B型胸主动脉夹层动脉瘤的治疗策略.pptx

《B型胸主动脉夹层动脉瘤的治疗策略.pptx》由会员分享，可在线阅读，更多相关《B型胸主动脉夹层动脉瘤的治疗策略.pptx（27页珍藏版）》请在淘文阁 - 分享文档赚钱的网站上搜索。

1、The Therapy for Type BThoracic Aortic DissectionMedical Surgical Endovascular 第1页/共28页Clinical MaterialMale 74 Famale 4Age:5573y Hypertension:51CAD:4Chronic renal insufficiency:4Diabetes mellitus 419902005Chronic pulmonary occlusion disease:19第2页/共28页78 casesAcute 34Chronic 44Clinical Material第3页/共2

2、8页Chest PainHeartrenallung Symptoms(Short Breath)Pulse:Decreased（60%）BP :Normal or HighSymptoms&Signs第4页/共28页Diagnosis Methods Echocardiogram (TTE&TEE)CTMRIAngiography第5页/共28页Surgical Therapy （48）Medical Therapy （30）Local resection&patch 2Prosthetic vessel replacement 3Endovascular Stent 15Actue （17

3、）Chronica （31）Prosthetic vessel replacement 14Endovascular Stent 14第6页/共28页 48Local resection&patch 0 0/2Prosthetic vessel replacement 3 2/14Endovascular Stent 0/14 0/15Emergency Selective AMI BleedingResults:operative mortality 第7页/共28页One stent 21Two stents 6Results:No operative deathComplications

4、:Leak 2Three stents 1第8页/共28页 Rupture：4/6 Trachea：1 Esophagus：1 Chest：2Late term death：8Results:Medical Therapy mortality（30）第9页/共28页Results:Long-term Prosthetic vessel replacement 12 (17years):Hoarse 3/5 Death 2Endovascular Stent 29 (3mon.4years):No complications&death第10页/共28页One year after implan

5、t Stent第11页/共28页Discussion第12页/共28页Medical vsvs Surgical?The Time of Surgery：Emergency vsvs Selective?Operative Methods：Conventional vsvs Endo?The Therapy for Type BThoracic Aortic Dissection第13页/共28页COBPThe Therapy for Type BThoracic Aortic DissectionMedical TherapyVascular DilatorCalcium antagonis

6、tBlocker第14页/共28页The Complications of SurgeryThe Complications of SurgeryTraumaAnesthesiaBleedingSpinal injuryBrain Renal LungsAMI第15页/共28页Endovascular Graft Endovascular Graft Methods 1.By femoral artery 2.By Aortic Arch第16页/共28页 The Excellences of Endovascular therapyInvasive&safe therapyReduce th

7、e operative morbidity&mortalitySave BloodIt is a new and effective therapy 第17页/共28页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 arte

8、riesThe general conditionThe general condition 第18页/共28页leakleakNeckNeck the true the true conditionconditionArteries Arteries branchbranchThe Reasons of the leakSurgeon11%44%11%44%Prosthetic 第19页/共28页DiagnosisMild AngiographyCTPrevent&Treatment Leak(I)TreatmentSeverere-do-stentSurgicalObservation第2

9、0页/共28页Prevent&Treatment Leak(II)PatientsStentsAnatomy Surgical Skill 第21页/共28页Multiple laceration&Segments Huge false lumen True lumen:small,neck,cylinder Importance organs perfusion?(by the false lumen)The peripheral arteriesLong term of the effects?Chronic Type B Path-physiological 第22页/共28页Makin

10、g sure diagnosis(Clinical Diagnosis)The Diagnosis of Aortic DissectionConclusion(I)Complications?(Pathologic&Physiologic Diagnosis)The location&range(Pathologic Diagnosis)第23页/共28页Multi-expertise CooperationMulti-expertise Cooperation：Surgeon,Physician Surgeon,Physician、Radiology Radiology、Anesthesi

11、aAnesthesiaMulti-therapyMulti-therapy：Medicinal Medicinal、SurgicalSurgical、EndovascularEndovascularConsiderationConsideration：Pathology&physiology Pathology&physiology （CTCT，MRI MRI，Angiography)Angiography)Conclusion (II)第24页/共28页Conclusion(III)Medical EndovascularSurgicalSub-acute BChronic BAcute phase Post OPFirst choice?!第25页/共28页 Acute Repeat PainHypertension Diameter expand quickly RuptureMal-perfusion Sub-acute or ChronicDiameter 5cmWhthin one year 1cmThe Therapy for Type BThoracic Aortic DissectionSurgical Indications第26页/共28页Thanks2005.Nov.Beijing第27页/共28页