Common pitfalls in abdominal aortic surgery and how to deal with them

master's thesis

• Title (croatian): Uobičajene zamke u operaciji abdominalne aorte i kako se s njima nositi
• Author: Hettiarachchige Tikiri Ooshadhi Shalane Perera
• Mentor: Tomislav Meštrović (mentor)
• Committee member: Tomislav Meštrović (predsjednik povjerenstva)
• Committee member: Predrag Pavić (član povjerenstva)
• Committee member: Anko Antabak (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Surgery); Zagreb
• Defense date and country: 2024-07-12, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Surgery

Abstract

An aneurysm is a focal enlargement of an artery to 1.5 times its normal diameter or more. Most abdominal aortic aneurysms are asymptomatic until they rupture, but some are detected when an imaging study is done for other purposes. The risk factors for abdominal aortic aneurysms are smoking, male sex, age (above sixty-five), hypertension, ischemic heart disease, peripheral vascular disease and positive family history. There are many different modalities that can be used to diagnose an abdominal aortic aneurysm, but ultrasonography is used for screening since it is economical and doesn't expose the patients to ionizing radiation. Abdominal aortic aneurysm can be managed either medically or surgically. Medical management involves therapy to reduce cardiovascular risk factors and quitting smoking, which is appropriate for asymptomatic individuals with smaller aneurysm sizes. The need for surgical intervention for abdominal aortic aneurysms is based on the size (diameter of 5.0 cm or greater for women and 5.5 cm or greater for men), the rate of progression and the presence of symptoms. While a symptomatic aneurysm needs to be treated urgently (as it is a sign of impending rupture), since rupture of the abdominal aortic aneurysm is a medical emergency that requires immediate repair. There are two primary methods of abdominal aortic aneurysm repair: open and endovascular (EVAR). EVAR is preferred over open surgical intervention, due to its lower morbidity and mortality rates, minimal invasiveness, shorter length of hospital stay, and lower rate of complications such (as myocardial infarction, respiratory failure,
renal failure, colonic ischemia and graft infections). On the other hand, EVAR has demonstrated specific complications related to increased long-term morbidity and mortality, such as endoleaks and stent-graft migration. The aim of this study is to elucidate
the common pitfalls in open and endovascular repair of abdominal aortic aneurysms, and the prevention and treatment of complications.

Abstract (croatian)

Aneurizma je žarišna dilatacija arterije na 1,5 puta njezinog normalnog promjera ili više. Većina aneurizama abdominalne aorte je asimptomatska sve dok ne pukne, iako se neke otkriju kada se radi slikovna studija u druge svrhe. Čimbenici rizika za nastanak aneurizme abdominalne aorte su pušenje, muški spol, dob iznad šezdeset i pet godina, hipertenzija, ishemijska bolest srca, periferne vaskularne bolesti i pozitivna obiteljska anamneza. Postoji mnogo različitih modaliteta koji se mogu koristiti za dijagnosticiranje aneurizme trbušne aorte, ali ultrazvuk se koristi za probir jer je ekonomičan i ne izlaže pacijente ionizirajućem zračenju. Aneurizma abdominalne aorte može se liječiti konzervativno ili kirurški. Konzervativno liječenje uključuje terapiju za smanjenje kardiovaskularnih čimbenika rizika i prestanak pušenja, što je prikladno za asimptomatske osobe s manjom veličinom aneurizme. Potreba za kirurškom intervencijom kod aneurizme abdominalne aorte temelji se na veličini (promjer 5,0 cm ili veći za žene i 5,5 cm ili veći za muškarce), brzini progresije i prisutnosti simptoma. Dok simptomatsku aneurizmu treba hitno liječiti (kao znak prijeteće rupture), ruptura aneurizme trbušne aorte je emergentno medicinsko stanje koje zahtijeva trenutni popravak. Postoje dvije primarne metode popravka aneurizme abdominalne aorte:
otvorena i endovaskularna (EVAR). EVAR se preferira u odnosu na otvorenu kiruršku intervenciju, zbog manje neposredne stope morbiditeta i mortaliteta, minimalne invazivnosti i potrebe za kraćim boravkom u bolnici te zbog manje stope komplikacija kao što su infarkt miokarda, respiratorno zatajenje, zatajenje bubrega, ishemija debelog crijeva i infekcije presatka. S druge strane, EVAR je pokazao specifične komplikacije povezane s povećanim dugoročnim morbiditetom i mortalitetom, kao što su endoleak i migracija stent-grafta. Cilj ove studije je razjasniti uobičajene zamke kod otvorenog i
endovaskularnog popravka aneurizama abdominalne aorte, kako bi se poboljšala prevencija i liječenje komplikacija.

• Keywords: Abdominal Aortic Aneurysms; Pitfalls; Complications; EVAR; Open Surgery; Reintervention
• Keywords (croatian): aneurizma abdominalne aorte; komplikacije i problemi; reintervencija
• Language: english
• URN:NBN: urn:nbn:hr:105:779195
• Study programme: Title: Medicine (in English language); Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2024-10-21 07:50:33