b型胸主动脉夹层动脉瘤的治疗策略.ppt

The Therapeutic Strategy for Type B Thoracic Aortic Dissection Peoples Hospital , Peking University 北京大学 人民医院 Xie Jiyan ( 解基严 ), et al, 78 cases Acute 34 Chronic 44 Clinical Material Chest Pain Heart\renal\lung Symptoms (Short Breath) Pulse: Decreased （ 60% ） BP : Normal or High Symptoms Signs Diagnosis Methods Echocardiogram (TTETEE) CT MRI Angiography Surgical Therapy （ 48 ） Medical Therapy （ 30 ） Local resection patch 2 Prosthetic vessel replacement 3 Endovascular Stent 15 Actue （ 17 ） Chronica （ 31 ） Prosthetic vessel replacement 14 Endovascular Stent 14 48 Local resection patch 0 0/2 Prosthetic vessel replacement 3 2/14 Endovascular Stent 0/14 0/15 Emergency Selective AMI Bleeding Results: operative mortality One stent 21 Two stents 6 Results: No operative death Complications :Leak 2 Three stents 1 Rupture ： 4/6 Trachea ： 1 Esophagus ： 1 Chest ： 2 Late term death ： 8 Results: Medical Therapy mortality （ 30 ） Results: Long-term Prosthetic vessel replacement 12 (1~7years ): Hoarse 3/5 Death 2 Endovascular Stent 29 (3mon.~4years): 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 B Thoracic Aortic Dissection CO BP The Therapy for Type B Thoracic Aortic Dissection Medical Therapy Vascular Dilator Calcium antagonist ? — Blocker The Complications of Surgery Trauma Anesthesia Bleeding Spinal injury Brain Renal Lungs AMI Endovascular 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 It is a new and effective therapy Local Anatomy Condition Age Important Organs Functions The Therapy for Type B Thoracic Aortic Dissection The length of the