B型胸主動脈夾層動脈瘤的治療策略

1、The Therapy for Type BThoracic Aortic DissectionMedical Surgical Endovascular Clinical MaterialMale 74 Famale 4Age: 5573y Hypertension: 51CAD:4Chronic renal insufficiency : 4Diabetes mellitus 419902005Chronic pulmonary occlusion disease: 1978 casesAcute 34Chronic 44Clinical MaterialChest PainHeartre

2、nallung Symptoms (Short Breath)Pulse: Decreased （60%）BP : Normal or HighSymptoms & SignsDiagnosis Methods Echocardiogram (TTE&TEE)CTMRIAngiographySurgical Therapy （ 48）Medical Therapy （ 30）Local resection & patch 2Prosthetic vessel replacement 3Endovascular Stent 15Actue （17 ）Chronica （3

3、1）Prosthetic vessel replacement 14Endovascular Stent 14 48Local resection & patch 0 0/2Prosthetic vessel replacement 3 2/14Endovascular Stent 0/14 0/15Emergency Selective AMI BleedingResults: operative mortality One stent 21Two stents 6Results: No operative deathComplications :Leak 2Three stents

4、 1 Rupture：4/6 Trachea：1 Esophagus：1 Chest ：2Late term death：8Results: Medical Therapy mortality （ 30）Results: Long-term Prosthetic vessel replacement 12 (17years ): Hoarse 3/5 Death 2Endovascular Stent 29 (3mon.4years): No complications & deathOne year after implant StentDiscussionMedical vsvs

5、Surgical?The Time of Surgery： Emergency vsvs Selective?Operative Methods： Conventional vsvs Endo?The Therapy for Type BThoracic Aortic DissectionCOBPThe Therapy for Type BThoracic Aortic DissectionMedical TherapyVascular DilatorCalcium antagonistBlockerThe Complications of SurgeryThe Complications o

6、f SurgeryTraumaAnesthesiaBleedingSpinal injuryBrain Renal LungsAMIEndovascular Graft Methods 1. By femoral artery 2. By Aortic Arch The Excellences of Endovascular therapyInvasive & safe therapyReduce the operative morbidity & mortalitySave BloodIt is a new and effective therapy Local Anatom

7、y ConditionLocal Anatomy ConditionAgeImportant Organs FunctionsThe Therapy for Type BThoracic Aortic DissectionThe length of the neckThe Shape of the true & false lumen The artery branch The peripheral arteriesThe general conditionThe general condition leakleakNeckNeck the true the true conditio

8、nconditionArteries Arteries branchbranchThe Reasons of the leakSurgeon11%44%11%44%Prosthetic DiagnosisMild AngiographyCTPrevent & Treatment Leak (I)TreatmentSeverere-do-stentSurgicalObservationPrevent & Treatment Leak (II)PatientsStentsAnatomy Surgical Skill Multiple laceration & Segment

9、s Multiple laceration & Segments Huge false lumen Huge false lumen True lumen : small , neck , True lumen : small , neck , cylinder cylinder Importance organs Importance organs perfusion ? (by the false lumen) (by the false lumen)The peripheral arteriesLong term of the effects? Chronic Type B Pa

10、th-physiological Making sure diagnosis( Clinical Diagnosis)The Diagnosis of Aortic DissectionConclusion ( I )Complications?(Pathologic & Physiologic Diagnosis)The location & range(Pathologic Diagnosis)Multi-expertise CooperationMulti-expertise Cooperation： Surgeon, PhysicianSurgeon, Physicia

11、n、 RadiologyRadiology、AnesthesiaAnesthesiaMulti-therapyMulti-therapy： MedicinalMedicinal、SurgicalSurgical、EndovascularEndovascularConsiderationConsideration： Pathology & physiology Pathology & physiology （CTCT， MRIMRI， Angiography)Angiography)Conclusion ( II )Conclusion ( III)Medical Endovas

12、cularSurgicalSub-acute BChronic BAcute phase Post OPFirst choice?! Acute Repeat PainHypertension Diameter expand quickly RuptureMal-perfusion Sub-acute or ChronicDiameter 5cmWhthin one year 1cmThe Therapy for Type BThoracic Aortic DissectionSurgical IndicationsThanks2005.Nov.BeijingDiagnosis Methods

13、 Echocardiogram (TTE&TEE)CTMRIAngiography 48Local resection & patch 0 0/2Prosthetic vessel replacement 3 2/14Endovascular Stent 0/14 0/15Emergency Selective AMI BleedingResults: operative mortality Endovascular Graft Methods 1. By femoral artery 2. By Aortic Arch The Excellences of Endovascu

14、lar therapyInvasive & safe therapyReduce the operative morbidity & mortalitySave BloodIt is a new and effective therapy Multi-expertise CooperationMulti-expertise Cooperation： Surgeon, PhysicianSurgeon, Physician、 RadiologyRadiology、AnesthesiaAnesthesiaMulti-therapyMulti-therapy： MedicinalMedicinal、SurgicalSurgical、EndovascularEndovascularConsiderationConsideration： Pathology & physiology Pathology & physiology （CTCT， MRIMRI， Angiogr