Hirurško lečenje penetrantnog aterosklerotskog ulkusa descendentne aorte
Sažetak
Uvod. Penetrantni aterosklerotski ulkus (PAU) aorte predstavlja progresivno prodiranje aterosklerotskog procesa u unutrašnji i središnji sloj zida aorte. PAU je lezija visokog rizika zbog štetnog uticaja na integritet zida aorte sa mogućim smrtnim ishodom. Prikaz bolesnika. Bolesnik sa jakim i oštrim bolom u grudima koji se širio u leđa, ali bez znakova ishemije miokarda na elektrokardiogramu, primljen je u našu kliniku. Transtorakalna ehokardiografija nije pokazala patološku promenu na ascedentnoj aorti. Međutim, kompjuterizovana tomografija (KT) pokazala je postojanje aortnog ulkusa sa različitim stepenom subadventicijalnog krvarenja u regionu Th 8–9 torakalne aorte. Usled neposredne rupture PAU, bolesnik je upućen na operaciju. Intraoperativno, nađen je subadventicijalni hematom dužine 15 cm u posterolateralnom delu descedentne aorte, 5 cm iznad dijafragme i 7 cm ispod odvajanja leve potključne arterije. Posle odstranjivanja zahvaćenog dela aorte, urađena je rekonstrukcija aorte Dacron-skim graftom prečnika 24 mm. Kontrolna KT pokazala je zadovoljavajuću rekonstrukciju descedentne aorte. Zaključak. Pored toga što je retko, PAU je potencijalno fatalno oboljenje. Otvorena hirurgija je efikasna metoda lečenja PAU, premda se u novije vreme razvijaju endovaskularne metode rešavanja ovog problema.
Ključne reči:
aorta, torakalna; aorta, ruptura; arterioskleroza; ulceracija; dijagnostičke tehnike i procedure; hirurgija, kardiovaskularna, procedure; graftovi.Reference
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