B型胸主动脉夹层动脉瘤治疗策略方案.ppt

TheTherapeuticStrategyforTypeBThoracicAorticDissection,PeoplesHospital,PekingUniversity北京大学人民医院,XieJiyan(解基严),etal,TheTherapyforTypeBThoracicAorticDissection,Medical,Surgical,Endovascular,ClinicalMaterial,Male74Famale4,Age:5573y,Hypertension:51,CAD:4,Chronicrenalinsufficiency:4,Diabetesmellitus4,19902005,Chronicpulmonaryocclusiondisease:19,78cases,Acute34,Chronic44,ClinicalMaterial,ChestPain,HeartrenallungSymptoms(ShortBreath),Pulse:Decreased（60%）,BP:NormalorHigh,Symptoms&Signs,DiagnosisMethods,Echocardiogram(TTE&TEE),CT,MRI,Angiography,SurgicalTherapy（48）,MedicalTherapy（30）,Localresection&patch2,Prostheticvesselreplacement3,EndovascularStent15,Actue（17）,Chronica（31）,Prostheticvesselreplacement14,EndovascularStent14,48,Localresection&patch00/2,Prostheticvesselreplacement32/14,EndovascularStent0/140/15,EmergencySelective,AMIBleeding,Results:operativemortality,Onestent21,Twostents6,Results:,Nooperativedeath,Complications:Leak2,Threestents1,Rupture：4/6Trachea：1Esophagus：1Chest：2Latetermdeath：8,Results:,MedicalTherapymortality（30）,Results:Long-term,Prostheticvesselreplacement12(17years):Hoarse3/5Death2,EndovascularStent29(3mon.4years):Nocomplications&death,OneyearafterimplantStent,Discussion,MedicalvsSurgical?,TheTimeofSurgery：EmergencyvsSelective?,OperativeMethods：ConventionalvsEndo?,TheTherapyforTypeBThoracicAorticDissection,CO,BP,TheTherapyforTypeBThoracicAorticDissection,MedicalTherapy,TheComplicationsofSurgery,Trauma,Anesthesia,Bleeding,Spinalinjury,BrainRenalLungs,AMI,EndovascularGraft,Methods1.Byfemoralartery2.ByAorticArch,TheExcellencesofEndovasculartherapy,Invasive&safetherapy,Reducetheoperativemorbidity&mortality,SaveBlood,Itisanewandeffectivetherapy,LocalAnatomyCondition,Age,ImportantOrgansFunctions,TheTherapyforTypeBThoracicAorticDissection,Thelengthoftheneck,TheShapeofthetrue&falselumen,Thearterybranch,Theperipheralarteries,Thegeneralcondition,leak,Neck,thetruecondition,Arteriesbranch,TheReasonsoftheleak,Surgeon,11%44%,11%44%,Prosthetic,Diagnosis,Mild,Angiography,CT,Prevent&TreatmentLeak(I),Treatment,Severe,re-do-stentSurgical,Observation,Prevent&TreatmentLeak(II),Patients,Stents,Anatomy,SurgicalSkill,Multiplelaceration&Segments,Hugefalselumen,Truelumen:small,neck,cylinder,Importanceorgansperfusion?(bythefalselumen),Theperipheralarteries,Longtermoftheeffects?,ChronicTypeBPath-physiological,Makingsurediagnosis(ClinicalDiagnosis),TheDiagnosisofAorticDissection,Conclusion(I),Complications?(Pathologic&PhysiologicDiagnosis),Thelocation&range(PathologicDiagnosis),Multi-expertiseCooperation：Surgeon,Physician、Radiology、Anesthesia,Multi-therapy：Medicinal、Surgical、Endovascular,Consideration：Pathology&physiology（CT，MRI，Angiography),Conclusion(II),Conclusion(III),Medical,Endovascular,Surgical,Sub-acuteBChronicB,AcutephasePostOP,Firstchoice,?!,AcuteRepeatPainHypertensionDiameterexpandquicklyRuptu