1、慢性胸主动脉夹层动脉瘤 (病例讨论),李 松 奇 中山大学附属第一医院 血管外科 ,病例资料,男 72岁 2006年7月因胸闷及活动后气促于广医一附院检查发现胸主动脉瘤 出院意见为定期复查 暂不予处理 2007年7月中山一院检查发现主动脉夹层动脉瘤无明显胸背部疼痛病史 高血压病史12年 6年前曾有心绞痛发作一次,PROCEDURE,0.035 guidewire from left brachial artery Angiography confirm the position of primary tear Put guidewire to the right femoral artery
2、from the true lumen Put Hunter-head catheter to the aortic arch and angiography again Change the super-stiff guidewire Deployment stent,Metro,Medtronic Talent 40-150,Follow-up data,1 week after TEVAR,Half a year after TEVAR,1 WEEK AFTER TEVAR,HALF A YEAR AFTER TEVAR,comparison,1 WEEK AFTER TEVAR,HAL
3、F A YEAR AFTER TEVAR,1 WEEK AFTER TEVAR,HALF A YEAR AFTER TEVAR,1 WEEK AFTER TEVAR,HALF A YEAR AFTER TEVAR,1 WEEK AFTER TEVAR,HALF A YEAR AFTER TEVAR,讨 论,降主动脉扭曲的处理继发性破口处理的指征及方法,Thanks!,MALPERFUSION MICHIGAN CLASSIFICATION,TREATING MALPERFUSION,DYNAMIC OBSTRUCTIONENDOGRAFT ACROSS INTIMAL TEARSFENESTR
4、ATIONSTATIC OBSTRUCTIONSTENTS FOR UNCOMPLICATED STENOSISWITH MECHANICAL THROMBECTOMY FOR STENOSIS COMPLICATED BY POST-OBSTRUCTIVE THROMBOSIS OF TRUE LUMEN OR EMBOLISM TO TRUE LUMEN,Endografing vs. Fenetration,Stenting for uncomplicated stenosis,Endovascular Treatment (Non-endograft option),Static ob
5、struction: uncovered stents in origin of branchesDynamic obstruction: percutaneous fenestration of the intimal flap,WHAT FENESTRATION DOES,CREATES HOLE IN THE FLAP SEPARATING FALSE AND TRUE LUMENRAISES PRESSURE IN THE TRUE LUMENPROMOTES FLOW IN THE FALSE LUMEN,WHAT FENESTRATION DOES NOT DO,DOES NOT REDUCE PRESSURE IN THE FALSE LUMENDOES NOT “DECOMPRESS” THE FALSE LUMENDOES NOT MODIFY THE RISK OF ACUTE AORTIC RUPTURE IN TYPE A DISSECTIONSDOES NOT REDUCE LONG-TERM ANEURYSMAL DEGENERATION OF THE FALSE LUMEN,
