Acute aortic dissection of treatment _83768 by heku


									?Acute aortic dissection of


Acute aortic dissection of treatment

Zhengzhou University fifth affiliated hospital of general subjects
Cui Wei (450052)

[Abstract] purpose of acute aortic dissection of diagnostic and
therapeutic methods. Method: on 18 patients with acute aortic
dissection of clinical data for analysis. Result: 18 cases of
patients with aortic dissection, 15 cases of surgery, 2 years after
reviewing stand no internal leakage, no transfer location good.
Conclusion: by this group summary analysis of clinical data,
improving diagnosis and treatment of disease. D e B a k e y patients
through Endovascular treatment to good effect. Zhengzhou University
fifth hospital surgical Cui Wei Dong

Aortic dissection is a way to very dangerous disease after. But as
ever on this lack of understanding of the disease often misdiagnosed
and delay treatment. For a long time its treatment principles is
provided in the application of control blood pressure, receptor
blockers, for existing rupture tendency or limb ischemia patients for
surgical treatment of selectivity. Traditional surgical treatment has
a high mortality rate of surgery and complications. In recent years,
with Endovascular technologies will now homes over the past few years
I admitted in 18 patients with Aortic Dissection report are as

1.1 clinical data: 18 thoracic aortic dissection male 13 cases,
female 5 cases, age 37 ~ 50 years of age, 18 cases patients have
symptoms are sudden of Thoracoabdominal or back knife-like or tearing
severe pain, persistent. To be strong pain or meperidine failed to
effectively alleviate the pain. Patients presenting Globus, sweating
skin facial cyanosis, signs, 17 cases is significantly higher than
normal blood pressure. 3 cases accompanied by pain in the left lower
extremity cool hemp. Out-patient diagnosed 4 cases. Dissection D e B
a k e y 16 cases, DeBakey type 2 cases.

1.2 treatment methods:

1.2.1 conservative treatment:

Acute aortic dissection and effective control of blood pressure
decrease cardiac output and thereby reduce vascular dystonia. Is the
key to reducing aortic rupture. SNP and beta blockers are the
preferred drug. And to be calm, and relieve pain. You can quickly
control the symptoms.

1.2.2 imaging assessment: by ultrasonography and CT Angiography (CTA),
digital subtraction angiography (DSA) on the mezzanine of the range,
the gap for the location of the source of the blood supply to vital
organs and the sensing of the neck.

1.2.3 surgical treatment:

Surgery performed under general anesthesia, first Seldinger technique
puncture the left brachial artery, place the mark catheter ascending
aorta and aortic angiography tell cavity, break location, proximal
neck with aneurysms CTA controlled further verification. Choose a
suitable graft. Select the iliac vessels distorts, no obvious the
narrow side of the anatomy of the femoral artery. Select Shanghai
minimally invasive stent, femoral artery catheterization in wire
heparinization, the femoral artery in incising, 1/2-week trail, graft
along super hard wire import descending aorta. To further determine
where control of blood pressure after the fixed internal sheath, exit
outer sheath will support the release. Launch support conveyor,
aortic angiography again do understand left subclavian artery mouth
open, false lumen disappear, no internal leakage, stand location good.
Operation was successful.

1.3 results:

18 cases of patients with aortic dissection, 15 cases of surgery, 2
years after reviewing stand no internal leakage, no transfer location
good. 1 cases of conservative treatment for economic reasons through
after the acute stage, oral antihypertensive drugs. Follow-up of 3
years is still alive. Two additional cases DeBakey1-defaulting
patients Renmin Hospital of Beijing University.
2 discussion:

2.1 misdiagnosis: (1) in the past we on acute aortic dissection of a
lack of understanding, because of its sudden onset of symptoms are
caused by back pain, abdominal pain, or suffer the symptoms of
ischemia. Often be misdiagnosed as acute myocardial infarction, acute
abdomen, acute arterial embolism, etc [1]. (2) the lack of a clear
diagnosis of inspection means: color, MR, CT. Now with our awareness
of the disease, Sonography, MR, CT in clinical application of
universal access. More and more patients were early diagnosis to

2.2 treatment: dissection is a disease and symptoms may appear
dangerous diseases that often can't be transferred. Basic hospital
through color, enhanced CT basically can determine the diagnosis, but
the aneurysm parting, crevasse of location, size of main branches of
the carotid artery blood means the checks carried out at local
hospitals cannot. Are dependent on the CTA, DSA angiography MRA or
check. So give the conservative treatment of effective control of
blood pressure, pain relief, calm the patient safety through the
acute stage, to further examine the treatment time is the treatment
of early stage win.

There are statistics, early onset after 50% of the patients die
within 48 hours, 70% will die within 1 week, every hour of death risk
1% [2]. Only 10-15% may have acute lesions into chronic arterial
aneurysms. DeBakey reports results of surgical treatment of 179 cases,
surgical mortality rate is 21%, a five-year survival rate of 50%, the
10-year survival rate of 17% [3]. Traditional surgical approaches need
thoracic surgery, trauma, surgery more complex, complications,
mortality is high. But in recent years towards the treatment of
vascular surgery, minimally invasive therapy of direction. In imaging
technology guided on vascular system diseases treatment for various
Chamber, which also produces the Endovascular treatment of new
concepts. The vascular surgery traditional difficult aortic aneurysms,
adding layer or by endovascular treatment and surgery simplistic,
reduced complications and reduce the risk [4], 18 cases, 15 cases
selected its Endovascular, are good curative effect.

Reference documents

[1] Lu dongfeng. aortic dissection report of 3 cases [J] Chinese
Journal of misdiagnosis 2008.8 (4) 879
[2] Wang Chung-Ho. aortic dissection and dissection of [J] Chinese
Journal of general surgery, 2002.17 (1): 5-8

[3] Debakey ME,et alAneurysms of the thoracie aortaAnalysis of 179
patients treated by resection. J Thorae Surg 363931958

[4] zhangzhe. Mr bibo. peritoneal stent DebakeyIII aortic dissection
[j] China minimally invasive medical journal 2008.8. (1) 70-71

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