贾鑫 主动脉夹层的病理生理与临床转归

B型主动脉夹层病理生理 及临床转归 贾 鑫 解放军总医院血管外科CE C2 01 1 CE C2 01 1 CE C2 01 1 CE C2 01 1 ←1st entry site 2nd/3rd/4th re-entry CE C2 01 1 CE C2 01 1 TEE、IVUS help to understand hemodynamics CE C2 01 1 CE C2 01 1 Acute （＜14d） Rupture Ischemia Chronic （＞14d） Aneurysm CE C2 01 1 CE C2 01 1 Visceral Ischemia CE C2 01 1 CE C2 01 1 Endoscopy CE C2 01 1 CE C2 01 1 Amputation before TEVAR CE C2 01 1 CE C2 01 1 Spinal cord and viseralischemia CE C2 01 1 CE C2 01 1 Stanford A: Immediate surgery Stanford B: BMT: control BP and HR Surgery only for complicated: rupture ischemia Surgery CE C2 01 1 CE C2 01 1 Stanford B: 75% survive acute phase 5y survival 50-70% 10y survival 20-50% Am J Cardiol 2001 Jun 15;87(12):1378-82 Stanford A : mortality 70% in 3d Surgery Indication CE C2 01 1 CE C2 01 1 Natual history • Aneurysm • 5y survival 50-70% • 10y survival 20-50% CE C2 01 1 CE C2 01 1 Endovascular techniques • fenestration before 1994 • Branch PTA before1994 • TEVAR 1994 CE C2 01 1 CE C2 01 1 Perfect TEVAR ≠ Perfect Result CE C2 01 1 CE C2 01 1 CE C2 01 1 CE C2 01 1 Acute （＜14d） Rupture Ischemia Chronic （＞14d） Aneurysm CE C2 01 1 CE C2 01 1 Could TEVAR reverse ischemia? Kidney and limb ischemia CE C2 01 1 CE C2 01 1 Could TEVAR reverse ischemia？ CE C2 01 1 CE C2 01 1 内脏动脉完全由假腔供血是否可以进行腔内修复术？ Could TEVAR worsen ischemia? CE C2 01 1 CE C2 01 1 Changes of viseral blood supply after TEVAR 90% improved； 10% remain unchanged； 0% deteriorated。 <> 2004:22 CE C2 01 1 CE C2 01 1 PressPress TearTear SeverSever CE C2 01 1 CE C2 01 1 Could TEVAR prevent expansionand final rupture? CE C2 01 1 CE C2 01 1 Ideal result：complete heal CE C2 01 1 CE C2 01 1 与病变解剖特点、技术、器材有关 CE C2 01 1 CE C2 01 1 Bad result： no heal and expansion →→ ←← Ø=34mm Ø=49mm →→ ←← Thrombosis→ CE C2 01 1 CE C2 01 1 • Key for a successful TEVAR: Choose the right patient! CE C2 01 1 CE C2 01 1 Entry site CE C2 01 1 CE C2 01 1 Evaluate viseralartery CE C2 01 1 CE C2 01 1 Basic techniques • Pre-OP evaluation lesion, anatomy co-morbidity • During OP track spot vessel SG preparation • Post CE C2 01 1 CE C2 01 1 INDICATION FOR TEVAR Absolute （1）acute complicated （2）chronic, possible rupture Relative （1）acute uncomplicated （2）anatomy;lifeexpectancy Suitable anatomy CE C2 01 1 CE C2 01 1 THANKS Dr. Jiaxin@gmail.com CE C2 01 1 CE C2 01 1