B型胸主动脉夹层动脉瘤地治疗策略.ppt

* The Therapeutic Strategy for Type B Thoracic Aortic Dissection People’s Hospital , Peking University 北京大学 人民医院 Xie Jiyan(解基严), et al, The Therapy for Type B Thoracic Aortic Dissection Medical Surgical Endovascular Clinical Material Male 74 Famale 4 Age: 55~73y Hypertension: 51 CAD:4 Chronic renal insufficiency : 4 Diabetes mellitus 4 1990~2005 Chronic pulmonary occlusion disease: 19 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