1、B型胸主动脉夹层动脉型胸主动脉夹层动脉瘤的治疗策略瘤的治疗策略Chest PainHeartrenallung 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 Sten
2、t 15Actue （17）Chronica （31）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:Le
3、ak 2Three stents 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 vsv
4、s 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
5、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 Anatomy ConditionLoc
6、al 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 conditionconditionArteries A
7、rteries 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&Segments Multiple laceration&Segments Huge fals
8、e 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 Path-physiological Making sure diagnosis(Clinical Diagnosis)The
9、Diagnosis of Aortic DissectionConclusion(I)Complications?(Pathologic&Physiologic Diagnosis)The location&range(Pathologic Diagnosis)Multi-expertise CooperationMulti-expertise Cooperation：Surgeon,PhysicianSurgeon,Physician、RadiologyRadiology、AnesthesiaAnesthesiaMulti-therapyMulti-therapy：MedicinalMedi
10、cinal、SurgicalSurgical、EndovascularEndovascularConsiderationConsideration：Pathology&physiology Pathology&physiology （CTCT，MRIMRI，Angiography)Angiography)Conclusion (II)Conclusion(III)Medical EndovascularSurgicalSub-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.Beijing
