主动脉综合征.ppt

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1、急性主动脉综合征急性主动脉综合征常见症状：胸痛常见症状：胸痛 Stanford A型相当于型相当于Debakey 型和型和型型 Stanford B 型相当于型相当于Debakey 型型 蘑菇样袋状主动脉管腔，边缘向外突起穿透性溃疡穿透性溃疡(PAU)Developed in partnership with the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines,American Association for Thoracic Sur

2、gery,American College of Radiology,American Stroke Association,Society of Cardiovascular Anesthesiologists,Society for Cardiovascular Angiography and Interventions,Society of Interventional Radiology,Society of Thoracic Surgeons,and Society for Vascular Medicine.Endorsed by the North American Societ

3、y for Cardiovascular Imaging.主动脉疾病的治疗选择主动脉疾病的治疗选择 3D-RATech.success rate 356/363(98.1%)No.of stent-graft366Surgical bypass33(9.1%)In-hospital death10(2.8%)Stroke9(2.5%)Paraplegia2(0.6%)Iliac artery injury 1(0.3%)Surgical conversion3(0.8%)Follow-up rate:298/353 (84.4%)Death(24):pneumonia(4),secondary

4、 dissection(2),unknown(18)Survival rate:91.9%2 death(Type B)1 recovered after surgery Stent migration:7(2.4%)Recovered with additional stent-graft Secondary dissection:3(1.0%)本中心经验本中心经验带膜支架植入建议带膜支架植入建议Entity/SubgroupClassificationLevel of EvidencePenetrating ulcer/intramural hematoma AsymptomaticIII

5、C SymptomaticIIaCAcute traumatic IBChronic traumaticIIaCAcute Type B dissection IschemiaIA No ischemiaIIbCSubacute dissectionIIbBChronic dissectionIIbBNote:Table 15 in full-text version of TAD Guidelines.Reprinted from Svensson et al.Expertconsensus document on the treatment of descending thoracic a

6、ortic disease using endovascular stentgrafts.Ann Thorac Surg.2008;85:S1 41.每年每年20例例/百万人群（欧美）百万人群（欧美）每年每年43例例/百万人群百万人群（97-02年台湾）年台湾）如不治疗：如不治疗：35-70%在在48内死亡，内死亡，60-90%一周内死亡一周内死亡 患者资料患者资料临床处理临床处理杂交治疗杂交治疗Tech.success rate 432/440(98.2%)No.of stent-graft443Surgical bypass39(8.86%)In-hospital death10(2.5%

7、)Stroke1 (Minor stroke)Paraplegia2 (0.45%)Iliac injury 12002.12-2010.6 Follow-up rate:341/397 (86.8%)Death(10):pneumonia(1),secondary dissection(2),unknown(7)Survival rate:97.1%(331/341)2 death(DeBakey II)1 recovered after surgery Stent migration:5(1.3%)Recovered with additional stent-graft Secondary dissection:3(0.88%)CT 示：示：B 型型PAU 伴伴 IMHCT示主动脉弓部小溃疡形成示主动脉弓部小溃疡形成1月后月后CT复查示溃疡增大，假性动脉瘤形成复查示溃疡增大，假性动脉瘤形成case2主动脉弓部可见较大蘑菇状溃疡主动脉弓部可见较大蘑菇状溃疡 3.5个月后主动脉弓部溃疡消失，弓部管径增大形成真性动脉瘤个月后主动脉弓部溃疡消失，弓部管径增大形成真性动脉瘤 9.5个月个月后弓部真性动脉瘤进一步增大后弓部真性动脉瘤进一步增大case3