Anatomske varijacije poplitealne arterije kao faktor rizika za njenu laceraciju prilikom totalne artroplastike kolena: kontroverze uz ilustrativni prikaz slučaja

  • Jelena Boljanović asistentUniversity of Belgrade, Faculty of Medicine, Institute of Anatomy “Niko Miljanić”, Belgrade, Serbia
  • Miodrag Glišić Institute for Orthopedic Surgery “Banjica”, Belgrade, Serbia
  • Nenad Ilijevski Institute for Cardiovascular Diseases “Dedinje”, Belgrade, Serbia
  • Matija Bećirović Institute for Orthopedic Surgery “Banjica”, Belgrade, Serbia
  • Smiljana Stojanović University of Belgrade, Faculty of Medicine, Laboratory for Vascular Anatomy, Belgrade, Serbia
  • Ivana Pavković Institute for the Improvement of Life Activities, Belgrade, Serbia
  • Katarina Djurdjević University of Belgrade, Faculty of Medicine, Institute of Anatomy “Niko Miljanić”, Belgrade, Serbia
  • Valentina Blagojević University of Belgrade, Faculty of Medicine, Institute of Anatomy “Niko Miljanić”, Belgrade, Serbia
DOI: https://doi.org/10.2298/VSP241005021B
Ključne reči: artritis, reumatoidni;, artroplastika kolena;, angiografija, tomografska, kompjuterizovana;, intraoperativne komplikacije;, faktori rizika;, a. poplitea;, lečenje, ishod.

Sažetak


Uvod. Povreda poplitealne arterije (PA) tokom operacije zamene zgloba kolena je retka ali izuzetno ozbiljna komplikacija. Većina vaskularnih komplikacija prilikom operacija kolena može se sprečiti pažljivim preoperativnim pregledom bolesnika. Prikaz bolesnika. Predstavljamo slučaj 51-godišnje žene koja je primljena u bolnicu na rutinsku operaciju totalne artroplastike kolena (TAK) zbog reumatoidnog artritisa. Bolesnica je operisana standardnim medijalnim parapatelarnim pristupom u spinalnoj anesteziji. Korišćen je implant sa fiksnim ležajem. Operacija je uspešno obavljena ali je nakon otpuštanja poveske došlo do prekomernog krvarenja, što je ukazalo na moguću povredu PA, te je poveska ponovo postavljena. Povreda PA je uočena nakon eksploracije poplitealne regije, dok zadnja kapsula nije bila oštećena. Revaskularizacija Dacron vaskularnim graftom je odmah urađena. Trećeg dana nakon operacije, bolesnica je imala tegobe koje su izazvale sumnju na okluziju grafta te je prebačena na Kliniku za kardiovaskularnu hirurgiju. Angiografija multidetetorskom kompjuterizovanom tomografijom je potvrdila totalnu okluziju poplitealnog Dacron grafta i urađena je operacija. Okludirani graft je uklonjen i poplitealno-tibioperonealni bajpas je urađen korišćenjem autolognog grafta vene safene magne. Urađene su i bočne i zadnje fasciotomije. Na tromesečnom kontrolnom pregledu bolesnica je ostala asimptomatska sa poboljšanjem funkcije dorzalne fleksije skočnog zgloba. Zaključak. Preoperativna ispitivanja mogu pomoći u identifikaciji bolesnika koji imaju najveći rizik od komplikacija PA tokom TAK. Ako dođe do vaskularnih komplikacija, rano prepoznavanje i hitna intervencija vaskularnog hirurga su esencijalni u pozitivnom ishodu lečenja.

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Objavljeno
2025/04/29
Broj časopisa
Vol. 82 Br. 04 (2025): Vojnosanitetski pregled
Rubrika
Prikaz bolesnika