Lečenje aneurizmi splanhničnih arterija – rezultati i iskustva jednog centra
Sažetak
Uvod/Cilj. Aneurizme visceralnih arterija (visceral artery aneurysms – VAAs) su retka, ali po život potencijalno opasna stanja. Sa porastom dostupnih dijagnostičkih i terapijskih mogućnosti, raste potreba za određivanjem optimalnog terapijskog pristupa–endovaskularna (EV) rekonstrukcija vs. otvorena hirurška (open surgery – OS) rekonstrukcija. Cilj rada bio je da se analiziraju ishodi lečenja obolelih od VAA u jednom centru i uporedi efikasnost EV i OS pristupa. Metode. Istraživanjem je obuhvaćeno 27 OS (OS grupa) ili EV (EV grupa) intervencija za VAA, sprovedenih u našoj ustanovi od januara 2010. do novembra 2023. godine, kod 27 bolesnika, 13 muškog i 14 ženskog pola prosečne starosti 57 ± 13 godina. Odluke o lečenju donosio je multidisciplinarni tim, koji su činili vaskularni hirurg, anesteziolog i interventni radiolog. Rezultati. Od ukupno 27 bolesnika, 9 je zbrinuto kao hitni slučajevi, od kojih je 6 imalo rupturu aneurizme. Najčešća je bila aneurizma slezinske arterije, 50,0% svih VAAs. Trinaest bolesnika podvrgnuto je EV rekonstrukciji, hibridnom pristupu 1 bolesnik, a OS rekonstrukciji 13 bolesnika. Tehnički uspeh bio je 24/27 ili 88,9%. Embolizacijom spiralama lečeno je 11 bolesnika, dok su 2 bolesnika lečena ugradnjom pokrivenog stenta. U grupi bolesnika lečenih EV putem nije bilo smrntih ishoda. Kod 14 bolesnika urađeno je OS hirurško lečenje sa 9 VAA resekcija i arterijskih rekonstrukcija (7 Dacron graftom, 1 politetrafluoroetilen graftom i 1 autovenskim graftom), uz 2 splenektomije i 3 isključenja aneurizme. Usled jakog krvarenja, 2 bolesnika su preminula tokom operacije, a jedan posle zahvata zbog crevnih ishemijskih komplikacija. Prosečno trajanje hospitalizacije posle OS ili EV procedure iznosilo je 7,43 i 4,92 dana, redom. Zaključak. Lečenje EV pristupom je bezbedno, sa manje invazivnosti i kraćim boravkom u bolnici i pogodno je za elektivne i hitne slučajeve, kada je to tehnički izvodljivo. Primena OS pristupa ostaje pouzdana mogućnost u centrima sa velikim brojem operacija, posebno za složene slučajeve koji nisu pogodni za EV pristup ili kod bolesnika sa niskim rizikom. Odluka o lečenju treba da bude vođena karakteristikama VAA (veličina, simptomi, lokacija, morfologija), komorbiditetima bolesnika i specifičnim kliničkim kontekstom, poput prethodnih abdominalnih operacija.
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