Kirurško liječenje torakoabdominalnih aneurizama aorte

master's thesis

• Title (english): Surgical treatment of thoracoabdominal aortic aneurysms
• Author: Klara Macan
• Mentor: Predrag Pavić (mentor)
• Committee member: Tomislav Meštrović (predsjednik povjerenstva)
• Committee member: Anko Antabak (član povjerenstva)
• Committee member: Predrag Pavić (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Surgery); Zagreb
• Defense date and country: 2023-07-13, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Surgery

Abstract

Torakoabdominalna aneurizma aorte (TAAA) je degenerativna bolest aorte u kojoj dolazi do postupnog proširenja njenog promjera za 50% više od normalnih granica. TAAA čine oko 2% ukupnog broja aneurizama aorte te su ujedno i najrjeđe. Čimbenici rizika koji ubrzavaju razvoj aneurizme uključuju: arterijsku hipertenziju, koronarnu bolest, šećernu bolest, muški spol, starije od 70 godina, bijela rasa, pušenje, kroničnu opstruktivnu plućnu bolest te bubrežno zatajenje. Prema Crawfordovoj klasifikaciji modificiranoj prema Safiju dijelimo ih na 5 tipova. TAAA većinom su asimptomatske te se najčešće otkriju slučajno tijekom kliničkog pregleda. Pacijenti sa simptomatskom TAAA većinom se prezentiraju s oštrom i konstantnom boli u području abdomena, u leđima, prsima, u slabinama ili u preponama. Pretrage koje se koriste za početno postavljanje dijagnoze TAAA su nativni rendgenogram i ultrazvuk, dok se u preoperativnoj obradi najčešće koristi MSCT aortografija s kontrastom. Otvorena je rekonstrukcija zlatni standard liječenja TAAA, no povezuje se s visokim operativnim mortalitetom i perioperativnim komplikacijama. Endovaskularni i hibridni pristup predstavljaju alternativne opcije za visokorizične pacijente. TEVAR označava endovaskularni postupak postavljanja torakalnog aortnog stent-grafta, dok su BEVAR/FEVAR oblici totalnog endovaskularnog popravka TAAA koji ne zahtijevaju ni torakotomiju ni laparotomiju. Hibridni popravak TAAA kombinacija je otvorenog i endovaskularnog pristupa.

Abstract (english)

Thoracoabdominal aortic aneurysm (TAAA) is a degenerative aortic disease in which the diameter of the aorta gradually expands by more than 50% of its normal limits. TAAA make 2% of total number of aortic aneurysms and are the rearest. Risk factors associated with accelerated development of aneurysms are hypertension, coronary disease, diabetes, male gender, age over 70 years, caucasian descent, smoking, chronic obstructive pulmonary disease and renal failure. According to Safi’s modification of Crawford TAAA classification there are 5 types of TAAA. They are mostly asymptomatic and discovered during physical examination. Patients with symptomatic TAAA usually experience sharp and constant pain in their abdomen, back, chest, loins or groins. Initial diagnostic tests include RTG and ultrasound while MSCT aortography with contrast is mostly used in preoperative assessment. Open repair is the gold standard treatment of TAAAs but it is associated with high rates of operative mortality and perioperative complications. Endovascular and hybrid treatment provide alternative options for high-risk patients. TEVAR is an endovascular procedure during which an aortic stent-graft is placed in the thoracic aorta while BEVAR/FEVAR are types of total endovascular aneurysm repair that do not require neither thoracotomy nor laparotomy. Hybrid TAAA repair is a combination of open and endovascular approach.

• Keywords: torakoabdominalna aneurizma aorte; otvorena rekonstrukcija; TEVAR; BEVAR/FEVAR; hibridni popravak
• Keywords (english): thoracoabdominal aortic aneurysm; open reconstruction; TEVAR; BEVAR/FEVAR; hybrid repair
• Language: croatian
• URN:NBN: urn:nbn:hr:105:781224
• 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: 2023-10-26 09:35:08