Kirurško liječenje i prevencija komplikacija nakon TEVAR-a

master's thesis

• Title (english): Surgical managment and prevention of complications after TEVAR
• Author: Mara Parentić
• Mentor: Tomislav Meštrović (mentor)
• Committee member: Predrag Pavić (predsjednik povjerenstva)
• Committee member: Anko Antabak (član povjerenstva)
• Committee member: Tomislav Meštrović (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Surgery); Zagreb
• Defense date and country: 2024-07-12, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Surgery

Abstract

Torakalni endovaskularni aortalni popravak (TEVAR) je minimalno invazivan zahvat koji se prvenstveno koristi za liječenje torakalnih i torakoabdominalnih aneurizmi, akutnog aortalnog sindroma, kronične disekcije i traumatskih ozljeda aorte. Iako TEVAR zbog svoje minimalno invazivne prirode nudi brojne prednosti u odnosu na otvoreni kirurški zahvat, on može uzrokovati razne komplikacije uključujući hematome i pseudoaneurizme na mjestu pristupa, endoleakove, infekcije ili migracije grafta, neurološke komplikacije poput ishemije leđne moždine ili moždanog udara te druge ishemijske probleme. Također, može doći do retrogradne disekcije, ishemije crijeva, oštećenja bubrega i formiranja fistula između aorte i gastrointestinalnog ili plućnog sustava. Prevencija ovih komplikacija je ključna za uspješan ishod TEVAR-a. Ona uključuje temeljitu predoperativnu evaluaciju bolesnika i pažljivo planiranje svakog zahvata detaljnom analizom slikovne dijagnostike. Potrebno je procijeniti anatomsku morfologiju svakog bolesnika kako bi se odabrao odgovarajući endograft i smanjio rizik zahvata. Osim detaljne procjene, ključna je pažljiva i precizna izvedba endovaskularnog zahvata, kao i dugoročno praćenje bolesnika kako bi se na vrijeme prepoznale i spriječile komplikacije. Kirurško liječenje komplikacija nakon TEVAR-a često je neophodno kada endovaskularne reintervencije nisu uspješne ili izvedive. Najčešće se kirurški liječe hematomi i pseudoaneurizme koje nastaju nakon perkutanih endovaskularnih pristupa. Ostale komplikacije koje zahtijevaju kirurški pristup uključuju endoleakove, retrogradnu disekciju, infekciju endografta i nastale ishemijske komplikacije. Kirurške metode obično uključuju eksplantaciju neuspjelog stent grafta i otvoreni kirurški popravak aorte tijekom kojeg se postavlja sintetička proteza.

Abstract (english)

Thoracic Endovascular Aortic Repair (TEVAR) is a minimally invasive procedure primarily used for the treatment of thoracic and thoracoabdominal aneurysms, acute aortic syndrome, chronic dissection, and traumatic aortic injuries. Although TEVAR offers numerous advantages over open surgical repair due to its minimally invasive nature, it can cause various complications, including hematomas and pseudoaneurysms at the access site, endoleaks, graft infections or migrations, neurological complications such as spinal cord ischemia or stroke, and ischemic problems. Additionally, retrograde dissection, intestinal ischemia, kidney damage, and the formation of fistulas between the aorta and the gastrointestinal or pulmonary systems can occur. Preventing these complications is crucial for the successful outcome of TEVAR. This involves a thorough preoperative evaluation of the patient and careful planning of each procedure through detailed analysis of diagnostic images. It is necessary to assess the anatomical morphology of each patient to select the appropriate endograft and reduce procedural risks. In addition to detailed assessment, precise and careful execution of the endovascular procedure is essential, as well as long-term monitoring of the patient to detect and prevent complications in a timely manner. Surgical treatment of complications following TEVAR is often necessary when endovascular reinterventions are unsuccessful or not feasible. Hematomas and pseudoaneurysms that occur after percutaneous endovascular access are most commonly treated surgically. Other complications requiring surgical intervention include endoleaks, retrograde dissections, graft infections, and ischemic complications. Surgical methods usually involve the explantation of a stent graft and open repair of the aorta, during which a synthetic prosthesis is placed.

• Keywords: TEVAR; komplikacije; prevencija; kirurško liječenje
• Keywords (english): TEVAR; complications; prevention; surgical treatment
• Language: croatian
• URN:NBN: urn:nbn:hr:105:188550
• 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: 2024-07-01 15:22:08