主動(dòng)脈支架術(shù)后內(nèi)漏CT診斷及分型課件

EndoleaksafterendovascularaorticStent-Grafting:CTdiagnosisLuoSongDepartmentofMedicalImaging,JinlingHospitalEndoleaksafterendovasculara1OutlineConceptandhistoryCauseImagingdiagnoseClassificationCT

charactersSummaryOutlineConceptandhistory2ConceptandhistoryIn1991,thefirstsuccessfulendovascularabdominalaorticrepair(EVAR)In1994,thefirstthoracicendovascularaorticrepair(TEVAR)In1996,Whitefirstsuggestedthatthisphenomenonofincompletebetweentheaorticwallandastent-graftresultingin“paragraftflow”betermedendoleakConceptandhistoryIn1991,th3ConceptandhistoryWhite’sgroupthensuggestedaclassificationnomenclaturebasedontimeandsiteofoccurrenceIn1998,Whiteetalrevisedtheirendoleakclassificationschemeagaininto4distincttypesandanadditionaltype(endotension)Whiteetal.JENDOVASCSURG,1998ConceptandhistoryWhite’sgro4ConceptandhistoryEndotension:thereisdemonstrablepressurewithinasacbutnoendoleakidentifiedIn2002aconsensusconferencewasheldonendoleaksandendotensionafterEVAR,andaclassificationschemewasformalizedConceptandhistoryEndotension5VeithFJetal.JVascSurg,2002VeithFJetal.JVascSurg,6景在平等，中國實(shí)用外科雜志，2002景在平等，中國實(shí)用外科雜志，20027CauseProximalDistalStent-graftBranchvesselsCauseProximal8Clinicalaortic-relatedmortalityreoperationreinterventionIncidencerate:between12%and20%Clinicalaortic-relatedmortali9ImagingdiagnoseCTDSAMRIUltrasoundImagingdiagnoseCT10DSAGleasonetal.ThoracicandCardiovascularSurgery,2009DSAGleasonetal.Thoracicand11MRIblood-pooltime-resolvedcinePittonetal.AJR,2005MRIblood-poolPittonetal.AJR12UltrasoundOperatorexpertiseBodyhabitusBowelgasTheairwithinthelungTEEIntravascularultrasoundUltrasoundOperatorexpertise13ClassificationTimeWithin30days:primaryorearlyOccurringlater:secondary,delayed,orlateSiteGraft-relatedorperigraftNoggraft-relatedorretrogradeClassificationTime14Whiteetal.JENDOVASCSURG,1998ClassificationWhiteetal.JENDOVASCSURG,15ClassificationSzeetal.CircCardiovascIntervent,2009ClassificationSzeetal.Circ16ClassificationClassification17TypeⅠFlowfromeithertheproximalordistalThemostcommontypeTypeⅠFlowfromeithertheprox18TypeⅡRetrogradeaorticbranchvesselbloodflowTypeⅡRetrogradeaorticbranch19TheleftsubclavianarteryTheleftsubclavianartery20TypeⅢStructuralfailurewiththestentgraftHolesinthestentgraftfabric,Stent-graftfracturesJunctionalseparationsTypeⅢStructuralfailurewith21AngularAngular22TypeⅣFromtheporesseepthroughandintotheexcludedsegmentofaortaEarliergenerationstent-graftsTypeⅣFromtheporesseepthro23ArteryphaseDelayphaseArteryphaseDelayphase24SummaryClassificationisimportantEndoleakclassification:thoracicaorticdissectionendovascularaorticrepairSummaryClassificationisimpor25Lehmkuhl,etal.Radiology,2013,9Lehmkuhl,etal.Radiology,20126ResearchprogressSommeretal.Radiology,2012ResearchprogressSommeretal27Stolzmannetal.Radiology2008Stolzmannetal.28Thanks！Thanks！29EndoleaksafterendovascularaorticStent-Grafting:CTdiagnosisLuoSongDepartmentofMedicalImaging,JinlingHospitalEndoleaksafterendovasculara30OutlineConceptandhistoryCauseImagingdiagnoseClassificationCT

charactersSummaryOutlineConceptandhistory31ConceptandhistoryIn1991,thefirstsuccessfulendovascularabdominalaorticrepair(EVAR)In1994,thefirstthoracicendovascularaorticrepair(TEVAR)In1996,Whitefirstsuggestedthatthisphenomenonofincompletebetweentheaorticwallandastent-graftresultingin“paragraftflow”betermedendoleakConceptandhistoryIn1991,th32ConceptandhistoryWhite’sgroupthensuggestedaclassificationnomenclaturebasedontimeandsiteofoccurrenceIn1998,Whiteetalrevisedtheirendoleakclassificationschemeagaininto4distincttypesandanadditionaltype(endotension)Whiteetal.JENDOVASCSURG,1998ConceptandhistoryWhite’sgro33ConceptandhistoryEndotension:thereisdemonstrablepressurewithinasacbutnoendoleakidentifiedIn2002aconsensusconferencewasheldonendoleaksandendotensionafterEVAR,andaclassificationschemewasformalizedConceptandhistoryEndotension34VeithFJetal.JVascSurg,2002VeithFJetal.JVascSurg,35景在平等，中國實(shí)用外科雜志，2002景在平等，中國實(shí)用外科雜志，200236CauseProximalDistalStent-graftBranchvesselsCauseProximal37Clinicalaortic-relatedmortalityreoperationreinterventionIncidencerate:between12%and20%Clinicalaortic-relatedmortali38ImagingdiagnoseCTDSAMRIUltrasoundImagingdiagnoseCT39DSAGleasonetal.ThoracicandCardiovascularSurgery,2009DSAGleasonetal.Thoracicand40MRIblood-pooltime-resolvedcinePittonetal.AJR,2005MRIblood-poolPittonetal.AJR41UltrasoundOperatorexpertiseBodyhabitusBowelgasTheairwithinthelungTEEIntravascularultrasoundUltrasoundOperatorexpertise42ClassificationTimeWithin30days:primaryorearlyOccurringlater:secondary,delayed,orlateSiteGraft-relatedorperigraftNoggraft-relatedorretrogradeClassificationTime43Whiteetal.JENDOVASCSURG,1998ClassificationWhiteetal.JENDOVASCSURG,44ClassificationSzeetal.CircCardiovascIntervent,2009ClassificationSzeetal.Circ45ClassificationClassification46TypeⅠFlowfromeithertheproximalordistalThemostcommontypeTypeⅠFlowfromeithertheprox47TypeⅡRetrogradeaorticbranchvesselbloodflowTypeⅡRetrogradeaorticbranch48TheleftsubclavianarteryTheleftsubclavianartery49TypeⅢStructuralfailurewiththestentgraftHolesinthestentgraftfabric,Stent-