主动脉夹层腔内修复的现状与问题.ppt

N:裸区V：内脏区PennclassificationofischemicpresentationsinacutetypeAaorticdissectionNoischemia(PennclassAa)Localizedischemia(PennclassAb)Generalizedischemia(PennclassAc)Combinedischemia(PennclassAbc)—localizedandgeneralizedischemiatogetherUniversityofPennsylvaniaClassificationofAcuteStanfordType-BAorticDissectionClinicalPresentationDefinitionofClinicalPresentationClassClassA(Uncomplicated)Absenceofbranch-vesselischemiaorcirculatorycompromiseTypeIhighriskforfutureaorticcomplicationsTypeIIlowriskforfutureaorticcomplicationsClassB(Complicated)Branch-vesselmalperfusionClassC(Complicated)CirculatorycompromiseType-Iaorticrupturewithhemorrhageoutsidetheaorticwallwith/withoutcardiacarrest,shock,andhemothoraxType-IIthreatenedaorticrupturetypicallyheraldedbyrefractorypainand/orhypertensionClassBC(Complicated)Branch-vesselmalperfusioncombinedwithcirculatorycompromiseDISSECT:DurationofdissectionIntimaltear(primary)locationwithintheaortaSizeofaortaSegmental?extentofaorticinvolvementfromproximaltodistalboundaryClinicalcomplicationsrelatedtodissectionThrombosisofaorticfalselumenDake,M.D.,Thompson,M.,VanSambeek,M.,etal.,DISSECT:ANewMnemonic-basedApproachtotheCategorizationofAorticDissection.EuropeanJournalofVascularandEndovascularSurgery,2013.46(2):175-190.主动脉弓TEVAR近左锁骨下破口：重建LSALCCA-LSA转流LSA烟囱支架覆盖LSA取得足够的锚定，但仍有截瘫风险开窗开槽单分支支架主动脉弓TEVARLSA烟囱支架BrianJ.Manning,KrassiIvancev,PeterL.Harris，Insitufenestrationintheaorticarch，JournalofVascularSurgeryVolume52,Issue22010491-494开窗、开槽支架分体式整体式单分支支架微创Castor近左颈总破口：杂交技术01RCCA-LCCA/RCCA-LCCA-LSA烟囱技术02LCCA烟囱03LSA和LCCA双烟囱分支支架+LCCA-LSA旁路04主动脉弓TEVAR近无名破口：杂交技术升主动脉-IA-LCCA-LSA旁路烟囱技术IA和LCCA双烟囱三分支支架主动脉弓TEVAR烟囱支架三分支支架InoueKetal.Circulation1999;100:II-316-Ii-321Moon等通过CTA行对162例患者的升主动脉重建和精确测量，从解