TheTherapyforTypeBThoracicAorticDissectionMedicalSurgicalEndovascularClinicalMaterialMale74Famale4Age:55~73yHypertension:51CAD:4Chronicrenalinsufficiency:4Diabetesmellitus41990~2005Chronicpulmonaryocclusiondisease:1978casesAcute34Chronic44ClinicalMaterialChestPainHeart\renal\lungSymptoms

(ShortBreath)Pulse:Decreased（60%）BP:NormalorHighSymptoms&SignsDiagnosisMethodsEchocardiogram(TTE&TEE)CTMRIAngiographySurgicalTherapy（48）MedicalTherapy（30）Localresection&patch2Prostheticvesselreplacement3EndovascularStent15Actue（17）Chronica（31）Prostheticvesselreplacement14EndovascularStent1448Localresection&patch00/2Prostheticvesselreplacement32/14EndovascularStent0/140/15EmergencySelectiveAMIBleedingResults:operativemortality

Onestent21Twostents6Results:NooperativedeathComplications:Leak2Threestents1

Rupture：4/6

Trachea：1Esophagus：1Chest：2Latetermdeath：8Results:MedicalTherapymortality

（30）Results:Long-termProstheticvesselreplacement12(1~7years):Hoarse3/5Death2EndovascularStent29

(3mon.~4years):Nocomplications&deathOneyearafterimplantStentDiscussionMedicalvs

Surgical?TheTimeofSurgery：

EmergencyvsSelective?OperativeMethods：

ConventionalvsEndo?TheTherapyforTypeBThoracicAorticDissectionCOBPTheTherapyforTypeBThoracicAorticDissectionMedicalTherapyVascularDilatorCalciumantagonist?—BlockerTheComplicationsofSurgeryTraumaAnesthesiaBleedingSpinalinjuryBrainRenalLungsAMIEndovascularGraftMethods

1.Byfemoralartery

2.ByAorticArchTheExcellencesofEndovasculartherapyInvasive&safetherapyReducetheoperativemorbidity&mortalitySaveBloodItisanewandeffectivetherapyLocalAnatomyConditionAgeImportantOrgansFunctionsTheTherapyforTypeBThoracicAorticDissectionThelengthoftheneckTheShapeofthetrue&falselumenThearterybranchTheperipheralarteriesThegeneralcondition

leakNeckthetrueconditionArteriesbranchTheReasonsoftheleakSurgeon11%~44%11%~44%Prosthetic

DiagnosisMildAngiographyCTPrevent&TreatmentLeak(I)TreatmentSeverere-do-stentSurgicalObservationPrevent&TreatmentLeak(II)PatientsStentsAnatomySurgicalSkillMultiplelaceration&SegmentsHugefalselumenTruelumen:small,neck,cylinderImportanceorgansperfusion?

(bythefalselumen)TheperipheralarteriesLongtermoftheeffects?ChronicTypeBPath-physiologicalMakingsurediagnosis(ClinicalDiagnosis)TheDiagnosisofAorticDissectionConclusion(I)Complications?(Pathologic&PhysiologicDiagnosis)Thelocation&range(PathologicDiagnosis)Multi-expertiseCooperation：

Surgeon,Physician、

Radiology、AnesthesiaMulti-therapy：

Medicinal、Surgical、EndovascularConsideration：

Pathology&physiology

（CT，MRI，Angiography)Conclusion(II)Conclusion(III)MedicalEndovascularSurgicalSub-acuteBChronicBAcutephase

PostOPFirstchoice?!Acute

RepeatPainHype