Visceralna hibridna rekonstrukcija torakoabdominalne aneurizme aorte nakon otvorene rekonstrukcije aortne disekcije tipa A procedurom Bentall uz pomoć tehnike elephant trunk

  • Ivan Marjanović Clinic for Vascular and Endovascular Surgery Military Medical Academy, Belgrade, Serbia; Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia
  • Momir Šarac Clinic for Vascular and Endovascular Surgery Military Medical Academy, Belgrade, Serbia; Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia
  • Aleksandar Tomić Clinic for Vascular and Endovascular Surgery, Military Medical Academy; Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia
  • Siniša Rusović Institute of Radiology, Military Medical Academy, Belgrade, Serbia
  • Leposava Sekulović Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia; Institute of Radiology, Military Medical Academy, Belgrade, Serbia
  • Marko Leković Clinic for Vascular and Endovascular Surgery Military Medical Academy, Belgrade, Serbia
  • Mihailo Bezmarević Clinic for General Surgery, Military Medical Academy, Belgrade, Serbia
DOI: https://doi.org/10.2298/3190
Ključne reči: aortic aneurysm, thoracic||, ||aneurizma, torakalna, vascular surgical procedures||, ||hirurgija, vaskularna, procedure, treatment outcome||, ||lečenje, ishod, comorbidity||, ||komorbiditet,

Sažetak


Uvod. Rekonstrukcija hronične disekcije tipa B i aneurizme torakoabdominalne aorte (TAAA), zaostale nakon urgentne rekonstrukcije ascendentne aorte i luka aorte zbog akutne disekcije tipa A, predstavlja jednu od najvećih izazova u hirurgiji. Komplikacije hronične disekcije tipa B su nastanak aneurizme aorte i njena ruptura sa visokom stopom smrtnosti. Prikazana je visceralna hibridna rekonstrukcija TAAA nakon hronične disekcije tipa B i procedure Bentall tehnikom elephant trunk zbog akutne aortne disekcije tipa A, kod bolesnika sa visokim rizikom od peroperativnog mortaliteta. Prikaz bolesnika. Bolesnica, stara 62 godine, primljena je u našu ustanovu radi rekonstrukcije Crawford tipa I TAAA nakon hronične disekcije. Bolesnica je imala akutnu aortnu disekciju tipa A ranije, zbog čega je operisana. Učinjena je procedura Bentall tehnikom elephant trunk sa zamenom valvule. Na prijemu bolesnica je imala koronarnu bolest (infarkt miokarda, dva puta u protekle tri godine), zastojnu srčanu bolest sa ejekcionom frakcijom od 25% i hroničnu opstruktivnu bolest pluća. Na kompjuterizovanoj tomografiji (KT) aorte TAAA je prikazana sa maksimalnim prečnikom od 93 mm u descendentnoj grudnoj aorti nakon hronične disekcije. Sve visceralne arterije poticale su iz pravog lumena sa izuzetkom celijačne arterije (CA), i završetak hronične disekcije nalazio se ispod ishodišta gornje mezenterične arterije (GMA). Bolesnica je podvrgnuta prvo otvorenoj hirurškoj rekonstrukciji GMA, CA i desne bubrežne arterije (DBA). Postoperativni tok protekao je bez komplikacija. Endovaskularna rekonstrukcija TAAA sprovedena je kao druga procedura jedan mesec kasnije, pri čemu je za proksimalnu zonu fiksiranja endografta korišćena procedura elephant trunk, a za distalnu zonu fiksiranja nivo odvajanja DBA. Postoperativno, bolesnica nije imala neurološki deficit, a funkcija bubrega, jetre i ostalih abdominalnih organa bila je normalna. Kontrolna KT nakon šest meseci pokazala je potpuno isključenje aneurizme iz sistemske cirkulacije bez endoleak-a i dobar protok krvi kroz visceralne anastomoze. Zaključak. Kod bolesnika sa komorbiditetima, kao što je kod prikazane bolesnice, visceralna hibridna rekonstrukcija hronične disekcije tipa B sa TAAA može predstavljati terapiju izbora.

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Objavljeno
2015/04/24
Broj časopisa
Vol. 71 Br. 9 (2014)
Rubrika
Prikaz bolesnika