主动脉夹层腔内修复的现状与问题讲解学习

N: 裸区 V：内脏区
Institute of Vascular Surgery Fudan University
Vascular Surgery Zhongshan Hospital
Penn classification of ischemic presentations in acute type A aortic dissection
Type-II threatened aortic rupture typically heralded by refractory pain and/or hypertension
Clinical Presentation
Definition of Clinical Presentation Class
Class A
Absence of branch-vessel ischemia or circulatory compromise
(Uncomplicated) Type I high risk for future aortic complications
Type II low risk for future aortic complications
Class B (Complicated)
Branch-vessel malperfusion
Class C (Complicated)
Circulatory compromise
Type-I aortic rupture with hemorrhage outside the aortic wall with/without cardiac arrest, shock, and hemothorax
• 内漏及逆撕等仍是需要继续攻克的难题。
Institute of Vascular Surgery Fudan University
Vascular Surgery ZhongshLeabharlann n Hospital临床分期
既往：急性期：发病14d内 慢性期：发病14d后
目前提出亚急性期，但定义不一： INSTEAD ：2w-6w VIRTUE ：14d-28d IRAD： 8d-30d 目前基于安全性倾向于在亚急性期行TEVAR术
Institute of Vascular Surgery Fudan University
Vascular Surgery Zhongshan Hospital
Institute of Vascular Surgery Fudan University
Vascular Surgery Zhongshan Hospital
Steuer, J., Bjorck, M., Mayer, D., et al., Distinction between acute and chronic type B aortic dissection: is there a sub-acute phase? Eur J Vasc Endovasc Surg, 2013. 45(6): 627-31.
Institute of Vascular Surgery Fudan University
Vascular Surgery Zhongshan Hospital
University of Pennsylvania Classification of Acute Stanford Type-B Aortic Dissection
Institute of Vascular Surgery Fudan University
Vascular Surgery Zhongshan Hospital
临床分型
• 40多年前De Bakey分型和Stanford分型 • 2005年景在平 “3N3V”分型 • 2009年Augoustides提出 Penn分型 • 2013年Dake教授提出DISSECT分类
Institute of Vascular Surgery Fudan University
Vascular Surgery Zhongshan Hospital
• TEVAR治疗15年来，在治疗理念、操作技术及支 架器具方面都取得了较大进展，如在升主动脉夹 层及弓部夹层领域也逐渐应用。
• 长期的随访结果证实了TEVAR已成为B型夹层的首 先治疗方式。
主动脉夹层腔内修复的现状与问题
复旦大学附属中山医院 血管外科 复旦大学血管外科研究所
符伟国 胡国华 王玉琦
Institute of Vascular Surgery Fudan University
Vascular Surgery Zhongshan Hospital
1999年Dake和Nienaber分别报道TEVAR技术治疗 急性B型主动脉夹层。
Institute of Vascular Surgery Fudan University
Vascular Surgery Zhongshan Hospital
Institute of Vascular Surgery Fudan University
Vascular Surgery Zhongshan Hospital
• No ischemia (Penn class Aa ) • Localized ischemia (Penn class Ab) • Generalized ischemia (Penn class Ac) • Combined ischemia (Penn class Ab&c)—
localized and generalized ischemia together
非复杂TBAD中也有因假腔通畅而预后差的 亚群，所谓非复杂性可能是误称，还需要仔 细分出真正稳定的AD！
Augoustides, J.G., Szeto, W.Y., Woo, E.Y., et al., The complications of uncomplicated acute
type-B dissection: the introduction of the Penn classification. J Cardiothorac Vasc Anesth, 2012. 26(6): 1139-44.