{"id":3070,"date":"2023-02-10T21:01:10","date_gmt":"2023-02-10T21:01:10","guid":{"rendered":"https:\/\/www.karotidnahirurgija.com\/?page_id=3070"},"modified":"2023-02-23T17:04:07","modified_gmt":"2023-02-23T17:04:07","slug":"10-3-klemovanje-supraaortalnih-grana","status":"publish","type":"page","link":"https:\/\/www.karotidnahirurgija.com\/?page_id=3070","title":{"rendered":"10.3. KLEMOVANJE SUPRAAORTALNIH GRANA"},"content":{"rendered":"

\"\"<\/a><\/p>\n

<\/p>\n

OP\u0160TI PRINCIPI REKONSTRUKCIJA
SUPRAAORTALNIH GRANA<\/h1>\n

<\/a><\/h1>\n

\n

\n

10.3. KLEMOVANJE SUPRAAORTALNIH GRANA<\/p>\n

<\/h3>\n<\/div>\n<\/p>\n
\n

Svako klemovanje supraaortalnih grana dovodi do ishemije mozga. Zato mora biti \u0161to kra\u0107e, a ako ne mo\u017ee biti kratko neophodna je protekcija intraluminalnim shunt-om.<\/p>\n

Klemuje se \u201czdrav\u201d arterijski segment, atraumatskom klemom, i to samo toliko da blokiramo cirkulaciju, ne vi\u0161e od toga da ne bi smo povredili arteriju. Pre klemovanja treba preko instrumenta palpirati mesto zauzdavanja.<\/p>\n

Ako arteriju moramo klemovati na mestu gde postoji plak, klema ne sme biti popre\u010dno u odnosu na njega. Tako \u0107emo izbe\u0107i njegovu destrukciju i eventualnu distalnu embolizaciju.<\/p>\n

Preporu\u010duje se prvo proksimalno zauzdavanje, a zatim dalje preparisanje, da bi smo se obezbedili za slu\u010daj krvarenja.<\/p>\n

Svaka suvi\u0161na manipulacija arterijom mo\u017ee dovesti do lezije intime.<\/p>\n

Dobra arterijska rekonstrukcija, nakon arteriotomije, zahteva beskrvnu arteriju sa vidljivom intimom. Zato krvna struja mora biti privremeno blokirana. To mo\u017eemo posti\u0107i na tri na\u010dina:<\/p>\n

    \n
  • Parcijalno<\/b> <\/b>ili<\/b> <\/b>tangencijalno<\/b> <\/b>klemovanje<\/b> <\/b>Satinsky<\/b> <\/b>klemom<\/b> <\/b>se re\u0111e primenjuje. Osim kod ascendentne aorte, aortnog luka i descendentne aorte nema arterija \u010dija se rekonstrukcija ne mo\u017ee zavr\u0161iti sa totalnim klemovanjem.<\/span> <\/span>Pri<\/span> <\/span>klemovanju<\/span> <\/span>mora<\/span> <\/span>se<\/span> <\/span>ra\u010dunati<\/span> <\/span>sa<\/span> <\/span>opasno\u0161\u0107u<\/span> <\/span>da<\/span> <\/span>pritisak<\/span> <\/span>klemom<\/span> <\/span>ledira<\/span> <\/span>obolelu<\/span> <\/span>intimu,<\/span> <\/span>koja<\/span> <\/span>se<\/span> <\/span>mo\u017ee<\/span> <\/span>fragmentrati.<\/span> <\/span>Tangencijalno<\/span> <\/span>klemovanje<\/span> <\/span>pru\u017ea<\/span> <\/span>slab<\/span> <\/span>uvid<\/span> <\/span>u<\/span> <\/span>arterijski<\/span> <\/span>lumen,<\/span> <\/span>pa<\/span> <\/span>je<\/span> <\/span>kvalitet<\/span> <\/span>anastomoze<\/span> <\/span>\u010desto<\/span> <\/span>problemati\u010dan.<\/span> <\/span>Postoji<\/span> <\/span>mogu\u0107nost<\/span> <\/span>spadanja<\/span> <\/span>kleme.<\/span><\/li>\n<\/ul>\n
      \n
    • Kompletno<\/b><\/span> <\/b><\/span>transverzalno<\/b><\/span> <\/b><\/span>klemovanje<\/b><\/span> <\/b><\/span>ima<\/span> <\/span>prednosti.<\/span> <\/span>Mogu\u0107nost<\/span> <\/span>lediranja<\/span> <\/span>intime<\/span> <\/span>je<\/span> <\/span>najmanja,<\/span> <\/span>ako<\/span> <\/span>se<\/span> <\/span>klema<\/span> <\/span>postavi<\/span> <\/span>paralelno<\/span> <\/span>sa<\/span> <\/span>plakom,<\/span> <\/span>bez<\/span> <\/span>suvi\u0161nog<\/span> <\/span>zatezanja.<\/span> <\/span>Ekspozicija<\/span> <\/span>lumena<\/span> <\/span>je<\/span> <\/span>bolja,<\/span> <\/span>pa<\/span> <\/span>je<\/span> <\/span>mogu\u0107e<\/span> <\/span>napraviti<\/span> <\/span>savr\u0161eniju<\/span> <\/span>anastomozu.<\/span> <\/span>Ako<\/span> <\/span>postoje<\/span> <\/span>indicije<\/span> <\/span>da<\/span> <\/span>se<\/span> <\/span>rekonstrukcija<\/span> <\/span>ne<\/span> <\/span>mo\u017ee<\/span> <\/span>zavr\u0161iti<\/span> <\/span>toliko<\/span> <\/span>brzo<\/span> <\/span>da<\/span> <\/span>se<\/span> <\/span>izbegnu<\/span> <\/span>ishemi\u010dne<\/span> <\/span>lezije<\/span> <\/span>treba<\/span> <\/span>postaviti<\/span> <\/span>intraluminalni<\/span> <\/span>shunt.<\/span><\/li>\n
    • Intraluminalna<\/b><\/span> <\/b><\/span>okluzije<\/b><\/span> <\/b><\/span>arterije<\/b><\/span> <\/b><\/span>se<\/span> <\/span>mo\u017ee<\/span> <\/span>posti\u0107i<\/span> <\/span>balon-kateterom<\/span> <\/span>(Fogarty),<\/span> <\/span>ili<\/span> <\/span>dilatatorom<\/span> <\/span>odgovaraju\u0107eg<\/span> <\/span>promera.<\/span> <\/span>Intraluminalna<\/span> <\/span>okluzija<\/span> <\/span>se<\/span> <\/span>preporu\u010duje:<\/span>
      <\/span>(a)<\/span> <\/span>za<\/span> <\/span>arterije<\/span> <\/span>fragilnog<\/span> <\/span>zida,<\/span> <\/span>koji<\/span> <\/span>se<\/span> <\/span>klemovanjem<\/span> <\/span>mo\u017ee<\/span> <\/span>povrediti,<\/span>
      <\/span>(b)<\/span> <\/span>kod<\/span> <\/span>te\u0161ko<\/span> <\/span>dostupnih<\/span> <\/span>arterija<\/span> <\/span>\u010dije<\/span> <\/span>je<\/span> <\/span>preparisanje<\/span> <\/span>rizi\u010dno,<\/span> <\/span>kao<\/span> <\/span>\u0161to<\/span> <\/span>je<\/span> <\/span>to<\/span> <\/span>kod<\/span> <\/span>reoperacija,<\/span> <\/span>periarterijske<\/span> <\/span>fi<\/span>broze<\/span> <\/span>ili<\/span> <\/span>arterita,<\/span>
      <\/span>(c)<\/span> <\/span>kod<\/span> <\/span>nepredvi\u0111enih<\/span> <\/span>krvarenja<\/span> <\/span>(rupturirana<\/span> <\/span>aneurizma),<\/span> <\/span>gde<\/span> <\/span>bi<\/span> <\/span>dalje<\/span> <\/span>preparisanje<\/span> <\/span>do<\/span> <\/span>stavljanja<\/span> <\/span>kleme<\/span> <\/span>izazvalo<\/span> <\/span>krvarenje.<\/span><\/li>\n<\/ul>\n<\/div>\n

      \"\"<\/p>\n

      \n

      Mobiliziranje glavnog <\/em>arterijskog stabla <\/em>sa zauzdavanjem <\/em>bo\u010dnih grana vla\u017enim <\/em>trakama (vascular<\/em>ties) \u0161to omogu\u0107ava <\/em>privremeni prekid <\/em>cirkulacije u njima.<\/em><\/p>\n<\/div>\n

      \"\"<\/p>\n

      \n

      Tehnika hemostaze <\/em>lediranih bo\u010dnih <\/em>grana;\u00a0 (A) \u0160avligaturom, <\/em>(B) <\/em>Bo\u010dnim suturama kod <\/em>tangencijalne lezije <\/em>arterije i (C) \u0160avom <\/em>na mestu raskidanja <\/em>bo\u010dne grane<\/em><\/p>\n<\/div>\n

      \"\"<\/p>\n

      \n

      Klemovanje arterije: (a) Parcijalno, tangencijalno klemovanje arterije Satinsky klemom za termino-lateralnu anastomozu i (B) Popre\u010dno klemovanje arterije paralelno sa pravcem predominantne arte- rioskleroti\u010dne lezije, obi\u010dno za termino-terminalnu anastomozu.<\/em><\/p>\n<\/div>\n


      \n<\/p>\n","protected":false},"excerpt":{"rendered":"

      OP\u0160TI PRINCIPI REKONSTRUKCIJASUPRAAORTALNIH GRANA 10.3. KLEMOVANJE SUPRAAORTALNIH GRANA Svako klemovanje supraaortalnih grana dovodi do ishemije mozga. Zato mora biti \u0161to kra\u0107e, a ako ne mo\u017ee biti kratko neophodna je protekcija intraluminalnim shunt-om. Klemuje se \u201czdrav\u201d arterijski segment, atraumatskom klemom, i to samo toliko da blokiramo cirkulaciju, ne vi\u0161e od toga da ne bi smo povredili […]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"footnotes":""},"class_list":["post-3070","page","type-page","status-publish","hentry"],"acf":[],"yoast_head":"\n10.3. KLEMOVANJE SUPRAAORTALNIH GRANA - KAROTIDNA HIRURGIJA<\/title>\n<meta name=\"description\" content=\"Svako klemovanje supraaortalnih grana dovodi do ishemije mozga. 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