Metrika

  • citati u SCIndeksu: [1]
  • citati u CrossRef-u:0
  • citati u Google Scholaru:[]
  • posete u poslednjih 30 dana:14
  • preuzimanja u poslednjih 30 dana:9

Sadržaj

članak: 1 od 1  
2002, vol. 130, br. 7-8, str. 258-264
Rano otkrivanje asimptomske karotidne bolesti kod osoba s obliterantnom arteriosklerozom donjih ekstremiteta
aKlinički centar Niš, Klinika za opštu hirurgiju
bUniverzitet u Beogradu, Medicinski fakultet, Institut za kardiovaskularne bolesti 'Dedinje'
Ključne reči: krvni sudovi donjih ekstremiteta; ateroskleroza
Sažetak
Rana detekcija asimptomske karotidne bolesti u opštoj populaciji nije efikasna i skupa je. Rutinski skrining asimptomske karotidne bolesti vrši se detekcijom karotidnog šuma auskultacijom i pregledom karotidnih arterija ultrazvukom. Racionalni pristup je utvrđivanje lezija u pojedmnim rizičnim grupama bolesnika. Cilj rada je utvrđivanje učestalosti asimptomske karotidne stenoze kod 109 bolesnika sa simptomskom obliterantnom arteriosklerozom donjih ekstremiteta: 60 posto bolesnika se žalilo na bol u mirovanju, 25 posto je s ulceracijama ili gangrenom i 15 posto s klaudikacionim tegobama. Na osnovu merila iz studije ACAS, kod 40 naših bolesnika (36,7 posto) postojala je hemodinamski signifikantna stenoza više od 60 posto ili okluzija, dok je kod 32 bolesnika (29 posto) stenoza bila više od 70 posto ili je bila u pitanju okluzija. Najveća je učestalost stabilnih fibroznih i fibrolipidnih plakova (70 posto). Površina plaka je kod više od jedne polovine bolesnika iregularna, a ulcerisana kod jedne četvrtine. Znatna stenoza karotidnih arterija udružena je s prethodnim vaskularnim hirurškim operacijama, starošću bolesnika preko 60 godina arterijskom hipertenzijom, ASPI manjim od 0,50 i karotidnim šumom. Jedino je šum nad karotidnim arterijama nezavisan faktor, pri čemu je senzitivnost svega 67 posto. Bez opravdanja je i ograničeni skrining znatne stenoze karotidnih arterija kod neurološki asimptomskih bolesnika sa simptomskom obliterantnom arteriosklerozom donjih ekstremiteta, zatim podgrupe bolesnika s faktorima rizika (muški pol, starost preko 60 godina, arterijska hipertenzija, dijabetes melitus, pušenje duvana, nenormalni nivo lipida u serumu), sa šumom nad karotidnim arterijama, ASPI manjim od 0,5, kod bolesnika s prethodnim hirurškim operacijama na krvnim sudovima. Skrining asimptomske stenoze karotidnih arterija indikovan je kod svih bolesnika sa simptomskom obliterantnom arteriosklerozom donjih ekstremiteta, osim kod onih kod kojih se profilaksijska endarterektomija karotidnih arterija ne preporučuje zbog komorbidnih stanja ili duboke starosti.
Reference
*** (1995) Endarterectomy for asymptomatic carotid artery stenosis. Executive Committee for the Asymptomatic Carotid Atherosclerosis Study. JAMA, 273(18): 1421-8
Ahn, S.S., Baker, J.D., Walden, K., Moore, W.S. (1991) Which asymptomatic patients should undergo routine screening carotid duplex scan?. Am J Surg, 162(2): 180-3; dis
Alexandrova, N.A., Gibson, W.C., Norris, J.W., Maggisano, R. (1996) Carotid artery stenosis in peripheral vascular disease. J Vasc Surg, 23(4): 645-9
American Heart Association (1998) Stroke (Brain Attack) Statistics: Heart and Stroke Guide
Barnes, R.W., Liebman, P.R., Marszalek, P.B., Kirk, C.L., Goldman, M.H. (1981) The natural history of asymptomatic carotid disease in patients undergoing cardiovascular surgery. Surgery, 90(6): 1075-83
Brener, B.J., Hermans, H., Eisenbud, D., i dr. (1996) Management of patients requiring coronary bypass and carotid endarterectomy. u: Moore W. [ur.] Surgery for cerebrovascular disease, Philadelphia, itd: W.B. Saunders, str. 278-288
Darling, R.C., Paty, P.S., Shah, D.M., Chang, B.B., Leather, R.P. (1996) Eversion endarterectomy of the internal carotid artery: Technique and results in 449 procedures. Surgery, 120(4): 635-9; dis
de Virgilio, C., Toosie, K., Arnell, T., Lewis, R.J., Donayre, C.E., Baker, J.D., Melany, M., White, R.A. (1997) Asymptomatic carotid artery stenosis screening in patients with lower extremity atherosclerosis: A prospective study. Ann Vasc Surg, 11(4): 374-7
DeBakey, M.E., Lawrie, G.M., Glaeser, D.H. (1985) Patterns of atherosclerosis and their surgical significance. Ann Surg, 201(2): 115-31
Faggioli, G.L., Curl, G.R., Ricotta, J.J. (1990) The role of carotid screening before coronary artery bypass. J Vasc Surg, 12(6): 724-9; dis
Gentile, A.T., Taylor, L.M., Moneta, G.L., Porter, J.M. (1995) Prevalence of asymptomatic carotid stenosis in patients undergoing infrainguinal bypass surgery. Arch Surg, 130(8): 900-4
Gerraty, R.P., Gates, P.C., Doyle, J.C. (1993) Carotid stenosis and perioperative stroke risk in symptomatic and asymptomatic patients undergoing vascular or coronary surgery. Stroke, 24(8): 1115-8
Golledge, J., Cuming, R., Ellis, M., Davies, A.H., Greenhalgh, R.M. (1997) Carotid plaque characteristics and presenting symptom. Br J Surg, 84(12): 1697-701
Gray-Weale, A.C., Graham, J.C., Burnett, J.R., Byrne, K., Lusby, R.J. (1988) Carotid artery atheroma: Comparison of preoperative B-mode ultrasound appearance with carotid endarterectomy specimen pathology. J Cardiovasc Surg (Torino), 29(6): 676-81
Green, R.M., Ouriel, K. (1994) Peripheral arterial disease. u: Schwartz S.I., Shires G.T., Spencer F.C. [ur.] Principles of Surgery, New York, itd: McGraw-Hill, str. 925-77
Halliday, A.W., Thomas, D., Mansfield, A. (1994) The Asymptomatic Carotid Surgery Trial (ACST). Rationale and design. Steering Committee. Eur J Vasc Surg, 8(6): 703-10
Hobson, R.W., Weiss, D.G., Fields, W.S., Goldstone, J., Moore, W.S., Towne, J.B., Wright, C.B. (1993) Efficacy of carotid endarterectomy for asymptomatic carotid stenosis: The Veterans Affairs Cooperative Study Group. N Engl J Med, 328(4): 221-7
Howard, G., Chambless, L.E. (1991) A multicenter validation study of Doppler ultrasound versus angiogram. J Stroke Cerebvasc Dis, 1, str. 166-73
Klop, R.B., Eikelboom, B.C., Taks, A.C. (1991) Screening of the internal carotid arteries in patients with peripheral vascular disease by colour-flow duplex scanning. Eur J Vasc Surg, 5(1): 41-5
Langsfeld, M., Gray-Weale, A.C., Lusby, R.J. (1989) The role of plaque morphology and diameter reduction in the development of new symptoms in asymptomatic carotid arteries. J Vasc Surg, 9(4): 548-57
Marek, J., Mills, J.L., Harvich, J., Cui, H., Fujitani, R.M. (1996) Utility of routine carotid duplex screening in patients who have claudication. J Vasc Surg, 24(4): 572-7; dis
Moore, W.S., Barnett, H.J., Beebe, H.G., Bernstein, E.F., Brener, B.J., Brott, T., Caplan, L.R., Day, A., Goldstone, J., Hobson, R.W. (1995) Guidelines for carotid endarterectomy. A multidisciplinary consensus statement from the ad hoc Committee, American Heart Association. Stroke, 26(1): 188-201
Norris, J.W., Zhu, C.Z., Bornstein, N.M., Chambers, B.R. (1991) Vascular risks of asymptomatic carotid stenosis. Stroke, 22(12): 1485-90
Prati, P., Vanuzzo, D., Casaroli, M., di Chiara, A., de Biasi, F., Feruglio, G.A., Touboul, P.J. (1992) Prevalence and determinants of carotid atherosclerosis in a general population. Stroke, 23(12): 1705-11
Rautenberg, W., Mess, W., Hennerici, M. (1990) Prognosis of asymptomatic carotid occlusion. J Neurol Sci, 98(2-3): 213-20
Sanguigni, V., Gallu, M., Strano, A. (1993) Incidence of carotid artery atherosclerosis in patients with coronary artery disease. Angiology, 44(1): 34-8
Sarker, R., Moore, W.S. (1993) Management of asymptomatic carotid stenosis. Surg Rounds, 16, str. 597-603
Summer, D. (1977) Noninvasive measurement of segmental arterial pressure. u: Rutherford R.B. [ur.] Vascular Surgery, Philadelphia, itd: W.B. Saunders, str. 87-94
Thompson, J.E. (1991) Carotid endarterectomy for asymptomatic carotid stenosis: An update. J Vasc Surg, 13(5): 669-76
Turnipseed, W.D., Berkoff, H.A., Belzer, F.O. (1980) Postoperative stroke in cardiac and peripheral vascular disease. Ann Surg, 192(3): 365-8
Wolf, P.A., Kannel, W.B., Sorlie, P., McNamara, P. (1981) Asymptomatic carotid bruit and risk of stroke. The Framingham study. JAMA, 245(14): 1442-5
Žikić, M., Bikar, D., Jovanović, M. (1997) Epidemiologija, klasifikacija i prevencija moždanog udara. Klin Eksperiment Neurolog, 2:183