型胸主动脉夹层动脉瘤的治疗策略

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1、TheTherapeuticStrategyforTypeBThoracicAorticDissectionPeople’sHospital,PekingUniversity北京大学人民医院XieJiyan(解基严),etal,TheTherapyforTypeBThoracicAorticDissectionMedicalSurgicalEndovascularClinicalMaterialMale74Famale4Age:55~73yHypertension:51CAD:4Chronicrenalinsufficiency:4Diabetesmell

2、itus41990~2005Chronicpulmonaryocclusiondisease:1978casesAcute34Chronic44ClinicalMaterialChestPainHeartrenallungSymptoms(ShortBreath)Pulse:Decreased（60%）BP:NormalorHighSymptoms&SignsDiagnosisMethodsEchocardiogram(TTE&TEE)CTMRIAngiographySurgicalTherapy（48）MedicalTherapy（30）Localr

3、esection&patch2Prostheticvesselreplacement3EndovascularStent15Actue（17）Chronica（31）Prostheticvesselreplacement14EndovascularStent1448Localresection&patch00/2Prostheticvesselreplacement32/14EndovascularStent0/140/15EmergencySelectiveAMIBleedingResults:operativemortalityOnestent21Tw

4、ostents6Results:NooperativedeathComplications:Leak2Threestents1Rupture：4/6Trachea：1Esophagus：1Chest：2Latetermdeath：8Results:MedicalTherapymortality（30）Results:Long-termProstheticvesselreplacement12(1~7years):Hoarse3/5Death2EndovascularStent29(3mon.~4years):Nocomplications&deathOne

5、yearafterimplantStentDiscussionMedicalvsSurgical?TheTimeofSurgery：EmergencyvsSelective?OperativeMethods：ConventionalvsEndo?TheTherapyforTypeBThoracicAorticDissectionCOBPTheTherapyforTypeBThoracicAorticDissectionMedicalTherapyVascularDilatorCalciumantagonistß—BlockerTheComplication

6、sofSurgeryTraumaAnesthesiaBleedingSpinalinjuryBrainRenalLungsAMIEndovascularGraftMethods1.Byfemoralartery2.ByAorticArchTheExcellencesofEndovasculartherapyInvasive&safetherapyReducetheoperativemorbidity&mortalitySaveBloodItisanewandeffectivetherapyLocalAnatomyConditionAgeImportantO

7、rgansFunctionsTheTherapyforTypeBThoracicAorticDissectionThelengthoftheneckTheShapeofthetrue&falselumenThearterybranchTheperipheralarteriesThegeneralconditionleakNeckthetrueconditionArteriesbranchTheReasonsoftheleakSurgeon11%~44%11%~44%ProstheticDiagnosisMildAngiographyCTPrevent&Tr

8、eatmentLeak(I)TreatmentSeverere-d