腔内介入治疗腹主动脉瘤__培训课件.ppt

* * Arteries are composed of three layers: ADVENTITIA The outer layer of the artery Composed primarily of connective tissue and elastic fibers Provides elastic and structural strength to the artery MEDIA The middle layer of the artery Composed of smooth muscle tissue Provides strength to the artery by allowing constriction/dilation. Weakening of this layer usually results in an aneurysm. Receives blood supply by diffusion and is innervated by the sympathetic nervous system. INTIMA The innermost arterial layer Paper-thin and composed primarily of endothelial cells Provides a smooth, thrombi-resistant surface and is nourished by the blood flowing through the artery. It is easily damaged by guidewires, catheters or plaque. Atherosclerosis is a disease caused by thickening of the intima. * Explain which type the patient has; note that saccular aneurysms will most likely need to be treated ASAP, regardless of the size. * The first endovascular AAA repair was reported by Dr. Parodi in 1991. We have come a very long way since that initial report. Mortality after endovascular aneurysm repair is approximately 1 to 2 percent, or approximately 1 / 3 that of open surgical repair. For ruptured aneurysms we have made some progress, but clearly not enough: The mortality rate continues to be fairly high at 15-20 percent. The risk of complications, including minor and major types, is 20-30 percent. The risk of lifetime secondary interventions is 10-15 percent. * LOGO 腹主动脉瘤 金昌 Abdominal aortic aneurysm, AAA Ref. Principles of Human Anatomy Third Edition by Gerard J. Tortora 动脉解剖 右肾动脉 左肾动脉 髂总动脉 肝固有动脉 肠系膜上动脉 肠系膜下动脉 腹腔干 Arterial Anatomy动脉解剖 Copyright 1989. Novartis. Reprinted with permission from the Atlas of Human Anatomy, illustrated by Frank H. Netter, M.D. All rights reserved. 腹主动脉瘤定义 定义： 腹主动脉管壁 永久性局限性扩张 直径正常50％ 病理生理 炎症：白细胞 细胞因子 自身抗原 蛋白水解酶：MMP-2，MMP-9 uPA，tPA 生物力学应力：弹性蛋白分布 血流湍流