型胸主动脉夹层动脉瘤的治疗策略

The Therapeutic Strategy for Type B Thoracic Aortic Dissection Peoples Hospital , Peking University 北京大学 人民医院 Xie Jiyan(解基严 ), et al, The Therapy for Type B Thoracic Aortic Dissection Medical Surgical Endovascular Clinical Material Male 74 Famale 4 Age: 5573y Hypertension: 51 CAD:4 Chronic renal insufficiency : 4 Diabetes mellitus 4 19902005 Chronic pulmonary occlusion disease: 19 78 cases Acute 34 Chronic 44 Clinical Material Chest Pain Heartrenallung Symptoms (Short Breath) Pulse: Decreased （ 60%） BP : Normal or High Symptoms & Signs Diagnosis Methods Echocardiogram (TTE&TEE) CT MRI Angiography Surgical Therapy （ 48） Medical Therapy （ 30） Local resection & patch 2 Prosthetic vessel replacement 3 Endovascular Stent 15 Actue （ 17 ） Chronica （ 31） Prosthetic vessel replacement 14 Endovascular Stent 14 48 Local resection & patch 0 0/2 Prosthetic vessel replacement 3 2/14 Endovascular Stent 0/14 0/15 Emergency Selective AMI Bleeding Results: operative mortality One stent 21 Two stents 6 Results: No operative death Complications :Leak 2 Three stents 1 Rupture： 4/6 Trachea： 1 Esophagus： 1 Chest ： 2 Late term death： 8 Results: Medical Therapy mortality （ 30） Results: Long-term Prosthetic vessel replacement 12 (17years ): Hoarse 3/5 Death 2 Endovascular Stent 29 (3mon.4years): No complications & death One year after implant Stent Discussion Medical vs Surgical? The Time of Surgery： Emergency vs Selective? Operative Methods： Conventional vs Endo? The Therapy for Type B Thoracic Aortic Dissection CO BP The Therapy for Type B Thoracic Aortic Dissection Medical Therapy Vascular Dilator Calcium antagonist Blocker The Complications of Surgery Trauma Anesthesia Bleeding Spinal injury Brain Renal Lungs AMI Endovascular Graft Methods 1. By femoral artery 2. By Aortic Arch The Excellences of Endovascular therapy Invasive & safe therapy Reduce the operative morbidity & mortality Save Blood It is a new and effective therapy Local Anatomy Condition Age Important Organs Functions The Therapy for Type B Thoracic Aortic Dissection The length of the neck The Shape of the true & false lumen The artery branch The peripheral arteries The general condition leak Neck the true condition Arteries branch The Reasons of the leak Surgeon 11%44% 11%44% Prosthetic Diagnosis Mild Angiography CT Prevent & Treatment Leak (I) Treatment Severe re-do-stent SurgicalObservation Prevent & Treatment Leak (II) Patients Stents Anatomy Surgical Skill Multiple laceration & Segments Huge false lumen True lumen : small , neck , cylinder Importance organs perfusion ? (by the false lumen) The peripheral arteries Long term of the effects? Chronic Type B Path-physiological Making sure diagnosis ( Clinical Diagnosis) The Diagnosis of Aortic Dissection Conclusion ( I ) Complications? (Pathologic & Physiologic Diagnosis) The location & range (Pathologic Diagnosis) Multi-expertise Cooperation： Surgeon, Physician、 Radiology、 Anesthesia Multi-therapy： Medicinal、 Surgical、 Endovascular Consideration： Pathology & physiology （ CT， MRI， Angiography) Conclusion ( II ) Conclusion ( III) Medical Endovascular Surgical Sub-acute B Chronic B Acute phase Post OP First choice ?! Acute Repeat Pain Hypertension Diameter expand quickly R