主动脉疾病-英文讲解材料.pptVIP

Aortic dissection Endovascular stent-grafting Nienaber et al. NEJM 1999, 340; 20:1539. Successful stenting in all 12 patients; Thrombosis of false lumen confirmed after 3 months by MRI. No morbidity/mortality in stented patients. Surgery associated with 4 deaths (p=0.09) and 5 serious adverse events (p=0.04) within 12 months. Aortic dissection Nienaber et al. NEJM 1999, 340; 20:1539. Aortic dissection Endovascular stent-grafting Dake et al. NEJM 1999, 340; 20:1546. Prospective evaluation of stent-graft insertion in patients with acute dissection 19 stented patients (4 type A, 15 type B); dissection involved aortic branches in 14 with symptomatic compromise of multiple branch vessels in 7 Aortic dissection Endovascular stent-grafting Dake et al. NEJM 1999, 340; 20:1546. Stenting was successful in all patients; complete thrombosis of false lumen achieved in 15 patients Revascularization of ischemic branch vessels was successful in 76% of obstructed branches 3 patients died at 30 days. Two patients with type B dissection had rupture of false lumen and died 8 hours and nine days after stent procedure One patient with type B dissection died at seven days as a result of sepsis associated with gut and leg infarction Aortic dissection Recommendations for therapy of chronic aortic dissection Class I Type A (Type I or II) – Surgery if symptoms or aortic regurgitation or aortic diameter 5-6cm Type B (Type III) – Surgery if symptoms or progressive aortic enlargement to ≥6cm Class IIa Type B (Type III) – Endovascular stenting if surgical indication and suitable anatomy Eur Heart J?2001; 22(18):1642-81. Aortic dissection Long-term follow-up BP control Transition to oral beta-blockers and antihypertensives with target BP 120/80. Surveillance imaging Imaging and clinical assessment at 1, 3, 6 and 12 months and then q6-12mo. MRI preferred modality, followed by CT and TEE. Repeat surgery 12-30% require repeat surgery for extension or recurrence, remote aneurysm formation, graft deh