{"id":3414,"date":"2023-02-12T11:30:40","date_gmt":"2023-02-12T11:30:40","guid":{"rendered":"https:\/\/www.karotidnahirurgija.com\/?page_id=3414"},"modified":"2023-02-23T17:07:36","modified_gmt":"2023-02-23T17:07:36","slug":"10-3-2-etrombendarterektomija","status":"publish","type":"page","link":"https:\/\/www.karotidnahirurgija.com\/?page_id=3414","title":{"rendered":"10.3.2  TROMBENDARTEREKTOMIJA"},"content":{"rendered":"<p><a href=\"\/index.php?page_id=3024\"><img decoding=\"async\" src=\"\/wp-content\/uploads\/2023\/02\/10.png\" alt=\"\"><\/a><\/p>\n<h1><a href=\"\/index.php?page_id=1408\"><\/p>\n<h1>OP\u0160TI PRINCIPI REKONSTRUKCIJA SUPRAAORTALNIH GRANA<\/h1>\n<p><\/a><\/h1>\n<div>\n<h3>\n<h2>10.3. KLEMOVANJE SUPRAAORTALNIH GRANA<\/p>\n<h2><\/h3>\n<\/div>\n<div>\n<h3>\n<h3>10.3.2.  Trombendarterektomija<\/p>\n<h3><\/h3>\n<\/div>\n<\/p>\n<div>\n<h2 align=\"JUSTIFY\">Trombendarterektomija<\/h2>\n<p align=\"JUSTIFY\">Podrazumeva odstranjivanje ateroskleroti\u010dne intime i medije koji izazivaju kriti\u010dnu stenozu okluziju arterije sa ili bez prizidnog trom- ba. Karotidna endartektomija daje konstatno dobre rezultate, pa se rekonstrukcija graftom primenjuje izuzetno retko. Mada je endarterektomija prvobitno uvedena u upotrebu za korekciju stenoza na ostijumu vertebralne arterije i na prvom segmentu subklavijalne arterije, ali se uvodjenjem endovaskularnih procedura sve redje radi. Endearterektomija brahiocefali\u010dnog trunkusa retko je u upotrebi, jer se bolji rezultati posti\u017eu by pass procedurom.<\/p>\n<p class=\"western\" style=\"text-align: left;\" align=\"JUSTIFY\">Endarterektomija zahteva \u201culazak u sloj\u201d, \u0161to zna\u010di u nivo <i>lamina-<\/i>e <i>elasticae<\/i><i> <\/i><i>externa<\/i>-e. Ako se endarterektomija izvodi u pravom sloju ona \u0107e biti brza, \u0161to je va\u017eno kad se radi o arteriji koja irigira mozak. Najlak\u0161e se ulazi u pravi sloj tamo gde je plak najdeblji ili kalcifikovan. De\u0161ava se da se nakon arteriotomije i ispiranja lumena otvorene arterije spontano odvoji ateroskleroti\u010dni plak od lamine elastike eksterne. To je idealan endarterektomijski sloj. Potom se odstranjuje u celini ateroskleroti\u010dni plak, a ostaje glatka povr\u0161ina bez intimalnih listi\u0107a i neravnina (<i>fl<\/i><i>ap<\/i>). Posebna pa\u017ena je neophodna na distalnom kraju endarterektomije. Endarterektomiju moramo zavr\u0161iti bez rezidualne stenoze i neravnina koje \u0107e nakon pu\u0161tanja krvne struje stvarati turbulenciju. Pojava turbulencije uslovljava deponovanje prizidnog tromba (akutna tromboza) i kasnije razvoj neointimalne hiperplazije (restenoza).<\/p>\n<p class=\"western\" align=\"JUSTIFY\">Kod endarterektomije subklavijalne arterije i brahiocefali\u010dnog trunkusa preostali deo zida (adventicija i laminima elastica interna) je tanak tako da postoji rizik od rupture i kasnijeg razvoja pseudoaneurizme. Ipak, postoperativne pseudoaneurizme su izuzetno redak nalaz.<\/p>\n<p class=\"western\"><strong>Trombendarterektomiju<\/strong> mo\u017eemo uraditi:<\/p>\n<ul>\n<li class=\"western\">kao <b>otvorenu<\/b>, ako je u pitanju kratak arterijski segment, ili<\/li>\n<li class=\"western\">kao <b>poluzatvo<\/b><b>r<\/b><b>en<\/b><b>u<\/b><b> <\/b>uz pomo\u0107 Vollmar-ovog ring strippera.<\/li>\n<\/ul>\n<p class=\"western\" align=\"JUSTIFY\"><b>Direktna<\/b><b> <\/b><b>sutura<\/b><b> <\/b>arterije mogu\u0107a je ako arterija nije suvi\u0161e gracilna, pa se njenim direktnim zatvaranjem ne stvara stenoza. Primenjuje se produ\u017eni, evertiraju\u0107i, atraumatski \u0161av (Prolen) \u010diji promer zavisi od promera arterije.<\/p>\n<\/div>\n<p><img decoding=\"async\" src=\"\/wp-content\/uploads\/2023\/02\/KNJIGA-Karotidna-hirurgija-118-e1676065716573.png\" alt=\"\"><\/p>\n<div>\n<p style=\"text-align: left;\" align=\"CENTER\"><em>Eksponirana karotidna bifurkacija sa zauzdanom gornjom tiroidnom i spolja\u0161njom karotidnom arterijom. <\/em><em>Distalno ansa cervicalis ukr\u0161ta ACI<\/em><\/p>\n<\/div>\n<p><img decoding=\"async\" src=\"\/wp-content\/uploads\/2023\/02\/KNJIGA-Karotidna-hirurgija-119.png\" alt=\"\"><\/p>\n<div>\n<p style=\"text-align: left;\" align=\"CENTER\"><em>Everziona endarterektomija kalcifikovanog plaka ACI<\/em><\/p>\n<\/div>\n<p><img decoding=\"async\" src=\"\/wp-content\/uploads\/2023\/02\/KNJIGA-Karotidna-hirurgija-120.png\" alt=\"\"><\/p>\n<div>\n<p style=\"text-align: left;\" align=\"CENTER\"><em>Everziona endarterektomija. Pregled lumena ACI koji mora biti potpuno \u010dist, Bez nerevnina i intinalnih flapova.<\/em><\/p>\n<p style=\"text-align: left;\" align=\"CENTER\">\n<\/div>\n<p><img decoding=\"async\" src=\"\/wp-content\/uploads\/2023\/02\/KNJIGA-Karotidna-hirurgija-121.png\" alt=\"\"><\/p>\n<div>\n<p style=\"text-align: left;\" align=\"CENTER\"><em>Provera retrogradnog toka iz ACI nakon endarterektomije<\/em><\/p>\n<\/div>\n<p><img decoding=\"async\" src=\"\/wp-content\/uploads\/2023\/02\/KNJIGA-Karotidna-hirurgija-122.png\" alt=\"\"><\/p>\n<div>\n<p style=\"text-align: left;\" align=\"CENTER\"><em>Endarterektomija spolja\u0161nje i zajedni\u010dke karotidne arterije.<\/em><\/p>\n<\/div>\n<p><img decoding=\"async\" src=\"\/wp-content\/uploads\/2023\/02\/KNJIGA-Karotidna-hirurgija-123.png\" alt=\"\"><\/p>\n<div>\n<p style=\"text-align: left;\" align=\"CENTER\"><em>Reimplantacija karotidne arterije. Evertiraju\u0107i \u0161av, Prolen 5 ili 6 0, u pravcu prema operatoru, od pete ka vrhu anastomoze.<\/em><\/p>\n<p style=\"text-align: left;\" align=\"CENTER\">\n<\/div>\n<p><img decoding=\"async\" src=\"\/wp-content\/uploads\/2023\/02\/KNJIGA-Karotidna-hirurgija-124.png\" alt=\"\"><\/p>\n<div>\n<p style=\"text-align: right;\"><em>Zavr\u0161ena reimplantaciona <br \/>anastomoza ACI..<\/em><\/p>\n<p style=\"text-align: right;\" align=\"CENTER\">\n<\/div>\n<p><img decoding=\"async\" src=\"\/wp-content\/uploads\/2023\/02\/KNJIGA-Karotidna-hirurgija-52.png\" alt=\"\"><\/p>\n<p><!--more--><br \/>\n<!-- {\"type\":\"layout\",\"children\":[{\"type\":\"section\",\"props\":{\"image_position\":\"center-center\",\"padding\":\"xsmall\",\"style\":\"default\",\"title_breakpoint\":\"xl\",\"title_position\":\"top-left\",\"title_rotation\":\"left\",\"vertical_align\":\"middle\",\"width\":\"default\"},\"children\":[{\"type\":\"row\",\"props\":{\"layout\":\"1-4,3-4\"},\"children\":[{\"type\":\"column\",\"props\":{\"image_position\":\"center-center\",\"media_overlay_gradient\":\"\",\"position_sticky_breakpoint\":\"m\",\"width_medium\":\"1-4\"},\"children\":[{\"type\":\"image\",\"props\":{\"image\":\"wp-content\\\/uploads\\\/2023\\\/02\\\/10.png\",\"image_svg_color\":\"emphasis\",\"link\":\"index.php?page_id=3024\",\"margin\":\"default\"}}]},{\"type\":\"column\",\"props\":{\"image_position\":\"center-center\",\"media_overlay_gradient\":\"\",\"position_sticky_breakpoint\":\"m\",\"width_medium\":\"3-4\"},\"children\":[{\"type\":\"headline\",\"props\":{\"content\":\"\n\n<h1>OP\\u0160TI PRINCIPI REKONSTRUKCIJA SUPRAAORTALNIH GRANA<\\\/h1>\",\"link\":\"index.php?page_id=1408\",\"title_color\":\"success\",\"title_decoration\":\"line\",\"title_element\":\"h1\",\"title_font_family\":\"default\"}},{\"type\":\"description_list\",\"props\":{\"column_breakpoint\":\"m\",\"layout\":\"grid-2\",\"list_element\":\"ul\",\"list_marker\":\"disc\",\"list_marker_color\":\"primary\",\"list_size\":\"collapse\",\"list_style\":\"striped\",\"meta_align\":\"below-content\",\"meta_style\":\"text-meta\",\"show_content\":true,\"show_link\":true,\"show_meta\":true,\"show_title\":true,\"title_element\":\"div\",\"title_grid_column_gap\":\"small\",\"title_grid_row_gap\":\"small\",\"title_grid_width\":\"auto\"},\"children\":[{\"type\":\"description_list_item\",\"props\":{\"title\":\"\n\n<h2>10.3. KLEMOVANJE SUPRAAORTALNIH GRANA\n\n<h2>\"}}]},{\"type\":\"description_list\",\"props\":{\"column_breakpoint\":\"m\",\"layout\":\"grid-2\",\"list_element\":\"ul\",\"list_marker\":\"disc\",\"list_marker_color\":\"primary\",\"list_size\":\"collapse\",\"list_style\":\"striped\",\"meta_align\":\"below-content\",\"meta_style\":\"text-meta\",\"show_content\":true,\"show_link\":true,\"show_meta\":true,\"show_title\":true,\"title_element\":\"div\",\"title_grid_column_gap\":\"small\",\"title_grid_row_gap\":\"small\",\"title_grid_width\":\"auto\"},\"children\":[{\"type\":\"description_list_item\",\"props\":{\"title\":\"\n\n<h3>10.3.2.  Trombendarterektomija\n\n<h3>\"}}]},{\"type\":\"nav\",\"props\":{\"grid\":\"1\",\"grid_divider\":true,\"image_vertical_align\":true,\"nav_style\":\"primary\",\"show_image\":true,\"show_meta\":true},\"children\":[{\"type\":\"nav_item\",\"props\":{\"icon\":\"git-branch\"},\"source\":{\"query\":{\"name\":\"customMenuItems\",\"arguments\":{\"id\":54,\"parent\":\"\",\"heading\":\"\",\"include_heading\":true,\"ids\":[\"3437\",\"3467\",\"3477\"]}},\"props\":{\"type\":{\"filters\":{\"search\":\"\"},\"name\":\"title\"},\"active\":{\"filters\":{\"search\":\"\"},\"name\":\"active\"},\"content\":{\"filters\":{\"search\":\"\"},\"name\":\"title\"},\"link\":{\"filters\":{\"search\":\"\"},\"name\":\"url\"}}}}],\"name\":\"submeni\"}]}]}]},{\"type\":\"section\",\"props\":{\"image_position\":\"center-center\",\"padding\":\"xsmall\",\"preserve_color\":true,\"style\":\"secondary\",\"title_breakpoint\":\"xl\",\"title_position\":\"top-left\",\"title_rotation\":\"left\",\"vertical_align\":\"middle\",\"width\":\"default\"},\"children\":[{\"type\":\"row\",\"children\":[{\"type\":\"column\",\"props\":{\"image_position\":\"center-center\",\"media_overlay_gradient\":\"\",\"position_sticky_breakpoint\":\"m\"},\"children\":[{\"type\":\"nav\",\"props\":{\"grid\":\"1\",\"grid_divider\":true,\"image_vertical_align\":true,\"nav_style\":\"primary\",\"show_image\":true,\"show_meta\":true},\"children\":[{\"type\":\"nav_item\",\"props\":{\"icon\":\"git-branch\"},\"source\":{\"query\":{\"name\":\"customMenuItems\",\"arguments\":{\"id\":54,\"parent\":\"\",\"heading\":\"\",\"include_heading\":true,\"ids\":[\"3352\",\"3351\",\"3531\"]}},\"props\":{\"type\":{\"filters\":{\"search\":\"\"},\"name\":\"title\"},\"active\":{\"filters\":{\"search\":\"\"},\"name\":\"active\"},\"content\":{\"filters\":{\"search\":\"\"},\"name\":\"title\"},\"link\":{\"filters\":{\"search\":\"\"},\"name\":\"url\"}}}}],\"name\":\"submeni\"}]}]}]},{\"type\":\"section\",\"props\":{\"image_position\":\"center-center\",\"padding\":\"xsmall\",\"preserve_color\":true,\"style\":\"default\",\"title_breakpoint\":\"xl\",\"title_position\":\"top-left\",\"title_rotation\":\"left\",\"vertical_align\":\"middle\",\"width\":\"default\"},\"children\":[{\"type\":\"row\",\"children\":[{\"type\":\"column\",\"props\":{\"image_position\":\"center-center\",\"media_overlay_gradient\":\"\",\"position_sticky_breakpoint\":\"m\"},\"children\":[{\"type\":\"text\",\"props\":{\"column\":\"1-3\",\"column_breakpoint\":\"m\",\"column_divider\":true,\"content\":\"\n\n<h2 align=\\\"JUSTIFY\\\">Trombendarterektomija<\\\/h2>\\n\n\n<p align=\\\"JUSTIFY\\\">Podrazumeva odstranjivanje ateroskleroti\\u010dne intime i medije koji izazivaju kriti\\u010dnu stenozu okluziju arterije sa ili bez prizidnog trom- ba. Karotidna endartektomija daje konstatno dobre rezultate, pa se rekonstrukcija graftom primenjuje izuzetno retko. Mada je endarterektomija prvobitno uvedena u upotrebu za korekciju stenoza na ostijumu vertebralne arterije i na prvom segmentu subklavijalne arterije, ali se uvodjenjem endovaskularnih procedura sve redje radi. Endearterektomija brahiocefali\\u010dnog trunkusa retko je u upotrebi, jer se bolji rezultati posti\\u017eu by pass procedurom.<\\\/p>\\n\n\n<p class=\\\"western\\\" style=\\\"text-align: left;\\\" align=\\\"JUSTIFY\\\">Endarterektomija zahteva \\u201culazak u sloj\\u201d, \\u0161to zna\\u010di u nivo <i>lamina-<\\\/i>e <i>elasticae<\\\/i><i> <\\\/i><i>externa<\\\/i>-e. Ako se endarterektomija izvodi u pravom sloju ona \\u0107e biti brza, \\u0161to je va\\u017eno kad se radi o arteriji koja irigira mozak. Najlak\\u0161e se ulazi u pravi sloj tamo gde je plak najdeblji ili kalcifikovan. De\\u0161ava se da se nakon arteriotomije i ispiranja lumena otvorene arterije spontano odvoji ateroskleroti\\u010dni plak od lamine elastike eksterne. To je idealan endarterektomijski sloj. Potom se odstranjuje u celini ateroskleroti\\u010dni plak, a ostaje glatka povr\\u0161ina bez intimalnih listi\\u0107a i neravnina (<i>fl<\\\/i><i>ap<\\\/i>). Posebna pa\\u017ena je neophodna na distalnom kraju endarterektomije. Endarterektomiju moramo zavr\\u0161iti bez rezidualne stenoze i neravnina koje \\u0107e nakon pu\\u0161tanja krvne struje stvarati turbulenciju. Pojava turbulencije uslovljava deponovanje prizidnog tromba (akutna tromboza) i kasnije razvoj neointimalne hiperplazije (restenoza).<\\\/p>\\n\n\n<p class=\\\"western\\\" align=\\\"JUSTIFY\\\">Kod endarterektomije subklavijalne arterije i brahiocefali\\u010dnog trunkusa preostali deo zida (adventicija i laminima elastica interna) je tanak tako da postoji rizik od rupture i kasnijeg razvoja pseudoaneurizme. Ipak, postoperativne pseudoaneurizme su izuzetno redak nalaz.<\\\/p>\\n\n\n<p class=\\\"western\\\"><strong>Trombendarterektomiju<\\\/strong> mo\\u017eemo uraditi:<\\\/p>\\n\n\n<ul>\\n\n\n<li class=\\\"western\\\">kao <b>otvorenu<\\\/b>, ako je u pitanju kratak arterijski segment, ili<\\\/li>\\n\n\n<li class=\\\"western\\\">kao <b>poluzatvo<\\\/b><b>r<\\\/b><b>en<\\\/b><b>u<\\\/b><b> <\\\/b>uz pomo\\u0107 Vollmar-ovog ring strippera.<\\\/li>\\n<\\\/ul>\\n\n\n<p class=\\\"western\\\" align=\\\"JUSTIFY\\\"><b>Direktna<\\\/b><b> <\\\/b><b>sutura<\\\/b><b> <\\\/b>arterije mogu\\u0107a je ako arterija nije suvi\\u0161e gracilna, pa se njenim direktnim zatvaranjem ne stvara stenoza. Primenjuje se produ\\u017eni, evertiraju\\u0107i, atraumatski \\u0161av (Prolen) \\u010diji promer zavisi od promera arterije.<\\\/p>\",\"margin\":\"default\"}}]}]}]},{\"type\":\"section\",\"props\":{\"image_position\":\"center-center\",\"padding\":\"xsmall\",\"style\":\"default\",\"title_breakpoint\":\"xl\",\"title_position\":\"top-left\",\"title_rotation\":\"left\",\"vertical_align\":\"middle\",\"width\":\"default\"},\"children\":[{\"type\":\"row\",\"props\":{\"column_gap\":\"small\",\"layout\":\"1-4,1-4,1-4,1-4|1-2,1-2,1-2,1-2\",\"margin\":\"remove-vertical\",\"row_gap\":\"small\"},\"children\":[{\"type\":\"column\",\"props\":{\"image_position\":\"center-center\",\"media_overlay_gradient\":\"\",\"position_sticky_breakpoint\":\"m\",\"width_medium\":\"1-4\",\"width_small\":\"1-2\"},\"children\":[{\"type\":\"image\",\"props\":{\"image\":\"wp-content\\\/uploads\\\/2023\\\/02\\\/KNJIGA-Karotidna-hirurgija-118-e1676065716573.png\",\"image_svg_color\":\"emphasis\",\"image_width\":\"300\",\"margin\":\"default\"}},{\"type\":\"text\",\"props\":{\"column_breakpoint\":\"m\",\"content\":\"\n\n<p style=\\\"text-align: left;\\\" align=\\\"CENTER\\\"><em>Eksponirana karotidna bifurkacija sa zauzdanom gornjom tiroidnom i spolja\\u0161njom karotidnom arterijom. <\\\/em><em>Distalno ansa cervicalis ukr\\u0161ta ACI<\\\/em><\\\/p>\",\"margin\":\"default\"}}]},{\"type\":\"column\",\"props\":{\"image_position\":\"center-center\",\"media_overlay_gradient\":\"\",\"position_sticky_breakpoint\":\"m\",\"width_medium\":\"1-4\",\"width_small\":\"1-2\"},\"children\":[{\"type\":\"image\",\"props\":{\"image\":\"wp-content\\\/uploads\\\/2023\\\/02\\\/KNJIGA-Karotidna-hirurgija-119.png\",\"image_svg_color\":\"emphasis\",\"image_width\":\"400\",\"margin\":\"default\"}},{\"type\":\"text\",\"props\":{\"column_breakpoint\":\"m\",\"content\":\"\n\n<p style=\\\"text-align: left;\\\" align=\\\"CENTER\\\"><em>Everziona endarterektomija kalcifikovanog plaka ACI<\\\/em><\\\/p>\",\"margin\":\"default\"}}]},{\"type\":\"column\",\"props\":{\"image_position\":\"center-center\",\"media_overlay_gradient\":\"\",\"position_sticky_breakpoint\":\"m\",\"width_medium\":\"1-4\",\"width_small\":\"1-2\"},\"children\":[{\"type\":\"image\",\"props\":{\"image\":\"wp-content\\\/uploads\\\/2023\\\/02\\\/KNJIGA-Karotidna-hirurgija-120.png\",\"image_svg_color\":\"emphasis\",\"image_width\":\"400\",\"margin\":\"default\"}},{\"type\":\"text\",\"props\":{\"column_breakpoint\":\"m\",\"content\":\"\n\n<p style=\\\"text-align: left;\\\" align=\\\"CENTER\\\"><em>Everziona endarterektomija. Pregled lumena ACI koji mora biti potpuno \\u010dist, Bez nerevnina i intinalnih flapova.<\\\/em><\\\/p>\\n\n\n<p style=\\\"text-align: left;\\\" align=\\\"CENTER\\\"><\\\/p>\",\"margin\":\"default\"}}]},{\"type\":\"column\",\"props\":{\"image_position\":\"center-center\",\"media_overlay_gradient\":\"\",\"position_sticky_breakpoint\":\"m\",\"width_medium\":\"1-4\",\"width_small\":\"1-2\"},\"children\":[{\"type\":\"image\",\"props\":{\"image\":\"wp-content\\\/uploads\\\/2023\\\/02\\\/KNJIGA-Karotidna-hirurgija-121.png\",\"image_svg_color\":\"emphasis\",\"image_width\":\"400\",\"margin\":\"default\"}},{\"type\":\"text\",\"props\":{\"column_breakpoint\":\"m\",\"content\":\"\n\n<p style=\\\"text-align: left;\\\" align=\\\"CENTER\\\"><em>Provera retrogradnog toka iz ACI nakon endarterektomije<\\\/em><\\\/p>\",\"margin\":\"default\"}}]}]}]},{\"type\":\"section\",\"props\":{\"image_position\":\"center-center\",\"padding\":\"none\",\"style\":\"default\",\"title_breakpoint\":\"xl\",\"title_position\":\"top-left\",\"title_rotation\":\"left\",\"vertical_align\":\"middle\",\"width\":\"default\"},\"children\":[{\"type\":\"row\",\"props\":{\"column_gap\":\"small\",\"layout\":\"1-4,1-4,1-4,1-4|1-2,1-2,1-2,1-2\",\"margin\":\"remove-vertical\",\"row_gap\":\"small\"},\"children\":[{\"type\":\"column\",\"props\":{\"image_position\":\"center-center\",\"media_overlay_gradient\":\"\",\"position_sticky_breakpoint\":\"m\",\"width_medium\":\"1-4\",\"width_small\":\"1-2\"},\"children\":[{\"type\":\"image\",\"props\":{\"image\":\"wp-content\\\/uploads\\\/2023\\\/02\\\/KNJIGA-Karotidna-hirurgija-122.png\",\"image_svg_color\":\"emphasis\",\"image_width\":\"300\",\"margin\":\"default\"}},{\"type\":\"text\",\"props\":{\"column_breakpoint\":\"m\",\"content\":\"\n\n<p style=\\\"text-align: left;\\\" align=\\\"CENTER\\\"><em>Endarterektomija spolja\\u0161nje i zajedni\\u010dke karotidne arterije.<\\\/em><\\\/p>\",\"margin\":\"default\"}}]},{\"type\":\"column\",\"props\":{\"image_position\":\"center-center\",\"media_overlay_gradient\":\"\",\"position_sticky_breakpoint\":\"m\",\"width_medium\":\"1-4\",\"width_small\":\"1-2\"},\"children\":[{\"type\":\"image\",\"props\":{\"image\":\"wp-content\\\/uploads\\\/2023\\\/02\\\/KNJIGA-Karotidna-hirurgija-123.png\",\"image_svg_color\":\"emphasis\",\"image_width\":\"400\",\"margin\":\"default\"}},{\"type\":\"text\",\"props\":{\"column_breakpoint\":\"m\",\"content\":\"\n\n<p style=\\\"text-align: left;\\\" align=\\\"CENTER\\\"><em>Reimplantacija karotidne arterije. Evertiraju\\u0107i \\u0161av, Prolen 5 ili 6 0, u pravcu prema operatoru, od pete ka vrhu anastomoze.<\\\/em><\\\/p>\\n\n\n<p style=\\\"text-align: left;\\\" align=\\\"CENTER\\\"><\\\/p>\",\"margin\":\"default\"}}]},{\"type\":\"column\",\"props\":{\"image_position\":\"center-center\",\"media_overlay_gradient\":\"\",\"position_sticky_breakpoint\":\"m\",\"width_medium\":\"1-4\",\"width_small\":\"1-2\"},\"children\":[{\"type\":\"image\",\"props\":{\"image\":\"wp-content\\\/uploads\\\/2023\\\/02\\\/KNJIGA-Karotidna-hirurgija-124.png\",\"image_svg_color\":\"emphasis\",\"image_width\":\"400\",\"margin\":\"default\"}},{\"type\":\"text\",\"props\":{\"column_breakpoint\":\"m\",\"content\":\"\n\n<p style=\\\"text-align: right;\\\"><em>Zavr\\u0161ena reimplantaciona <br \\\/>anastomoza ACI..<\\\/em><\\\/p>\\n\n\n<p style=\\\"text-align: right;\\\" align=\\\"CENTER\\\"><\\\/p>\",\"margin\":\"default\"}}]},{\"type\":\"column\",\"props\":{\"image_position\":\"center-center\",\"media_overlay_gradient\":\"\",\"position_sticky_breakpoint\":\"m\",\"width_medium\":\"1-4\",\"width_small\":\"1-2\"},\"children\":[{\"type\":\"image\",\"props\":{\"image\":\"wp-content\\\/uploads\\\/2023\\\/02\\\/KNJIGA-Karotidna-hirurgija-52.png\",\"image_svg_color\":\"emphasis\",\"image_width\":\"400\",\"margin\":\"default\"}}]}]}]}],\"version\":\"3.0.25\"} --><\/p>\n","protected":false},"excerpt":{"rendered":"<p>OP\u0160TI PRINCIPI REKONSTRUKCIJA SUPRAAORTALNIH GRANA 10.3. KLEMOVANJE SUPRAAORTALNIH GRANA 10.3.2. Trombendarterektomija Trombendarterektomija Podrazumeva odstranjivanje ateroskleroti\u010dne intime i medije koji izazivaju kriti\u010dnu stenozu okluziju arterije sa ili bez prizidnog trom- ba. Karotidna endartektomija daje konstatno dobre rezultate, pa se rekonstrukcija graftom primenjuje izuzetno retko. Mada je endarterektomija prvobitno uvedena u upotrebu za korekciju stenoza na ostijumu [&hellip;]<\/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-3414","page","type-page","status-publish","hentry"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.8 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>10.3.2 TROMBENDARTEREKTOMIJA - KAROTIDNA HIRURGIJA<\/title>\n<meta name=\"description\" content=\"Trombendarterektomija podrazumeva odstranjivanje ateroskleroti\u010dne intime i medije koji izazivaju kriti\u010dnu stenozu okluziju arterije sa ili bez prizidnog trom- ba. 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