Sindrom krađe krvi potključne arterije – hirurško ili endovaskularno lečenje

  • Vladimir Z Cvetić Clinical Center of Serbia, Clinic for Vascular and Endovascular Surgery, Belgrade, Serbia
  • Momčilo Čolić Clinical Center of Serbia, Clinic for Vascular and Endovascular Surgery, Belgrade, Serbia
  • Oliver Radmili Clinical Center of Serbia, Clinic for Vascular and Endovascular Surgery, Belgrade, Serbia
  • Igor Banzić Clinical Center of Serbia, Clinic for Vascular and Endovascular Surgery, Belgrade, Serbia; University of Belgrade, Faculty of Medicine, Belgrade, Serbia
  • igor Končar Clinical Center of Serbia, Clinic for Vascular and Endovascular Surgery, Belgrade, Serbia; University of Belgrade, Faculty of Medicine, Belgrade, Serbia
  • Borivoje Lukić Clinical Center of Serbia, Clinic for Vascular and Endovascular Surgery, Belgrade, Serbia
  • Lazar Davidović Clinical Center of Serbia, Clinic for Vascular and Endovascular Surgery, Belgrade, Serbia; University of Belgrade, Faculty of Medicine, Belgrade, Serbia
DOI: https://doi.org/10.2298/VSP160215215C
Ključne reči: subclavian artery||, ||a. subclavia, subclavian steal syndrome||, sindrom promene toka krvi, angioplasty||, ||angioplastika, stents||, ||stentovi, blood vessel prosthesis||, ||krvni sud, proteza, endovascular procedures||, ||endovaskularne procedure, vascular procedures, operative||, ||hirurgija, operativne procedure,

Sažetak


Uvod/Cilj. Sindrom “krađe” krvi potključne arterije uzrokovan je okluzijom ili stenozom proksimalnog segmenta potključne arterije sa njenim posledičnim retrogradnim punjenjem putem ipsilateralne vertebralne arterije. Cilj ovog rada bio je poređenje hirurške [karotido-supklavijalni bajpas (KSBP)] i endovaskularne metode [perkutana translumenska angioplas-tika (PTA) i stenting] sa aspekta ranih i udaljenih rezultata. Metode. Trideset bolesnika [16 (53,33%) muškaraca, prosečne starosti 60,1 ± 8,25 godina tretirano je KSBP i poređeno sa grupom od 40 bolesnika [18 (45%) muškaraca], prosečne starosti 57,75 ± 6,15 godina koji su tretirani PTA i stentingom potključne arterije. Rani i udaljeni rezultati su verifikovani razlikom u segmentnim pritiscima ruku, kliničkim i ultrasonografskim/angiograf-skim pregledom. Svi bolesnici su praćeni nakon mesec dana, 6 meseci i 12 meseci, a jednom godišnje nakon toga. Rezultati. Prosečni period praćenja iznosio je 22,37 ± 11,95 meseci. Utvrđene su 2 (6,67%) periproceduralne komplikacije u KSPB grupi (tranzitorni ishemijski atak kod 2 bolesnika) i 3 (7,5%) u PTA i stenting grupi (disekcija i distalna embolizacija kod jednog bolesnika, i hematom na mestu punkcije takođe kod jednog bolesnika). U KSPB grupi razlika u sistolnim pritiscima dve brahijalne arterije iznosila je: 42,6 ± 14,5 vs 4,75 ± 12,94 mmHg (p < 0,05), a u PTA i stenting grupi: 41,2 ± 15,35 vs 3,58 ± 5,83 mmHg (p < 0,05). Udaljeni uspeh u bypass grupi bio je 93,33%, a u PTA i stenting grupi 92,5% (p = 0,83). Zaključak. Obe metode, KSBP i PTA i stenting potključne arterije su bezbedne, efikasne i trajne. Imaju slične rane i udaljene rezultate. Tehnika PTA i stenting metod su izbora kod hemodinamski značajnih stenoza, subokluzija i segmentnih okluzija potključne arterije. KSBP je indikovan u slučaju difuznih okluzivnih lezija, ukoliko je PTA i stenting neuspešan ili ako se iskomplikuje.

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Objavljeno
2018/08/23
Broj časopisa
Vol. 74 Br. 12 (2017)
Rubrika
Originalni članak