Problematika interventno-radiološkog pristupa na femoralnoj i poplitealnoj arteriji

master's thesis

• Title (english): Problems of interventional radiology access to the femoral and popliteal arteries
• Author: Filip Opančar
• Mentor: Vinko Vidjak (mentor)
• Committee member: Marko Ajduk (predsjednik povjerenstva)
• Committee member: Ivica Sjekavica (član povjerenstva)
• Committee member: Vinko Vidjak (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Radiology); Zagreb
• Defense date and country: 2019-07-12, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Radiology

Abstract

Femoralna arterija neposredni je nastavak a. iliaca externa i najveća je opskrbna žila noge. Pruža se od lacuna vasorum ispod ingvinalnog ligamenta do distalnog otvora aduktornog kanala, gdje se nastavlja u poplitealnu arteriju. Obije arterije histološki spadaju u mišićne arterije. Periferna arterijska bolest (PAD) česta je bolest cirkulacije u kojoj suženje arterija uzrokuje smanjen dotok krvi u ekstremitete. U nogama simptomi arterijske insuficijencije pojavljuju se kao bolni grčevi u mišićima pri hodu koji se nazivaju intermitentne klaudikacije. Ateroskleroza je multifaktorijalna bolest, koja uzrokuje PAD, tijekom koje dolazi do odlaganja lipida u intimu i u mediju arterija. U dijagnostici PAD-a prvo se izvode neinvazivni hemodinamski testovi poput ankle brachial indexa (ABI), druga linija dijagnostike je Doppler ultrazvuk te slijede računalna tomografska angiografija (CTA), magnetska rezonantna angiografija (MRA) i digitalna subtrakcijska angiografija (DSA) koja je zlatni standard. Prema smjernicama za liječenje PAD-a Europskog kardiološkog društva iz 2017. godine preporuča se prestanak pušenja, zdrava prehrana, fizička aktivnost i primjena statina u svih pacijenata. Bypass operacija koristeći venu safenu magnu kao graft češći je pristup u lezija duljih od 25 cm od endovaskularnog. Endovaskularne metode postale su uobičajen način liječenja PAD-a zbog njihove minimalne invazivnosti i povezanosti sa smanjenjem kratkoročnog morbiditeta i mortaliteta. Ipak, u površinskoj femoralno i poplitealnoj arteriji (FPA), čak i najnovije tehnologije i dalje pokazuju kliničke rezultate koji ostavljaju značajan prostor za poboljšanje. Jedan od glavnih faktora za koje se smatra da je povezan s neuspjehom stenta u FPA jedinstveni je i visoko dinamički mehanički okoliš donjeg ekstremiteta. U ovom diplomskom radu objavljuju se preliminarni rezultati istraživanja vezanog za uspjeh endovaskularnog zahvata na femoro-poplitealnom segmentu (FPS) provedenog tijekom 2016./2017. godine u Kliničkoj bolnici „Merkur“.

Abstract (english)

The femoral artery is a direct continuation of a. iliaca externa and the main arterial supply to the leg. It lies between lacuna vasorum below the inguinal ligament and the distal passage of the adductor channel, where it becomes the popliteal artery. Both arteries histologically belong to the muscular arteries. Peripheral arterial disease (PAD) is a common circulation disease in which narrowing of the arteries cause reduced blood flow to the extremities. The symptoms of arterial insufficiency appear as painful muscle cramps of the legs called intermittent claudication. Atherosclerosis is a multifactor disease, which causes PAD, in which lipids are deposited in the intima and media of the artery. In the PAD diagnosis, non-invasive hemodynamic tests such as the ankle brachial index (ABI) are performed first, the second line of diagnostics is Doppler ultrasound followed by computed tomography angiography (CTA), magnetic resonance angiography (MRA) and digital subtraction angiography (DSA) which is the gold standard. 2017 European Society for Cardiology guidelines recommend smoking cessation, healthy diet, physical activity and statins use in all patients with PAD. Bypass surgery is indicated for lesions longer than 25 cm when an autologous great saphenous vein is available. Endovascular methods have become a common option of treating PAD due to their minimal invasiveness and association with the reduction of short-term morbidity and mortality. However, in superficial femoral and popliteal arteries (FPA), even the latest technologies still show clinical results that leave significant room for improvement. One of the main factors considered to be associated with failure of the stent in the FPA is the unique and highly dynamic mechanical environment of the lower extremity. This graduate thesis publishes preliminary findings of the research related to the success of endovascular surgery on the femoropopliteal segment (FPS) performed during 2016/2017 at the Clinical Hospital "Merkur".

• Keywords: femoroalna arterija; poplitealna arterija; periferna arterijska bolest; liječenje
• Keywords (english): femoral artery; popliteal artery; peripheral arterial disease; treatment
• Language: croatian
• URN:NBN: urn:nbn:hr:105:857681
• 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: 2020-02-17 15:19:50