夹层动脉瘤杂交手术弓上分支转流方式探讨.ppt

涉及主动脉弓的夹层动脉瘤杂交手术转流方式探讨Aortic Arch Bypass in Hybrid Operation for Aortic Dissection Aneurysm;主动脉夹层动脉瘤腔内修复术Aortic Dissection Endovascular Anuerysm Repair（EVAR）;主动脉夹层动脉瘤腔内修复术Aortic Dissection Endovascular Anuerysm Repair（EVAR）;主动脉夹层动脉瘤腔内修复术Aortic Dissection Endovascular Anuerysm Repair（EVAR）;夹层动脉瘤杂交手术弓上分支转流Aortic Dissection Hybrid Operation with Arch Bypass ;病例资料 Cases;弓上分支转流方式分类 Type of aortic arch bypass ;1.同侧转位 颈动脉-锁骨下动脉 Ipsilateral bypass: Carotid A.-SCA.;2.对侧转位 颈-颈-锁骨下动脉Contralateral Bypass: CA-CA-SCA;2.对侧转位 颈-颈-锁骨下动脉Contralateral Bypass：CA-CA-SCA;3.升主动脉转流;弓上分支转位病例—同侧转流Case 1: arch branch translocation (Ipsilateral bypass);;;;;;锁骨下动脉-颈动脉转流前后对比Effect of Bypass;TEVAR手术后After TEVAR;锁骨下动脉-颈动脉 对端吻合(SCA-CA: end-to-end)右位主动脉弓夹层动脉瘤Case 2: aortic dissection with right sided aortic arch ;瘘口位于弓顶，食道受压，进食困难。 ;双侧锁骨下动脉发自降主动脉 双侧颈动脉起自升主动脉 Bilateral SCA arise from descending aorta, bilateral carotid A. from ascending aorta. ;锁骨下动脉-颈动脉同侧转流 Ipsilateral Bypass from SCA to CA ;Angiography of After EVAR;术后1个月复查CTA;对侧转位 颈-颈-锁骨下动脉转流Contralateral bypass：Carotid - Carotid – SCA.;瘘口位于主动脉弓病例Case 3： entry on the arch;降主动脉多发瘘口 左侧血胸Multiple entry on descending aorta with left side hemothorax;弓上瘘口位置Entry on the arch;瘘口位于颈动脉开口附近Entry near Left Carotid Artery;;颈-颈动脉转流+左颈锁骨下动脉侧侧吻合CA-CA bypass+L. CA-SCA side-side anastomosis;;;主动脉夹层伴左侧颈动脉受累病例Case 4: aortic dissection with left carotid artery involvement;瘘口位置 entry position;;颈颈转流+颈锁骨下对端吻合CA-CA bypass + CA-SCA end-end anastomosis;总结 summary;Thanks for your attention！