主动脉夹层壁间血肿及穿通课件

主动脉夹层、壁间血肿及穿通性溃疡主动脉夹层、壁间血肿1概述急性主动脉综合征:(acuteaorticsyndromes,AAS)临床症状相似、发病急、威胁生命的一组主动脉疾患,发病机理不同,但可合并存在或相互演变。包括主动脉夹层(aorticdissection,AD)主动脉壁内血肿(intramuralaortichematoma,IMH)主动脉穿通性溃疡(penetratingaorticulcer,PAU)动脉瘤破裂创伤性主动脉离断概述2ADIMHPAU主动脉夹层向内破裂向外扩张假/真性动脉瘤或破裂限于中层PAUADIMHPAU3病因和病理生理学■典型AD发病机制中层囊性坏死→内膜撕裂病理学特点内膜撕裂真假“双腔”,存在交通远段同时存在再破口病因:仍不明确高血压(>70%患者)Marfan综合征医源性以及外伤主动脉瓣狭窄等病因和病理生理学4夹层的影像学征象真假双腔部位范围大小内膜片内膜破口假腔内附壁血栓主要分支受累情况急症指征:AI心包积血胸腔积血133,4m缺血00I591夹层的影像学征象5caseCT示升主动脉MH并B型ADcase620.2L假20.2L7夹层破口110例B型AD患者CT显示夹层再破口的数量再破口数012345678910合计例数211166111110夹层破口8急症指征-AIB型AD突发左心功能不全,室性心律失常升主动脉造影示主动脉瓣中等量返流,A型AD,升主动脉近端内膜破口,头臂动脉受累。急症指征-AI9急症指征-胸腔积血急症指征-胸腔积血10主动脉夹层壁间血肿及穿通课件11主动脉夹层壁间血肿及穿通课件12主动脉夹层壁间血肿及穿通课件13主动脉夹层壁间血肿及穿通课件14主动脉夹层壁间血肿及穿通课件15主动脉夹层壁间血肿及穿通课件16主动脉夹层壁间血肿及穿通课件17主动脉夹层壁间血肿及穿通课件18主动脉夹层壁间血肿及穿通课件19主动脉夹层壁间血肿及穿通课件20主动脉夹层壁间血肿及穿通课件21主动脉夹层壁间血肿及穿通课件22主动脉夹层壁间血肿及穿通课件23主动脉夹层壁间血肿及穿通课件24主动脉夹层壁间血肿及穿通课件25主动脉夹层壁间血肿及穿通课件26主动脉夹层壁间血肿及穿通课件27主动脉夹层壁间血肿及穿通课件28主动脉夹层壁间血肿及穿通课件29主动脉夹层壁间血肿及穿通课件30主动脉夹层壁间血肿及穿通课件31主动脉夹层壁间血肿及穿通课件32主动脉夹层壁间血肿及穿通课件33主动脉夹层壁间血肿及穿通课件34主动脉夹层壁间血肿及穿通课件35主动脉夹层壁间血肿及穿通课件36主动脉夹层壁间血肿及穿通课件37主动脉夹层壁间血肿及穿通课件38主动脉夹层壁间血肿及穿通课件39主动脉夹层壁间血肿及穿通课件40主动脉夹层壁间血肿及穿通课件41主动脉夹层壁间血肿及穿通课件42主动脉夹层壁间血肿及穿通课件43主动脉夹层壁间血肿及穿通课件44主动脉夹层壁间血肿及穿通课件45主动脉夹层壁间血肿及穿通课件46主动脉夹层壁间血肿及穿通课件47主动脉夹层壁间血肿及穿通课件48主动脉夹层壁间血肿及穿通课件49主动脉夹层壁间血肿及穿通课件50主动脉夹层壁间血肿及穿通课件51主动脉夹层、壁间血肿及穿通性溃疡主动脉夹层、壁间血肿52概述急性主动脉综合征:(acuteaorticsyndromes,AAS)临床症状相似、发病急、威胁生命的一组主动脉疾患,发病机理不同,但可合并存在或相互演变。包括主动脉夹层(aorticdissection,AD)主动脉壁内血肿(intramuralaortichematoma,IMH)主动脉穿通性溃疡(penetratingaorticulcer,PAU)动脉瘤破裂创伤性主动脉离断概述53ADIMHPAU主动脉夹层向内破裂向外扩张假/真性动脉瘤或破裂限于中层PAUADIMHPAU54病因和病理生理学■典型AD发病机制中层囊性坏死→内膜撕裂病理学特点内膜撕裂真假“双腔”,存在交通远段同时存在再破口病因:仍不明确高血压(>70%患者)Marfan综合征医源性以及外伤主动脉瓣狭窄等病因和病理生理学55夹层的影像学征象真假双腔部位范围大小内膜片内膜破口假腔内附壁血栓主要分支受累情况急症指征:AI心包积血胸腔积血133,4m缺血00I591夹层的影像学征象56caseCT示升主动脉MH并B型ADcase5720.2L假20.2L58夹层破口110例B型AD患者CT显示夹层再破口的数量再破口数012345678910合计例数211166111110夹层破口59急症指征-AIB型AD突发左心功能不全,室性心律失常升主动脉造影示主动脉瓣中等量返流,A型AD,升主动脉近端内膜破口,头臂动脉受累。急症指征-AI60急症指征-胸腔积血急症指征-胸腔积血61主动脉夹层壁间血肿及穿通课件62主动脉夹层壁间血肿及穿通课件63主动脉夹层壁间血肿及穿通课件64主动脉夹层壁间血肿及穿通课件65主动脉夹层壁间血肿及穿通课件66主动脉夹层壁间血肿及穿通课件67主动脉夹层壁间血肿及穿通课件68主动脉夹层壁间血肿及穿通课件69主动脉夹层壁间血肿及穿通课件70主动脉夹层壁间血肿及穿通课件71主动脉夹层壁间血肿及穿通课件72主动脉夹层壁间血肿及穿通课件73主动脉夹层壁间血肿及穿通课件74主动脉夹层壁间血肿及穿通课件75主动脉夹层壁间血肿及穿通课件76主动脉夹层壁间血肿及穿通课件77主动脉夹层壁间血肿及穿通课件78主动脉夹层壁间血肿及穿通课件79主动脉夹层壁间血肿及穿通课件80主动脉夹层壁间血肿及穿通课件81主动脉夹层壁间血肿及穿通课件82主动脉夹层壁间血肿及穿通课件83主动脉夹层壁间血肿及穿通课件84主动脉夹层壁间血肿及穿通课件85主动脉夹层壁间血肿及穿通课件86主动脉夹层壁间血肿及穿通课件87主动脉夹层壁间血肿及穿通课件88主动脉夹层壁间血肿及穿通课件89主动脉夹层壁间血肿及穿通课件90主动脉夹层壁间血肿及穿通课件91主动脉夹层壁间血肿及穿通课件92主动脉夹层壁间血肿及穿通课件93主动脉夹层壁间血肿及穿通课件94