Endovaskularno zbrinjavanje aneurizme supklavijalne arterije kod visokorizičnih bolesnika – iskustvo jednog centra

Ivan Radomir Marjanović; Aleksandar Tomić; Nebojša Marić; Danijela Pecarski; Momir Šarac; Dragana Paunović; Siniša Rusović

doi:10.2298/VSP150420091M

Ivan Radomir Marjanović Clinic for Vascular and Endovascular Surgery, Military Medical Academy, Belgrade, Serbia; Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia
Aleksandar Tomić Clinic for Vascular and Endovascular Surgery, Military Medical Academy, Belgrade, Serbia; Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia
Nebojša Marić Clinic for Thoracic Surgery, Military Medical Academy, Belgrade, Serbia
Danijela Pecarski School of Health Care Studies, Belgrade, Serbia
Momir Šarac Clinic for Vascular and Endovascular Surgery, Military Medical Academy, Belgrade, Serbia; Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia
Dragana Paunović Clinic for Vascular and Endovascular Surgery,Military Medical Academy, Belgrade, Serbia
Siniša Rusović Institute for Radiology, Military Medical Academy, Belgrade, Serbia

DOI: https://doi.org/10.2298/VSP150420091M

Ključne reči: subclavian artery||, ||a.subclavia, aneurysm||, ||aneurizma, aneurysm, ruptured||, ruptura, vascular surgical procedures||, ||hirurgija, vaskularna, procedure, stents||, ||stentovi, transplants||, ||graftovi, prognosis||, ||prognoza, mortality||, ||mortalitet,

Sažetak

Uvod/Cilj. Aneurizma arterije supklavije se retko javlja, ali su komplikacije ozbiljne. U novije vreme, pored otvorenog hirurškog zahvata, pojava stent-graftova omogućava i endovaskularnu rekonstrukciju. Prikazali smo naše prvo iskustvo sa endovaskularnom rekonstrukcijom aneurizme supklavijalne arterije kod šest bolesnika, pet muškaraca i jedne žene. Metode. Svi bolesnici u našoj studiji bili su visoko rizični za otvorenu rekonstrukciju prema ASA klasifikaciji. Aterosklerotska degeneracija arterije bila je uzročnik nastanka aneurizme kod svih bolesnika. Dva bolesnika imala su aneurizme supklavijalne arterije intratorakalno, dok su kod ostalih bolesnika aneurizme bile ekstratorakalno. Kod dva bolesnika aneurizma supklavijalne arterije bila je simptomatska, sa simptomima u vidu pritiska i bola u grudima kod jednog i hemoragičnog šoka i bola u grudima kod drugog, dok su kod preostalih bolesnika aneurizme bile asimptomatske. Za endovaskularnu rekonstrukciju koristili smo Viaban stent-graft. Kod jednog bolesnika sa rupturom aneurizme supklavijalne arterije koji je bio visokorizičan za otvorenu rekonstrukciju, primenili smo kombinovani endovaskularni postupak. Prvo smo pokrili ušće supklavijalne arterije torakalnim stent-graftom, a zatim smo postavili dva klema u proksimalni deo supklavijalne arterije. Rezultati. Nije bilo operativnog mortaliteta tokom endovaskularne rekonstrukcije, a uspešnost izvođenja procedure bila je 100%. Period praćenja bio je od tri meseca do tri godine. Tokom ovog perioda, jedan bolesnik je umro zbog srčanog popuštanja, a kod jednog bolesnika smo izveli novu endovaskularnu proceduru zbog pojave endolika tipa I. Zaključak. Endovaskularno lečenje aneurizme supklavijalne arterije preporučuje se kod bolesnika kod kojih anatomske karakteristike same aneurizme omogućavaju izvođenje iste, a posebno se preporučuju kod visokorizičnih bolesnika sa intratorakalnom lokalizacijom aneurizme radi prevencije komplikacija.

Biografije autora

Ivan Radomir Marjanović, Clinic for Vascular and Endovascular Surgery, Military Medical Academy, Belgrade, Serbia; Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia

Klinika za vaskularnu i endovaskularnu hirurgiju VMA

DOKTOR MEDICINSKIH NAUKA

Aleksandar Tomić, Clinic for Vascular and Endovascular Surgery, Military Medical Academy, Belgrade, Serbia; Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia

Klinika za vaskularnu i endovaskularnu hirurgiju VMA

DOKTOR MEDICINSKIH NAUKA

Nebojša Marić, Clinic for Thoracic Surgery, Military Medical Academy, Belgrade, Serbia

Klinika za grudnu hirurgiju VMA

Danijela Pecarski, School of Health Care Studies, Belgrade, Serbia

doktor farmaceutskih nauka

Momir Šarac, Clinic for Vascular and Endovascular Surgery, Military Medical Academy, Belgrade, Serbia; Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia

Klinika za vaskularnu i endovaskularnu hirurgiju VMA

Dragana Paunović, Clinic for Vascular and Endovascular Surgery,Military Medical Academy, Belgrade, Serbia

Klinika za vaskularnu i endovaskularnu hirurgiju VMA

Siniša Rusović, Institute for Radiology, Military Medical Academy, Belgrade, Serbia

Institur za radiologiju VMA

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