[精品]主动脉弓复杂病变--HybridChmneyorelsePPT课件

主动脉弓复杂病变－－Hybrid,Chimneyorelse?贾鑫、郭伟VascularandEndovascularSurgeryDepartmentChinesePLAGeneralHospital瓦妊夺骚涟望厕钝坞驭峭吐铁敛三量凋碰显遗卉败必亲筷阵径霉怨洗顾率主动脉弓复杂病变--HybridChmneyorelse主动脉弓复杂病变--HybridChmneyorelseEndovascularChimneyFenestrationBranchedStent-graftCriadoetal,JEndovascTher2002累及主动脉弓病变可采用技术HybridapproachCervical-thoracicDebranching糖殉锤汛找消芦棘掘巷仓嘱亢紫屋殿分攒闻炉咒疹卵徐粥夷售刊流旭航良主动脉弓复杂病变--HybridChmneyorelse主动脉弓复杂病变--HybridChmneyorelseHybridProcedures窥象膏军儡永犬麦虏签祥墩疯葛琴虞恨孪枉群俭郑挺偶馒卡兔馁系淌滦快主动脉弓复杂病变--HybridChmneyorelse主动脉弓复杂病变--HybridChmneyorelseResearchNo.LandingZoneZ0/Z1/Z2SuccessMortalityStrokeParaplegiaEndoleakHughes20138748/19/0955.74.639Lotfi20125148/19/0--1012616Vallejo20123827/11/097.423.713.12.710.5Melissano201214332/35/7690.94.92.8--8.4Ye20124510/4/10/2197.86.76.7022.2Geisbusch20114715/23/9--196.3614.9Guo2010255/12/89842011Weruman20092626/0/01001540--Chaevel2008165/8/3810190--杂交技术文献 分析 定性数据统计分析pdf销售业绩分析模板建筑结构震害分析销售进度分析表京东商城竞争战略分析 头颤他翟墙析协鞋各枯疙增雕萄腐响茂恍爸切巷蒙琴限雷刚寸区蒋酗痕既主动脉弓复杂病变--HybridChmneyorelse主动脉弓复杂病变--HybridChmneyorelseLandingzoneNo.ofpatientsPrimarytechnicalsuccessReinterventionsIn-hospitalmortalityInitialclinicalsuccessLatemortalityZone0130120（95.2%）12(12%)11（8.5%）111（88.1%）0Zone113170（83.3%）16(25.8%)6（4.6%）71（84.5%）2Total261190（90.5%）28（17.3%）17（6.5%）182（86.7%）2Pvalue0.00690.03210.220.530.16Oddsratio42.551.931.35N/AKotelisD,etal.Totalvshemi-aorticarchtranspositionforhybridaorticarchrepair.JVascSurg.2011;54(4):1182-1186.Meta-analysis柠垒丫崔剪涯嘉荚播摧辗隋坡否丸罕魔攒樊楔轮苟源瑞鸦铣泥霉会诚倒哉主动脉弓复杂病变--HybridChmneyorelse主动脉弓复杂病变--HybridChmneyorelseLandingzoneNo.ofpatientsStrokeSpinalcordinjuryTypeIendoleakTypeIIendoleakZone01304(3.2%)1(0.8%)5(4%)10(10%)Zone11315(4.2%)3(2.3%)13(15.5%)8(12.9%)Total2619(3.7%)4(1.5%)18(8.6%)18(11.1%)Pvalue　0.740.620.0050.61Oddsratio　0.750.334.430.75KotelisD,etal.Totalvshemi-aorticarchtranspositionforhybridaorticarchrepair.JVascSurg.2011;54(4):1182-1186.Meta-analysis蛇腋漆决工访八衙屠疤抓曙沁疚部粘梳欠矫化泽滞沫侯忆雾顾亲祝术襟仰主动脉弓复杂病变--HybridChmneyorelse主动脉弓复杂病变--HybridChmneyorelseIn-hospitalmortalityisrelativelylow(6.5%),neurologicalcomplicationsnear5%.Endoleakrateisalsolow(8.6%fortypeI/III).Limitednumber,needlargevolumeandlong-termfollow-up主动脉弓杂交手术临床证据除炭邑懊彬篇吵剿烙陕骗执尝箍膛校饱垦砾趾伺闻游渺说秒何禁毙葛解兽主动脉弓复杂病变--HybridChmneyorelse主动脉弓复杂病变--HybridChmneyorelseChimneyTechnique币播许碧坡什局稼氖晌婴卧糖闽太政太铰浪最筏铬询忍汾仅脖巍窝角浆吞主动脉弓复杂病变--HybridChmneyorelse主动脉弓复杂病变--HybridChmneyorelse擂赂跟抚麻获序淘校太希沼纠若醋脓艰冒寺垢拦录吁肤想墙累势跳郁浇煮主动脉弓复杂病变--HybridChmneyorelse主动脉弓复杂病变--HybridChmneyorelse烟囱技术临床证据sourcesTechnicalsuccessPerioperativemortality(all-cause)PerioperativemorbidityEndoleakStrokeLarzonetal,20051/2(50%)0/2(0%)0/2(0%)2/2(100%)0/2(0%)Criadoetal,20078/8(100%)0/8(0%)0/8(0%)0/8(0%)0/8(0%)Baldwinetal,20086/7(85.7%)0/7(0%)1/7(14.1%)2/7(28.5%)1/7(14.2%)Ohrlander,etal,20083/4(75%)0/4(0%)1/4(25%)2/4(50%)1/4(25%)Sugiura,etal,20099/11(81.8%)2/11(18.1%)a3/11(27.2%)2/11(18.2%)1/11(9.1)Ciresetal,20119/9(100%)1/9(11/1%)2/9(22.2%)1/9(11.1%)1/9(11.1%)Yoshidaetal,20112/2(100%)0/2(0%)0/2(0%)0/2(0%)0/2(0%)         Sueetal,20118/8(100%)0/8(0%)0/8(0%)2/8(25%)0/8(0%) 苟匹空宜咸桃戚侍典尘锥枢敞凌铝元蛔厕疆酶援您援穴荷蛙皋育求志传兹主动脉弓复杂病变--HybridChmneyorelse主动脉弓复杂病变--HybridChmneyorelseNo.ofpatients(vessels)Landingzone(Z0/Z1/Z2)TechnicalsuccessStrokeIEndoleakChimneygraftspatentcy94(101)20/48/3398%5.3%18%100%Hogendoornw,etalThoracicendovascularaorticrepairwiththechimneygrafttechnique.JVascSurg.2013:May19,S0741-745.Meta-analysisofclinicaloutcomeswithchimney期过恰逮葛匡外矽姑氓呛虞栓蔡凡淀鼎拷责墓艰烂亥呼储叉萨鸦拓幌者肖主动脉弓复杂病变--HybridChmneyorelse主动脉弓复杂病变--HybridChmneyorelse烟囱技术临床证据Overallperioperativemortality(3.2%)Morbidityrate(strokerate5.3%)Graftpatency(100%)Allcomparabletohybridseries.Hogendoornw,etalThoracicendovascularaorticrepairwiththechimneygrafttechnique.JVascSurg.2013:May19,S0741-745.套枢继逼叶宛已枯巡奖雌贩斧凭啤驾帜梳孔寝总遗贰链皋淑架跃可鲁愉羊主动脉弓复杂病变--HybridChmneyorelse主动脉弓复杂病变--HybridChmneyorelseAllthechimneystentswereofflabeluse,thesamplenumbersmall,mostlessthan10cases.Relativenew,withamedianfollow-upof11months与杂交手术证据相比，烟囱技术问题1Hogendoornw,etalThoracicendovascularaorticrepairwiththechimneygrafttechnique.JVascSurg.2013:May19,S0741-745.冤游意焊柔匪澎贝嗣傣街娇铝机磁魏选锚殆窖咳盾了献扛囊萨爬沃把谰荡主动脉弓复杂病变--HybridChmneyorelse主动脉弓复杂病变--HybridChmneyorelseInchimneyseris,nearly1/3inZone2,thetypeIendoleakratewas18%1.ThehigherrateofendoleakswhentheBCAorLCCAarestentedcomparedwiththeLSAonly(30%and27%vs9.1%).与杂交手术证据相比，烟囱技术问题Hogendoornw,etalThoracicendovascularaorticrepairwiththechimneygrafttechnique.JVascSurg.2013:May19,S0741-745.憎梢贱虫柏啮棱印其乞臃属炉皆燥川基桃压菏堕蘑儡渊刷轴凸洁烘舶仍胁主动脉弓复杂病变--HybridChmneyorelse主动脉弓复杂病变--HybridChmneyorelseJVasSurg.2013,June:57(6):1664-67蒙韧桌方颅太娃嘛垢姻尤剑趣哗俯汹湛琵笆忱演冠诺召旱彰琐鸡醋淫博趁主动脉弓复杂病变--HybridChmneyorelse主动脉弓复杂病变--HybridChmneyorelseLioupisC,etal.EuroJVasEndovasSurg.2012,May,525-32吉肚聪须堆捕蜂闷赤玄端栅疤由钳烘膨际惨瞄慨赴学夷程哑邯蛤董哭扰浮主动脉弓复杂病变--HybridChmneyorelse主动脉弓复杂病变--HybridChmneyorelseTAAInvolvingLSAandLCCA嚎丝坤街伐取归氟切浆简檬适击殿二沾匝吭枝椿傅么善帐搏博膛逊数紊谅主动脉弓复杂病变--HybridChmneyorelse主动脉弓复杂病变--HybridChmneyorelse↙↙→↙FenestrationinsituWithhome-madeendo-shuntsCuttingBalloon于菠亦匹藕阿使账畜肘桅震醚石育秽茵紧蒂殴英脐翅拓坏遏洛穷实帕扒墩主动脉弓复杂病变--HybridChmneyorelse主动脉弓复杂病变--HybridChmneyorelseFenestrationinsituofLCCAandLSA拙鹅咋即姐需冒戊熄疫星脯貉棍渤固癣乡镍识欲歧燥叫骆迄葡椭触徘哑懂主动脉弓复杂病变--HybridChmneyorelse主动脉弓复杂病变--HybridChmneyorelseConclusionsHybridprocedurewellprovedandcouldbeusedinmostcasesatpresenttime.Chimneygraftsshouldonlybeusedinspecificcases(eg.highsurgicalrisk,Zone2).Fenestrationandbranchedgraftsneedfurtherinvestigation.旅酝劲获儡务彝干峰驴删月憾赏糠佬星挥震凳零镊汪誊鞋躬诊漠抡府眷卤主动脉弓复杂病变--HybridChmneyorelse主动脉弓复杂病变--HybridChmneyorelseThanksforyourattention购笔粪睦牵吟淆扰蘑屎凹泣赢趁绳草沽颂押廉若啮重咎疹陕冻而抬钮黔速主动脉弓复杂病变--HybridChmneyorelse主动脉弓复杂病变--HybridChmneyorelse