| Abstract | Sindromi kod kojih je krvna žila pritisnuta ili uklještena drugim okolnim strukturama nazivaju se sindromima vaskularne kompresije. Po etiologiji se mogu podijeliti na stečene i kongenitalne, ali također i na sindrome nastale kompresijom mekog tkiva, kostiju, arterija, ligamenata, fibroznog tkiva, mišića i ostalih struktura koje pritišću vaskularne strukture. U ovom radu opisani su sindrom gornjeg otvora prsišta, sindrom orašara, anomalije koronarnih arterija, sindrom aduktornog kanala, Eagle sindrom, sindrom hipotenarnog čekića, May-Thurnerov sindrom, Dunbarov sindrom, sindrom lateralnog pazušnog otvora te sindrom kompresije poplitealne arterije. Simptomi se razlikuju zbog anatomske strukture koja je zahvaćena te variraju od boli, edema, bljedila do hematurije i aritmija. Patofiziološki mehanizam oštećenja započinje ozljedom i odgovorom endotela krvne žile zbog dugotrajne kompresije strukture na vanjski dio krvne žile. Komplikacije koje se mogu javiti su stenoza, poststenotička dilatacija, aneurizma te okluzije. Dijagnoza se postavlja na temelju anamneze, fizikalnog pregleda te neke od slikovnih dijagnostičkih metoda, ovisno koju strukturu želimo prikazati. Bitno je isključiti druge uzroke kompresije kao što su tumorske mase ili limfadenopatija jer im je incidencija veća, nego kod ovih sindroma. Vrlo često se koriste ultrazvučne metode u početnoj dijagnostičkoj obradi. Liječenje ovih sindroma može biti konzervativno, endovaskularno ili se pak mogu koristiti metode otvorene kirurgije jer je najčešće potrebno ukloniti uzrok kompresije kako bi došlo do poboljšanja. Kirurško liječenje komplikacija koje su nastale uslijed dugog djelovanja kompresije na žilu također je prisutno. Moderne metode dekompresije uključuju i laparoskopsku tehniku te robotski asistiranu kirurgiju, čija je primjena sve učestalija. Endovaskularne tehnike uključuju katetersku trombolizu, perkutanu mehaničku trombektomiju i perkutanu transluminalnu angioplastiku, dok se u otvorenoj kirurgiji najčešće koriste premosnice, trombektomija, trombendarterektomija, embolektomija i plastika zakrpom. |
| Abstract (english) | Syndromes where a blood vessel is pressed or entrapped by other surrounding structures are called vascular compression syndromes. By etiology, they can be divided into acquired and congenital, but also into syndromes caused by compression of soft tissue, bones, arteries, ligaments, fibrous tissue, muscles and other structures that exert compression on vascular structures. This paper describes upper thoracic outlet syndrome, Nutcracker syndrome, coronary artery anomalies, adductor canal syndrome, Eagle syndrome, Hypothenar hammer syndrome, May-Thurner syndrome, Dunbar syndrome, Quadrilateral Space Syndrome and popliteal artery compression syndrome. Symptoms differ due to the anatomical structure that is affected and vary from pain, edema, pallor to hematuria and arrhythmias. The pathophysiological mechanism of damage begins with the injury and response of the blood vessel endothelium, due to long-term compression of the structure on the outer part of the blood vessel. Complications that can occur are stenosis, post-stenotic dilation, aneurysm and occlusion. The diagnosis is based on history, physical examination and one of the imaging diagnostic methods, depending on which structure we want to review. It is important to rule out other causes of compression such as tumor masses or lymphadenopathy because they have higher incidence. Ultrasound methods are very often used in the initial diagnostic process. The treatment of these syndromes can be conservative, endovascular, or open surgery methods can be used, because it is usually necessary to remove the cause of compression for improvement. Surgical treatment of complications caused by the long-term effect of compression on the vessel is also present. Modern methods include laparoscopic technique and robot-assisted surgery, the use of which is becoming more frequent. Most frequently employed endovascular techniques are catheter thrombolysis, percutaneous mechanical thrombectomy and percutaneous transluminal angioplasty, while open surgery usually involves bypass, thrombectomy, thrombendarterectomy, embolectomy and patch angioplasty. |
