B型胸主动脉夹层动脉瘤的治疗策略课件.ppt

1、编辑课件Peoples Hospital,Peking University北京大学北京大学 人民医院人民医院Xie Jiyan(解基严解基严),),et al,编辑课件The Therapy for Type BThoracic Aortic DissectionMedical Surgical Endovascular 编辑课件Clinical MaterialMale 74 Famale 4Age:5573y Hypertension:51CAD:4Chronic renal insufficiency:4Diabetes mellitus 419902005Chronic pulmon

2、ary occlusion disease:19编辑课件78 casesAcute 34Chronic 44Clinical Material编辑课件Chest PainHeartrenallung Symptoms(Short Breath)Pulse:Decreased（60%）BP :Normal or HighSymptoms&Signs编辑课件Diagnosis Methods Echocardiogram (TTE&TEE)CTMRIAngiography编辑课件Surgical Therapy （48）Medical Therapy （30）Local resection&pat

3、ch 2Prosthetic vessel replacement 3Endovascular Stent 15Actue （17）Chronica （31）Prosthetic vessel replacement 14Endovascular Stent 14编辑课件 48Local resection&patch 0 0/2Prosthetic vessel replacement 3 2/14Endovascular Stent 0/14 0/15Emergency Selective AMI BleedingResults:operative mortality 编辑课件One st

4、ent 21Two stents 6Results:No operative deathComplications:Leak 2Three stents 1编辑课件 Rupture：4/6 Trachea：1 Esophagus：1 Chest：2Late term death：8Results:Medical Therapy mortality（30）编辑课件Results:Long-term Prosthetic vessel replacement 12 (17years):Hoarse 3/5 Death 2Endovascular Stent 29 (3mon.4years):No

5、complications&death编辑课件One year after implant Stent编辑课件Discussion编辑课件Medical vsvs Surgical?The Time of Surgery：Emergency vsvs Selective?Operative Methods：Conventional vsvs Endo?The Therapy for Type BThoracic Aortic Dissection编辑课件COBPThe Therapy for Type BThoracic Aortic DissectionMedical TherapyVasc

6、ular DilatorCalcium antagonistBlocker编辑课件The Complications of SurgeryThe Complications of SurgeryTraumaAnesthesiaBleedingSpinal injuryBrain Renal LungsAMI编辑课件Endovascular Graft Methods 1.By femoral artery 2.By Aortic Arch编辑课件 The Excellences of Endovascular therapyInvasive&safe therapyReduce the ope

7、rative morbidity&mortalitySave BloodIt is a new and effective therapy 编辑课件Local Anatomy 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 ge

8、neral conditionThe general condition 编辑课件leakleakNeckNeck the true the true conditionconditionArteries Arteries branchbranchThe Reasons of the leakSurgeon11%44%11%44%Prosthetic 编辑课件DiagnosisMild AngiographyCTPrevent&Treatment Leak(I)TreatmentSeverere-do-stentSurgicalObservation编辑课件Prevent&Treatment

9、Leak(II)PatientsStentsAnatomy Surgical Skill 编辑课件Multiple laceration&Segments 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 periphe

10、ral arteriesLong term of the effects?Chronic Type B Path-physiological 编辑课件Making sure diagnosis(Clinical Diagnosis)The Diagnosis of Aortic DissectionConclusion(I)Complications?(Pathologic&Physiologic Diagnosis)The location&range(Pathologic Diagnosis)编辑课件Multi-expertise CooperationMulti-expertise Co

11、operation：Surgeon,PhysicianSurgeon,Physician、RadiologyRadiology、AnesthesiaAnesthesiaMulti-therapyMulti-therapy：MedicinalMedicinal、SurgicalSurgical、EndovascularEndovascularConsiderationConsideration：Pathology&physiology Pathology&physiology （CTCT，MRIMRI，Angiography)Angiography)Conclusion (II)编辑课件Conc

12、lusion(III)Medical EndovascularSurgicalSub-acute BChronic BAcute phase Post OPFirst choice?!编辑课件 Acute Repeat PainHypertension Diameter expand quickly RuptureMal-perfusion Sub-acute or ChronicDiameter 5cmWhthin one year 1cmThe Therapy for Type BThoracic Aortic DissectionSurgical Indications编辑课件Thanks2005.Nov.Beijing