单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,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,The Therapy for Type B,Thoracic Aortic Dissection,Medical,Surgical,Endovascular,Clinical Material,Male 74 Famale 4,Age:5573y,Hypertension:51,CAD:4,Chronic renal insufficiency:4,Diabetes mellitus 4,19902005,Chronic pulmonary occlusion disease:19,78 cases,Acute 34,Chronic 44,Clinical Material,Chest Pain,Heartrenallung,Symptoms,(Short Breath),Pulse:Decreased 60%,BP :Normal or High,Symptoms&Signs,Diagnosis Methods,Echocardiogram (TTE&TEE),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,(17years):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 neck,The Shape of the true&false lumen,The artery branch,The peripheral arteries,The general condition,leak,Neck,the true condition,Arteries,branch,The Reasons of the leak,Surgeon,11%44%,11%44%,Prosthetic,Diagnosis,Mild,Angiography,CT,Prevent&Treatment Leak(I),Treatment,Severe,re-do-stent,Surgical,Observation,Prevent&Treatment Leak(II),Patients,Stents,Anatomy,Surgical Skill,Multiple laceration&Segments,Huge false lumen,True lumen:small,neck,cylinder,Importance organs,perfusion?,(by the false lumen),The peripheral arteries,Long term of the effects?,Chronic Type B,Path-physiological,Making sure diagnosis,(Clinical Diagnosis),The Diagnosis of Aortic Dissection,Conclusion(I),Complications?,(Pathologic&Physiologic,Diagnosis),The location&range,(Pathologic Diagnosis),Multi-expertise Cooperation：,Surgeon,Physician、,Radiology、Anesthesia,Multi-therapy：,Medicinal、Surgical、Endovascular,Consideration：,Pathology&physiology,CT，MRI，Angiography),Conclusion (II),Conclusion(III),Medical,Endovascular,Surgical,Sub-acute B,Chronic B,Acute phase,Post OP,First,choice,?!,Acute,Repeat Pain,Hypertension,Diameter expand quickly,Rupture,Mal-perfusion,Sub-acute or Chronic,Diameter 5cm,Whthin one year 1cm,The Therapy for Type B,Thoracic Aortic Dissection,Surgical Indications,Thanks,