članak: 1 od 1  
Srpski arhiv za celokupno lekarstvo
2009, vol. 137, br. 1-2, str. 10-17
jezik rada: srpski
originalan članak
doi:10.2298/SARH0902010D

Endovaskularno lečenje aneurizmi aorte - preliminarni rezultati
Klinika za vaskularnu hirurgiju, Institut za kardiovaskularne bolesti, Klinički centar Srbije, Beograd

e-adresa: vaskcl@eunet.rs

Sažetak

Uvod. Endovaskularno lečenje aneurizmi aorte je u kliničku praksu uvedeno početkom devedesetih godina dvadesetog veka. Zbog izuzetno visoke cene endovaskularnih stent-graftova i poznatih problema u kojima je naša zemlja bila prethodnih 15 godina, ove procedure su kod nas počele da se primenjuju tek nedavno. Cilj rada. Cilj rada je bio da se prikažu preliminarna iskustva u endovaskularnom lečenju aortnih aneurizmi na Klinici za vaskularnu hirurgiju Instituta za kardiovaskularne bolesti Kliničkog centra Srbije u Beogradu. Metode rada. Endovaskularno lečenje je primenjeno kod 33 bolesnika (30 muškaraca) s aneurizmom aorte starih 42-83 godine. Kod 23 bolesnika je ustanovljena aneurizma trbušne aorte, odnosno ilijačnih arterija (kod jednog bolesnika s hroničnom rupturom), a kod 10 je lečena aneurizma grudne aorte različite etiologije: kod tri bolesnika degenerativna aneurizma silaznog dela grudne aorte, kod četiri traumatska ruptura grudne aorte na tipičnom mestu (tri hronične posle 2-20 godina i jedna akutna u okviru politraume), kod jednog bolesnika s Marfanovim sindromom disekantna aneurizma grudne aorte, kod dva bolesnika penetrantni aterosklerotski ulkus, a kod jednog bolesnika torakoabdominalna aneurizma tip II koja je operisana hibridnom procedurom. Indikacija za endovaskularno lečenje jednog bolesnika bila je istmična lokalizacija aneurizme grudne aorte udružena s politraumom, dok su indikacije za lečenje ostalih bolesnika bila propratna stanja koja su ove bolesnike činila visokorizičnim za hirurško lečenje (starosno doba, oboljenja srca i pluća, cerebrovaskularni insult, prethodno otvaranje grudnog koša, odnosno trbušne duplje, niska ejekciona frakcija, prethodna laringektomija, idiopatska trombocitopenija). Svi bolesnici iz ove grupe su imali najmanje tri pomenuta faktora rizika. Za aneurizme grudne aorte korišćen je endovaskularni stent-graft Medtronic Valiant®, a za aneurizmu trbušne aorte Medtronic Talent®, s odgovarajućim sistemima za postavljanje i otpuštanje graftova. Kod po tri bolesnika je, po završenoj endovaskularnoj proceduri, hirurški rekonstruisana aneurizma femoralne arterije, odnosno nakon implantacije aortouniilijačnog stent-grafta urađen femoro-femoralni tzv. cross over bajpas. Rezultati. Tokom operacije, u neposrednom postoperacionom toku i tokom perioda nadgledanja od prosečno 1,6 godina jedan bolesnik je preminuo, kod dva se javio endolik tipa 1, a kod jednog okluzija grafta. Kod po jednog bolesnika urađena je konverzija u otvorenu proceduru i postpunkciona pseudoaneurizma aksilarne arterije. Drugih komplikacija (rast aneurizme, kolaps, deformitet i migracija endovaskularnog stent-grafta) nije bilo. Zaključak. Imajući u vidu medicinske i ekonomske aspekte, smatramo da je endovaskularno lečenje aortnih aneurizmi opravdano pre svega kod osoba s traumatskom akutnom aneurizmom grudne aorte, ali i kod starih i visokorizičnih bolesnika, čije je hirurško lečenje aneurizme grudne ili trbušne aorte praćeno visokom stopom smrtnosti.

Ključne reči

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