1、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 insuf
2、ficiency : 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
3、,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
4、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：4/6Trachea：1Esophagus：1Chest ：2Late term death：8,Results:,Medical Therapy mortality （ 30）,Results: Long-term,Prosthetic vessel replace
5、ment 12(17years ): Hoarse 3/5Death 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,T
6、he Therapy for Type B Thoracic Aortic Dissection,Medical Therapy,The Complications of Surgery,Trauma,Anesthesia,Bleeding,Spinal injury,Brain Renal Lungs,AMI,Endovascular Graft,Methods1. By femoral artery2. By Aortic Arch,The Excellences of Endovascular therapy,Invasive & safe therapy,Reduce the oper
7、ative 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
8、,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
9、 & 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 ),Com
10、plications? (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 ( II
11、I),Medical,Endovascular,Surgical,Sub-acute BChronic B,Acute phase Post OP,First choice,?!,Acute Repeat Pain Hypertension Diameter expand quickly Rupture Mal-perfusion,Sub-acute or ChronicDiameter 5cmWhthin one year 1cm,The Therapy for Type B Thoracic Aortic Dissection,Surgical Indications,Thanks,2005.Nov.Beijing,
