Title Kirurško liječenje bolesti torakalne aorte Title (english) Surgical treatment of thoracic aortic disease Author Antun Lipšinić Mentor Predrag Pavić (mentor)Committee member Damir Halužan (predsjednik povjerenstva)Committee member Tomislav Meštrović (član povjerenstva)Committee member Predrag Pavić (član povjerenstva)Granter University of Zagreb Defense date and country 2021-07-16, Croatia Scientific / art field, BIOMEDICINE AND HEALTHCARE Abstract Aneurizma torakalne aorte (engl. thoracic aortic aneurism, TAA) označava lokalno proširenje aorte koje najčešće nastaje kao posljedica ateroskleroze i tada se naziva degenerativna aneurizma aorte, a njezin razvoj uvjetovan je složenom interakcijom genetskih čimbenika, stanične neravnoteže i promjene hemodinamskih čimbenika. U Republici Hrvatskoj se godišnje dijagnosticira oko 50 slučajeva TAA. Tijekom posljednjih desetljeća je primijećen porast incidencije TAA, što se smatra posljedicom
... More mnogobrojnih čimbenika, kao što su napredak u tehnici slikovne dijagnostike i starenje populacije. Čimbenicima rizika za ubrzavanje razvoja aneurizme smatraju se bijela rasa, dob iznad 60 godina, muški spol, kronična opstruktivna plućna bolest, hipertenzija, pušenje i naslijeđe. TAA se češće pojavljuje u mlađih pacijenata koji boluju od raznih bolesti vezivnoga tkiva i u pacijenata s obiteljskom TAA i disekcijom. Otvorena rekonstrukcija je nekada bila uobičajen i klasičan način liječenja bolesti torakalne aorte, a danas se za liječenje te patologije preferira torakalni endovaskularni postupak postavljanja stent-grafta (engl. thoracic endovascular aortic reconstruction, TEVAR). Tijekom otvorene rekonstrukcije torakalne aorte vaskularnim se hvataljkama privremeno prekine krvotok kroz aneurizmu, ona se otvori, iz nje se izljušti tromb, podvežu se svi ogranci aneurizme (interkostalne arterije) i distalni krvotok se rekonstruira umetanjem dakronskoga ili teflonskoga transplantata između proksimalnog i distalnog zdravog dijela aorte. Indikacije za operaciju aneurizme aorte dijelimo na vitalne, apsolutne i relativne, a vitalne indikacije za operaciju aneurizme aorte su postojanje rupture, odnosno zadržane rupture aneurizme aorte i simptomatske aneurizme aorte koja je predznak rupture. Predoperativna obrada u kirurškom liječenju bolesti torakalne aorte sastoji se od uzimanja detaljne anamneze, provođenja fizikalnog pregleda i analize laboratorijskih nalaza, EKG-a i radioloških nalaza. S posebnom pozornošću se prije operacije trebaju analizirati srčana, plućna i bubrežna funkcija pacijenta. Najčešće komplikacije otvorene operacije torakalne aorte su: akutno bubrežno zatajenje i ishemija kralješnične moždine, a rezultat su privremene ishemije tijekom operacije. Postupci kojima se smanjuje rizik nastanka postoperativnih komplikacija su: distalna aortna perfuzija, intraoperacijska i postoperacijska drenaža cerebrospinalnog likvora i hipotermija. TEVAR je endovaskularni postupak postavljanja aortnog stent-grafta u torakalnu aortu. TEVAR ima manji mortalitet i morbiditet u usporedbi s kirurškim pristupom, a neke od komplikacija zahvata su oštećenje periferne vaskulature, ishemijski moždani udar i „popuštanje“ (engl. endoleak). Less Abstract (english) Thoracic aortic aneurysm (TAA) is a local aortic dilatation that most often occurs as a result of atherosclerosis and is then called a degenerative aortic aneurysm. It´s development is conditioned by a complex interaction of genetic factors, cellular imbalance and changes in hemodynamic factors. In the Republic of Croatia, about 50 cases of TAA are diagnosed annually. An increase in the incidence of TAA has been observed in recent decades, which is considered to be the result of many
... More factors, such as advances in imaging techniques and population aging. Risk factors for accelerating the development of aneurysms are caucasian descent, age over 60 years, male gender, chronic obstructive pulmonary disease, hypertension, smoking and heritage. TAA occurs more frequently in younger patients suffering from various connective tissue diseases and in patients with familial TAA and dissection. Open reconstruction was once a common and classic way of treating thoracic aortic disease and today thoracic endovascular aortic reconstruction (TEVAR) is preffered. During open thoracic aortic reconstruction, blood flow through the aneurysm is temporarily interrupted with vascular forceps, the aneurism is opened, thrombus is peeled off, all branches of the aneurysm are ligated and the distal blood flow is reconstructed by inserting a dacron or teflon graft between the proximal and distal healthy part of the aorta. Indications for aortic aneurysm surgery are divided into vital, absolute and relative. Vital indications for aortic aneurysm surgery are the existence of a rupture, delayed rupture of an aortic aneurysm and symptomatic aortic aneurysm which is a sign of rupture. Preoperative evaluation in the surgical treatment of thoracic aortic disease consists of taking a detailed medical history, conducting a physical examination, and analyzing laboratory findings, ECG, and radiological findings. The patient's cardiac, pulmonary, and renal function should be analyzed with special care prior to surgery. The most common complications of open thoracic aortic surgery are: acute renal failure and spinal cord ischemia, resulting from temporary ischemia during surgery. Procedures that reduce the risk of postoperative complications are: distal aortic perfusion, intraoperative and postoperative drainage of cerebrospinal fluid and hypothermia. TEVAR is an endovascular procedure for placing an aortic stent-graft in the thoracic aorta. TEVAR has a lower mortality and morbidity compared to the surgical approach and some of the complications of the procedure are damage to the peripheral vasculature, ischemic stroke and endoleak. Less Keywords
aneurizma torakalne aorte
aneurizma torakoabdominalne aorte
otvorena rekonstrukcija
TEVAR
Keywords (english)
thoracic aortic aneurism
thoracoabdominal aortic aneurism
open reconstruction
TEVAR
Language croatian URN:NBN urn:nbn:hr:105:630836 Study programme Title: Medicine Type of resource Text File origin Born digital Access conditions Open access Terms of use Created on 2022-03-07 13:14:07
