）Chronica（31）Prostheticvesselreplacement14EndovascularStent14第6页/共28页48Localresection&patch00/2Prostheticvesselreplacement32/14EndovascularStent0/140/15EmergencySelectiveAMIBleedingResults:operativemortality

第7页/共28页Onestent21Twostents6Results:NooperativedeathComplications:Leak2Threestents1第8页/共28页

Rupture：4/6

Trachea：1Esophagus：1Chest：2Latetermdeath：8Results:MedicalTherapymortality

（30）第9页/共28页Results:Long-termProstheticvesselreplacement12(1~7years):Hoarse3/5Death2EndovascularStent29

(3mon.~4years):Nocomplications&death第10页/共28页OneyearafterimplantStent第11页/共28页Discussion第12页/共28页Medicalvs

Surgical?TheTimeofSurgery：

EmergencyvsSelective?OperativeMethods：

ConventionalvsEndo?TheTherapyforTypeBThoracicAorticDissection第13页/共28页COBPTheTherapyforTypeBThoracicAorticDissectionMedicalTherapyVascularDilatorCalciumantagonistß—Blocker第14页/共28页TheComplicationsofSurgeryTraumaAnesthesiaBleedingSpinalinjuryBrainRenalLungsAMI第15页/共28页EndovascularGraftMethods

1.Byfemoralartery

2.ByAorticArch第16页/共28页TheExcellencesofEndovasculartherapyInvasive&safetherapyReducetheoperativemorbidity&mortalitySaveBloodItisanewandeffectivetherapy第17页/共28页LocalAnatomyConditionAgeImportantOrgansFunctionsTheTherapyforTypeBThoracicAorticDissectionThelengthoftheneckTheShapeofthetrue&falselumenThearterybranchTheperipheralarteriesThegeneralcondition

第18页/共28页leakNeckthetrueconditionArteriesbranchTheReasonsoftheleakSurgeon11%~44%11%~44%Prosthetic

第19页/共28页DiagnosisMildAngiographyCTPrevent&TreatmentLeak(I)TreatmentSeverere-do-stentSurgicalObservation第20页/共28页Prevent&TreatmentLeak(II)PatientsStentsAnatomySurgicalSkill第21页/共28页Multiplelaceration&SegmentsHugefalselumenTruelumen:small,neck,cylinderImportanceorgansperfusion?

(bythefalselumen)TheperipheralarteriesLongtermoftheeffects?ChronicTypeBPath-physiological第22页/共28页Makingsurediagnosis(ClinicalDiagnosis)TheDiagnosisofAorticDissectionConclusion(I)Complications?(Pathologic&PhysiologicDiagnosis)Thelocation&range(PathologicDiagnosis)第23页/共28页Multi-expertiseCooperation：

Surgeon,Physician、

Radiology、AnesthesiaMulti-therapy：

Medicinal、Surgical、EndovascularConsideration：

Pathology&physiology

（CT，MRI，Angiography)Conclusion(II)第24页/共28页Conclusion(III)MedicalEndovascularSurgicalSub-acuteBChronicBAcutephase

PostOPFirstchoice?!第25页/共28页Acute

RepeatPainHypertensionDiameterexpandquicklyRuptureMal-perf