Arch Bypass in Hybrid Operation for Aortic Dissection：对主动脉夹层的杂交手术弓旁路.pptVIP

* * * * * * * * * * * * * * Case 3 TEVAR Case 3 Closed hemothorax drainage 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 Case 4 Case 4 BYPASS 颈颈转流+颈锁骨下对端吻合CA-CA bypass + CA-SCA end-end anastomosis Case 4 总结 summary 1.颈部杂交手术可以对瘘口位于主动脉弓的夹层进行TEVAR手术 2.手术并发症发生率相对较低 3.转流方式可以根据患者情况个体化选择 4.防止并发症发生的要点是尽量缩短颈动脉阻断时间 ①Carotid hybrid operations make TEVAR procedure safe and possible for the aortic dissections with arch entries. ②With relatively low complication rate, ③the procedure can be customized for individual patient. ④Key point for complication prevention is to reduce the carotid artery blocking time as much as possible. Thanks for your attention！ 谢 谢！ Dept. of Vascular Surgery, 2nd Teaching Hosp. Harbin Medical University, Harbin, Heilongjiang, China 哈尔滨医科大学附属第二医院 血管外科 * * * * * * * * * * * * * * * * * * * * * * * * 夹层动脉瘤杂交手术弓上分支转流方式探讨Aortic Arch Bypass in Hybrid Operation for Aortic Dissection Aneurysm 哈尔滨医科大学附属第二医院 血管外科 姜维良 WEILIANG JIANG Dept. of Vascular Surgery, 2nd Teaching Hosp. Harbin Medical University, Harbin, Heilongjiang, China 150086 夹层动脉瘤杂交手术弓上分支转流Aortic Dissection Hybrid Operation with Arch Bypass  涉及主动脉弓分支的夹层动脉瘤，通过外科手术改变供血位置，可以创造出腔内修复的条件，使得腔内修复手术可以进行。 Aortic Dissection involving arch braches can be repaired with the assistance of the surgical operations alternating the vessel anatomy and creating optimal settings for endovascular repair. 病例资料 Cases 我科共完成主动脉夹层EVAR 112例 弓上分支转流 6例5.3%（6/112） Totally 112 cases of TEVAR for aortic dissection were performed in our unit, 6 (5.3%)of which with auxiliary arch bypass 病例资料 Cases 转流原因 Cause of bypass 同侧转流 Ipsilateral bypass 对侧转流 Contralateral bypass 弓上分支转位 Arch branch translocation 2 － 左侧优势椎动脉 Left side predominant vertebral artery 2 － 瘘口位于主动脉弓 Arch entry － 1 左颈动脉动脉瘤 Aneurysm on left carotid artery － 1 Total 6 4 2 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 目的：重建左侧优势椎动脉血流 2.对侧转位 颈-颈-锁骨下动脉