b型胸主動脈夾層動脈瘤的治療策略

1、The Therapy for Type BThoracic Aortic Dissection,Medical,Surgical,Endovascular,,,,Clinical Material,Male 74 Famale 4,Age: 55~73y,Hypertension: 51,CAD:4,Chronic renal insufficiency : 4,Diabetes melli

2、tus 4,1990~2005,Chronic pulmonary occlusion disease: 19,,78 cases,Acute 34,Chronic 44,Clinical Material,Chest Pain,Heart\renal\lung Symptoms (Short Breath),,Pulse: Decreased （60%）,BP : Normal or High,Symptoms &

3、amp; Signs,Diagnosis Methods,Echocardiogram (TTE&TEE),CT,MRI,Angiography,,Surgical Therapy （ 48）,Medical Therapy （ 30）,,,Local resection & patch 2,Prosthetic vessel replacement 3,Endovascul

4、ar Stent 15,Actue （17 ）,Chronica （31）,Prosthetic vessel replacement 14,Endovascular Stent 14,48,Local resection & patch 0 0/2,Prosthetic vessel replacem

5、ent 3 2/14,Endovascular Stent 0/14 0/15,Emergency Selective,AMI Bleeding,,,,,Results: operative mortality,One stent 21,Two stents 6,Results:,No

6、 operative death,Complications :Leak 2,Three stents 1,,Rupture：4/6 Trachea：1 Esophagus：1 Chest ：2Late term death：8,,,Results:,Medical Therapy mortality （ 30）,,,Results: Long-term,Prosthetic

7、vessel replacement 12 (1~7years ): Hoarse 3/5 Death 2,Endovascular Stent 29 (3mon.~4years):

8、 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 BT

9、horacic Aortic Dissection,CO,BP,The Therapy for Type BThoracic Aortic Dissection,Medical Therapy,,,,,,,,,The Complications of Surgery,Trauma,Anesthesia,Bleeding,Spinal injury,Brain Renal Lungs,,,,,,,,AMI,Endovascular

10、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

11、,It is a new and effective therapy,,,,,Local Anatomy Condition,Age,Important Organs Functions,The Therapy for Type BThoracic Aortic Dissection,The length of the neck,The Shape of the true & false lumen,The artery b

12、ranch,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

13、Leak (I),Treatment,Severe,re-do-stentSurgical,Observation,,,Prevent & Treatment Leak (II),,,,,,Patients,Stents,Anatomy,Surgical Skill,Multiple laceration & Segments,Huge false lumen,True lumen : small , neck ,

14、 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 Diagnos

15、is),The Diagnosis of Aortic Dissection,Conclusion ( I ),Complications?(Pathologic & Physiologic Diagnosis),The location & range(Pathologic Diagnosis),Multi-expertise Cooperation： Surgeon, Physician、

16、 Radiology、Anesthesia,Multi-therapy： Medicinal、Surgical、Endovascular,Consideration： Pathology & physiology （CT， MRI， Angiography),Conclusion ( II ),,Conclusion ( III),Med

17、ical,Endovascular,Surgical,Sub-acute BChronic B,Acute phase Post OP,,,,,,,,First choice,?!,Acute Repeat PainHypertension Diameter expand quickly RuptureMal-perfusion,Sub-acute or ChronicDiamet