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Vojnosanitetski pregled
2019, vol. 76, br. 3, str. 331-340
jezik rada: engleski
vrsta rada: kratki članak
doi:10.2298/VSP180606189Z

Creative Commons License 4.0
Hibridni tretman aneurizmi torakoabdominalne aorte - serija bolesnika i pregled literature
aUniverzitet u Beogradu, Medicinski fakultet, Klinički centar Srbije
bClinical Center of Serbia, Clinic for Vascular and Endovascular Surgery, Belgrade + University of Belgrade, Faculty of Medicine, Belgrade

e-adresa: petar91goldy@gmail.com

Projekat

Multidisciplinarna istraživanja relevantna za etiopatogenezu, dijagnostiku i savremeni tretman bolesti torakoabdominalne aorte i njenih grana (MPNTR - 175008)

Sažetak

Uvod/Cilj. Otvoreni tretman aneurizmi torakoabdominalne aorte (ThAAA) je značajan i težak poduhvat. Totalni endovaskularni tretman je moguć, ali u specijalizovanim institucijama i nije svuda prisutan. Hibridni tretman nudi alternativan pristup u tretmanu ThAAA. Cilj rada bio je prezentovanje naših dosadašnjih rezultata hibridnog tretmana ThAAA, kao i pregled literature. Metode. U radu je prikazan restrospektivni pregled svih bolesnika sa hibridnim tretmanom ThAAA u našoj ustanovi u periodu od januara 2011 do januara 2018. Hibridni tretman ThAAA je učinjen u dve faze: prvi stadijum je podrazumevao otvoreni visceralni debrančing, a drugi, nakon toga, plasiranje stent-grafta u odloženoj fazi. Pregledom literature izdovojeni su i analizirani sledeći podaci: ime prvog autora, godina publikacije, broj bolesnika, 30-dnevni/intrahospitalni mortalitet, procenat bolesnika sa permanentom paraplegijom, prisustvo endolika, prohodnost graftova, sveukupno preživljavanje nakon perioda prećenja i središnja vredost praćenja. Rezultati. Ukupno sedam bolesnika sa ThAAA je tretirano u našoj ustanovi. Nijedan slučaj intraoperativne smrti, niti nemogućnost plasmana endografta (TEVAR) nije zabeležen. Srednje vreme praćenja bolesnika je bilo 51,71 meseci (95% interval poverenja (IP): 14,67-88,74 meseci). Na kraju perioda praćenja svi bajpasevi su bili prohodni i nijedan slučaj migracije stent-grafta nije zabeležen. Posle godinu dana kod jednog bolesnika je zabeležen endolik tip Ib koji je uspešno tretiran. Ukupno dvadeset-sedam studija je izdvojeno za literaturni pregled. Tehnički uspeh je bio 91,69% (95% CI: 85,34-97,24%). Srednja vrednost permanentne paraplegije je bila 5,27% (95% CI: 3,55- 7,01%). Objedinjena stopa prohodnosti graftova tokom središnjeg perioda praćenja od 27,54 meseci (95% CI: 17,41-37,66 meseci) je bila 94,5% (95% CI: 92,5-96,5%). Objedinjena stopa endolikova tokom perioda praćenja je bila 16.72% (95% CI: 11,15-22,29%). Objedinjena stopa 30-dnevnog/intrahospitalnog morteliteta je bila 15,32% (95% CI: 11,04-19,61%), a stopa preživljavanja tokom perioda praćenja od 27,54 meseci 65,98% (95% CI: 58,15- 73,81%). Zaključak. Uprkos manjoj invazivnosti, hibridni pristup za tretman ThAAA je i dalje povezan sa značajnim morbiditetom i mortalitetom.

Ključne reči

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