Poređenje otvorene hirurgije i endovaskularnog tretmana asimptomatske juksta/pararenalne aneurizme abdominalne aorte

Petar Zlatanović

doi:10.5937/mp74-43558

petar_zlatanovic Univerzitetski klinički centar Srbije, Klinika za vaskularnu i endovaskularnu hirurgiju, Beograd, Srbija

DOI: https://doi.org/10.5937/mp74-43558

Ključne reči: aneurizma abdominalne aorte (AAA), jukstarenalna AAA (JAAA), pararenalna AAA (PAAA), endovascularni tretman AAA (endovascular aneurysm repair - EVAR), otvorena hirurgija (open surgical repair – OSR)

Sažetak

Endovaskularni treatman aneurizme abdominalne aorte (EVAR – endovascular aortic aneurysm repair) je široko prihvaćena metoda u lečenju pacijenata sa aneurizmom abdominalne aorte (AAA). Primenljivost EVAR-a je ograničena odsustvom adekvatnog aneurizmatskog vrata ili zahvatanjem visceralnih arterija, kao što je slučaj kod jukstarenalne i pararenalne AAA (JAAA/PAAA). Trenutni vodiči u tretmanu AAA preporučuju da operativno lečenje JAAA/PAAA, kao i izbor različitih tehnika i opcija trebaju da se razmatraju na osnovu opšteg stanja pacijenta, anatomije, lokalne rutine, stručnosti tima i preferencija pacijenata. Glavna prednost endovaskularnog tretmana leži u izbegavanju klemovanja aorte i kasnijem manjem riziku od bubrežne slabosti, manje hirurške traume, što vodi bržem oporavku i može biti korisno za pacijente sa visokim rizikom od otvorene hirurgije. Međutim, nedavne publikacije pokazuju da pacijenti sa JAAA/PAAA mogu da se leče u aortnim centrima velikog volumena sa niskim kratkoročnim mortalitetom i morbiditetom i dobrim srednjeročnim i dugoročnim rezultatima koji su jednaki kod oba modaliteta tretmana. Pacijenti sa niskim hirurškim rizikom mogu imati koristi od otvorene hirurgije, dok pacijenti sa visokim rizikom mogu imati koristi od endovaskularnog tretmana JAAA/PAAA. Ovakvi podaci pružaju korisne informacije koje pomažu kliničarima i pacijentima da izaberu između ove dve procedure kada su obe izvodljive.

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