主動脈綜合征

1、急性主動脈綜合征急性主動脈綜合征常見癥狀：胸痛常見癥狀：胸痛 stanford a型相當于型相當于debakey 型和型和型型 stanford b 型相當于型相當于debakey 型型 蘑菇樣袋狀主動脈管腔，邊緣向外突起穿透性潰瘍穿透性潰瘍(pau)developed in partnership with the american college of cardiology foundation/american heart association task force on practice guidelines, american association for thoracic su

2、rgery, american college of radiology, american stroke association, society of cardiovascular anesthesiologists, society for cardiovascular angiography and interventions, society of interventional radiology, society of thoracic surgeons, and society for vascular medicine. endorsed by the north americ

3、an society for cardiovascular imaging.主動脈疾病的治療選擇主動脈疾病的治療選擇 3d-ratech. success rate 356/363 (98.1%) no. of stent-graft366surgical bypass33 (9.1%) in-hospital death10 (2.8%) stroke9 (2.5%) paraplegia2 (0.6%) iliac artery injury 1 (0.3%) surgical conversion3 (0.8%) follow-up rate: 298/353 (84.4%)death

4、(24): pneumonia (4), secondary dissection (2), unknown (18) survival rate: 91.9% 2 death (type b ) 1 recovered after surgery stent migration: 7 (2.4%) recovered with additional stent-graft secondary dissection: 3 (1.0%) 本中心經(jīng)驗本中心經(jīng)驗帶膜支架植入建議帶膜支架植入建議entity/subgroupclassificationlevel of evidencepenetrat

5、ing ulcer/intramural hematoma asymptomaticiiic symptomaticiiacacute traumatic ibchronic traumaticiiacacute type b dissection ischemiaia no ischemiaiibcsubacute dissectioniibbchronic dissectioniibbnote: table 15 in full-text version of tad guidelines. reprinted from svensson et al. expertconsensus do

6、cument on the treatment of descending thoracic aortic disease using endovascular stentgrafts. ann thorac surg. 2008;85:s1 41. 每年每年20例例/百萬人群（歐美）百萬人群（歐美） 每年每年43例例/百萬人群百萬人群 （97-02年臺灣）年臺灣） 如不治療：如不治療：35-70% 在在48內(nèi)死亡，內(nèi)死亡，60-90% 一周內(nèi)死亡一周內(nèi)死亡 患者資料患者資料臨床處理臨床處理雜交治療雜交治療tech. success rate 432/440 (98.2%)no. of ste

7、nt-graft443surgical bypass39 (8.86%)in-hospital death10 (2.5%)stroke1 (minor stroke)paraplegia2 (0.45%)iliac injury 12002.12 - 2010.6 follow-up rate: 341/397 (86.8%)death (10): pneumonia (1),secondary dissection (2), unknown (7) survival rate: 97.1% (331/341) 2 death (debakey ii ) 1 recovered after surgery stent migration: 5 (1.3%) recovered with additional stent-graft secondary dissection: 3 (0.88%) ct 示：示：b 型型pau 伴伴 imhct示主動脈弓部小潰瘍形成示主動脈弓部小潰瘍形成1月后月后ct復查示潰瘍增大，假性動脈瘤形成復查示潰瘍增大，假性動脈瘤形成case2主動脈