Savremeno lečenje bolesnika sa aneurizmom poplitealne arterije u vaskularnim centrima u Srbiji

  • Aleksandar Zarić Military Medical Academy, Clinic for Vascular and Endovascular Surgery, Belgrade, Serbia
  • Aleksandar Tomić Military Medical Academy, Clinic for Vascular and Endovascular Surgery, Belgrade, Serbia
  • Ivan Marjanović Military Medical Academy, Clinic for Vascular and Endovascular Surgery, Belgrade, Serbia
  • Vladimir Manojlović University Clinical Center of Vojvodina, Clinic for Vascular Surgery, Novi Sad, Serbia
  • Nebojša Budakov University Clinical Center of Vojvodina, Clinic for Vascular Surgery, Novi Sad, Serbia
  • Anica Ilić University Clinical Center of Serbia, Clinic for Vascular and Endovascular Surgery, Belgrade, Serbia
  • Aleksandra Vujčić University Clinical Center of Serbia, Clinic for Vascular and Endovascular Surgery, Belgrade, Serbia
  • Mihajlo Nešković “Dedinje” Cardiovascular Institute, Clinic for Vascular Surgery, Belgrade, Serbia
  • Igor Atanasijević “Dedinje” Cardiovascular Institute, Clinic for Vascular Surgery, Belgrade, Serbia
  • Nemanja Stepanović University Clinical Center Niš, Clinic for Vascular Surgery, Niš, Serbia
  • Jelena Stanković General Hospital Užice, Užice, Serbia
  • Milan Jovanović General Hospital Užice, Užice, Serbia
  • Nenad Ilijevski “Dedinje” Cardiovascular Institute, Clinic for Vascular Surgery, Belgrade, Serbia
  • Igor Končar University Clinical Center of Serbia, Clinic for Vascular and Endovascular Surgery, Belgrade, Serbia
  • Lazar Davidović University Clinical Center of Serbia, Clinic for Vascular and Endovascular Surgery, Belgrade, Serbia
Ključne reči: endovaskularne procedure, a. poplitea, aneurizma, srbija, hirurgija, vaskularna, procedure

Sažetak


Uvod/Cilj. Aneurizma poplitealne arterije (APA) je najčešća aneurizma perifernih arterija i druga po učestalosti posle aneurizme abdominalne aorte (AAA). Međutim, njena učestalost je mala, a lečenje nestandardizovano. Formiranje multicentričnog nacionalnog registra moglo bi unaprediti dijagnostiku i lečenje APA. SerbVasc je novoformirani registar podataka o operisanim bolesnicima u vaskularnim centrima Srbije. Cilj rada bio je da se prikažu podaci iz hirurške prakse o dijagnostici i lečenju bolesnika sa APA u bolnicama u Srbiji. Metode. Vaskularni centri u Srbiji koji su prihvatili učešće u istraživanju prikupili su, retrospektivno, podatke o bolesnicima operisanim zbog APA u periodu od 2012. do 2018. godine. Prikupljeni su podaci o simptomatologiji, preoperativnoj dijagnostici, otvorenim i endovaskularnim tehnikama lečenja, kao i o rezultatu postoperativnog lečenja. Prikupljeni podaci su, radi analize između zemalja učesnica, prosleđeni VASCUNET internacionalnom projektu za APA. Isti podaci korišćeni su u analizi savremenog hirurškog lečenja APA u šest bolnica u Srbiji: Univerzitetski klinički centar Srbije, Institut za kardiovaskularne bolesti „Dedinje“, Vojnomedicinska akademija, Univerzitetski klinički centar Novi Sad, Univerzitetski klinički centar Niš i Opšta bolnica Užice. Rezultati. U periodu od 2012. do 2018, u šest bolnica u Srbiji prikupljeni su podaci o 342 procedure lečenja APA, kod 329 (96,2%) muškaraca i kod samo 13 (3,8%) žena. Učestalost hirurškog lečenja APA iznosila je 6,8 intervencija na million stanovnika godišnje. Prosečna starost bolesnika iznosila je 64,34 godine (od 29 do 87 godina). Izvršeno je ukupno 223 (65,8%) elektivnih intervencija. Amputacija i bolničko preživljavanje su smatrani glavnim ishodima lečenja. Tromboza, kao uzrok operacije, je zabeležena kod 110 (32,5%) bolesnika, a ruptura kod pet. Prosečan dijametar aneurizme iznosio je 35,3 mm, a nešto veći dijametar zabeležen je kod rupturiranih aneurizmi – prosečno 43,8 mm. Sintetski i venski graftovi su jednako korišćeni, kako u elektivnim, tako i u hitnim operacijama. Endovaskularne procedure korišćene su kod 6 (1,8%) bolesnika. Zaključak. Sprovedeno istraživanje potvrđuje vrednost postojanja registra podataka i njihove analize. Pokazalo se da je učestalost APA u Srbiji niska i da dobro organizovani skrining, čak i u okviru pojedinačnih bolnica, može značajno unaprediti prepoznavanje bolesnika sa APA i povećati broj elektivno operisanih bolesnika. Edukacija vaskularnih hirurga o upotrebi posteriornog pristupa može unaprediti zdravstveni sistem.

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2023/06/30
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