Endovaskularno lečenje rupture aneurizme abdominalne aorte

  • 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
  • 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
  • Aleksandar Tomić Clinic for Vascular and Endovascular Surgery, Military Medical Academy, Belgrade, Serbia; Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia
  • Sanja Šarac Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia; Clinic of Pulmology, Military Medical Academy, Belgrade, Serbia
  • Mihailo Bezmarević Clinic of General Surgery, Military Medical Academy, Belgrade, Serbia
DOI: https://doi.org/10.2298/1616
Ključne reči: aortic aneurysm, abdominal||, ||aorta, abdominalna, aneurizma, aortic rupture||, ruptura, comorbidity||, ||komorbiditet, diagnosis||, ||dijagnoza, vascular surgical procedures||, ||hirurgija, vaskularna, procedure, blood vessel prosthesis||, ||krvni sud, proteza, treatment outcome||, ||lečenje, ishod.,

Sažetak


Uvod. Ruptura aneurizme abdominalne aorte (AAA) predstavlja potencijalno smrtonosno stanje. Samo polovina bolesnika sa rupturom AAA stigne živa u bolnicu. Alternativa otvorenoj hirurškoj rekonstrukciji ovog stanja je endovaskularno lečenje. U radu je prikazano uspešno izvedeno endovaskularno lečenje rupturisane AAA kod bolesnika sa velikim brojem pratećih oboljenja. Prikaz bolesnika. Muškarac star 60 godina, primljen je u našu instituciju zbog difuznih bolova u trbuhu praćenih nadimanjem i podrigivanjem. Na ultrazvučnom pregledu abdomena viđena je AAA, što je potvrđeno i multislajsnom kompjuterizovanom angiografiji abdomena, koja je ukazala i na postojanje velikog retroperitonealnog hematoma. Zbog pratećih bolesti (prethodna operacija karcinoma larinksa i suženje larinksa na jednu trećinu, arterijska hipertenzija i kardiomiopatija sa ejekcionom frakcijom leve komore od 30%, stenoza desne unutrašnje karotidne arterije od 80%) odlučeno je da je lečenje izbora rupture AAA endovaskularno, u lokalnoj anesteziji i analgosedaciji. Endovaskularni grafting postignut je ugrađivanjem aortobiilijačne bifurkacione ekskluder endoproteze sa potpunom ekskluzijom aneurizmatske vreće, bez daljeg uvećanja hematoma i isticanja kontrasta. Postoperativni tok protekao je uredno, bez komplikacija. Na kontrolnom pregledu tri meseca kasnije, stanje bolesnika bilo je dobro. Zaključak. Endovaskularno lečenje rupturisane AAA može biti terapija izbora kod hemodinamski stabilnih bolesnika sa značajnim komorbiditetima ukoliko morfologija aneurizme to dozvaljava. Ova tehnika pruža veću šansu za preživljavanje, uz manji stepen intraoperativnog i postoperativnog morbiditeta i mortaliteta što potvrđuje i prikaz našeg bolesnika.

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Objavljeno
2015/04/21
Broj časopisa
Vol. 71 Br. 1 (2014)
Rubrika
Prikaz bolesnika