Primjena distalne aortne perfuzije u angiokirurškim rekonstrukcijama aneurizama torakoabdominalne aorte

master's thesis

• Title (english): Distal aortic perfusion in angio-surgical reconstructions of thoracoabdominal aortic aneurysms
• Author: Adam Vrbanić
• Mentor: Mladen Petrunić (mentor)
• Committee member: Tomislav Luetić (predsjednik povjerenstva)
• Committee member: Tomislav Meštrović (član povjerenstva)
• Committee member: Mladen Petrunić (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Surgery); Zagreb
• Defense date and country: 2016-07-15, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Surgery

Abstract

Otvorena je rekonstrukcija najznačajniji, najkorišteniji i najučinkovitiji terapijski pristup kod pacijenata s torakoabdominalnim aneurizmama aorte, s obzirom na visoki mortalitet i morbiditet koji prati to stanje. Međutim, sam terapijski postupak praćen je značajnim rizicima od komplikacija. Komplikacije su uglavnom rezultat privremenog prekida protoka kroz aortu i posljedične ishemije organa, prije svega kralježnične moždine s razvojem parapareze ili paraplegije. Stoga su razvijene različite dodatne metode zaštite (eng. „adjuncts“) kojima se smanjuje morbiditet i mortalitet otvorene rekonstrukcije, poput distalne aortne perfuzije, likvorske drenaže, selektivne visceralne perfuzije, lokalne i sistemske hipotermije, upotrebe medikamenata i druge. Metode distalne aortne perfuzije omogućuju perfuziju visceralnih organa i kralježnične moždine za vrijeme prekida protoka kroz aortu, smanjuju hemodinamsku nestabilnost i učestalost posljedičnih ishemijskih komplikacija, omogućuju dulje trajanje prekida protoka kroz aortu, a neke i pojednostavljuju prišivanje aortnih ogranaka na graft. Bez obzira na korist od distalne aortne perfuzije, pristup liječenju torakoabdominalnih aneurizmi aorte je multimodalan, s istovremenom upotrebom više zaštitnih metoda, u svrhu postizanja što boljeg postoperativnog ishoda. Tako je najčešće primjenjivana i najistraženija kombinacija distalne perfuzije aorte i drenaže cerebrospinalnog likvora, s visokom učinkovitošću u sprječavanju ishemijskih oštećenja kralježničke moždine. Bez obzira na sve navedene metode, angiokirurške rekonstrukcije torakoabdominalnih aneurizmi aorte i danas predstavljaju veliki izazov u vaskularnoj kirurgiji te je potrebno uložiti dodatne napore s ciljem otkrivanja što boljih kombinacija postojećih tehnika zaštite, ali i napore za traganjem i otkrivanjem novih tehnika.

Abstract (english)

Open surgical reconstruction is the most important, the most frequently used and the most efficient therapeutic approach in patients with thoracoabdominal aortic aneurysms, due to high mortality and morbidity accompanying this condition. However, the therapeutic procedure itself is accompanied by significant complication risks. Complications are mostly the result of the aortic “clamping time” and the resulting ischemic organ damages, primarily of spinal cord, with development of paraparesis or paraplegia. Various additional protective methods (adjuncts) have been developed, which decrease morbidity and mortality of the open reconstruction, like distal aortic perfusion, cerebrospinal fluid drainage, selective visceral perfusion, local and systemic hypothermia, the use of medications and others. Distal aortic perfusion methods enable the decrease of haemodynamic instabilities and consequential ischemic complications, provide the opportunity for prolonging the aortic clamping time and some of the methods simplify reimplantation of aortic branches to a graft. Regardless of the isolated benefits of the distal aortic perfusion, the approach to the treatment of thoracoabdominal aortic aneurysms is mostly multimodal with the concomitant use of several protective methods in order to achieve the best possible postoperative outcome. Thus, the combination of distal aortic perfusion and cerebrospinal fluid drainage is the most widely used and studied method, with high efficiency in preventing ischemic damages to the spinal cord. Despite all the mentioned methods, vascular surgical reconstructions of thoracoabdominal aortic aneurysms are still a great challenge in the vascular surgery, so additional efforts should be put in to find the best combinations of the existing protective techniques, but also to search for and find new techniques.

• Keywords: aneurizma aorte; otvorena rekonstrukcija; distalna aortna perfuzija; ishemija; parapareza; paraplegija
• Keywords (english): aortic aneurysm; open reconstruction; distal aortic perfusion; ischemia; paraparesis; paraplegia
• Language: croatian
• URN:NBN: urn:nbn:hr:105:711091
• Study programme: Title: Medicine; 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: 2017-07-07 09:17:46