{"id":3528,"date":"2023-02-12T13:07:35","date_gmt":"2023-02-12T13:07:35","guid":{"rendered":"https:\/\/www.karotidnahirurgija.com\/?page_id=3528"},"modified":"2023-02-23T17:11:56","modified_gmt":"2023-02-23T17:11:56","slug":"10-4-formiranje-arterijske-anastomoze","status":"publish","type":"page","link":"https:\/\/www.karotidnahirurgija.com\/?page_id=3528","title":{"rendered":"10.4. FORMIRANJE ARTERIJSKE ANASTOMOZE"},"content":{"rendered":"

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

<\/p>\n

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

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

\n

\n

10.4. FORMIRANJE ARTERIJSKE ANASTOMOZE<\/p>\n

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

FORMIRANJE ARTERIJSKE ANASTOMOZE<\/h2>\n<\/div>\n<\/div>\n

Anastomoza: spajanje dve arterije ili arterije sa graftom je op\u0161te mesto mnogih arterijskih rekonstrukcija. Postoje tri vrste arterijskih anastomoza:<\/p>\n

    \n
  • termino-terminalna,<\/li>\n
  • termino-lateralna i<\/li>\n
  • latero-lateralna.<\/li>\n<\/ul>\n

    Sutura arterije, kao i anastomoziranje arterije sa graftom izvodi se produ\u017enim, atraumatskim, evertiraju\u0107im \u0161avom (Prolen). Ako se radi o arteriji \u010diji lumen je manji od 4 mm, u cilju prevencije restenoze, koriste se pojedina\u010dni \u0161avovi. Promer konca zavisi od arterije i debljine i konzistencije njenog zida. Bitno je da unutra\u0161njost anastomoze bude glatka, bez defekata koji bi uslovljavali naknadno krvarenje i bez stenoza koje bi predisponirale trombozu rekonstruisanog segmenta. Pre pu\u0161tanja cirkulacije (skidanja klema) treba obavezno napraviti ispiranje (flushing) pu\u0161tanjem mlaza krvi iz distalne i proksimalne arterije, da bi se izbegla eventualna embolizacija.<\/p>\n<\/div>\n

    \"\"<\/p>\n

    \n

    Tehnika formiranja termino-terminalne anastomoze evertiraju\u0107im produ\u017enim \u0161avom (a). Arterija se suturira iznutra-spolja (b) da bi se spre\u010dila disekcija obolele intime.<\/em><\/p>\n<\/div>\n

    \n

    By<\/i> <\/i>pass<\/i> <\/i>graft<\/strong> na arterijama koje dovode krv do mozga mora biti anastomoziran tako da se iz krvne struje isklju\u010di (emboligeni) ateroskleroti\u010dni plak (dovoljno distalno i dovoljno proksimalno).<\/p>\n

    Bez obzira \u0161to je rekonstrukcija hemodinamski uredno napravljena, ako zaostanu arterijski segmenti sa kompleksnim plakovima i prizidnom trombozom distalna embolizacija \u0107e se de\u0161avati.<\/p>\n

    Postoperativno<\/b> <\/b>le\u010denje:<\/b> <\/b>Neposredno postoperativno le\u010denje podrazumeva neurolo\u0161ki monitoring, regulisanje hidroelektrolitnog statusa, korigovanje anemije, monitoring kardiorespiratornog sistema, pra\u0107enje diureze i urinarne acidoze itd.<\/p>\n

    Posebno su katastrofalne posledice: intraoperativne ishemije mozga, tromboze rekonstruisanog arterijskog segmenta i postrevaskularizacionog edema mozga.<\/p>\n<\/div>\n

    \n

    Antiedematozna<\/span> <\/span>i<\/span> <\/span>diuretska<\/span> <\/span>terapija,<\/span> <\/span>kao<\/span> <\/span>i<\/span> <\/span>monitoring<\/span> <\/span>arterijske<\/span> <\/span>tenzije<\/span> <\/span>i<\/span> <\/span>mo\u017edanih<\/span> <\/span>funkcija<\/span> <\/span>su<\/span> <\/span>va\u017eni.<\/span><\/p>\n

    Postoperativna<\/span> <\/span>antikoagulantna<\/span> <\/span>terapija<\/span> <\/span>ima<\/span> <\/span>dva<\/span> <\/span>razloga:<\/span><\/p>\n

    (1)<\/span> <\/span>spre\u010davanje<\/span> <\/span>lansiranja<\/span> <\/span>novih<\/span> <\/span>embolusa<\/span> <\/span>iz<\/span> <\/span>istog<\/span> <\/span>ili<\/span> <\/span>drugog<\/span> <\/span>emboligenog<\/span> <\/span>\u017eari\u0161ta<\/span> <\/span>(kardioembolizam)<\/span> <\/span>i<\/span><\/p>\n

    (2)<\/span> <\/span>spre\u010davanje<\/span> <\/span>tromboze<\/span> <\/span>zida<\/span> <\/span>embolektomisane<\/span> <\/span>arterije.<\/span> <\/span>Antitrombocitna<\/span> <\/span>terapija<\/span> <\/span>na<\/span> <\/span>duge<\/span> <\/span>staze<\/span> <\/span>se<\/span> <\/span>podrazumeva.<\/span><\/p>\n

    Prevencija<\/b><\/span> <\/b><\/span>infekcije<\/b><\/span> <\/b><\/span>u<\/span> <\/span>vaskularnoj<\/span> <\/span>hirurgiji<\/span> <\/span>podrazumeva:<\/span><\/p>\n

      \n
    • Sistematsku<\/span> <\/span>detekciju<\/span> <\/span>i<\/span> <\/span>le\u010denje<\/span> <\/span>infektivnih<\/span> <\/span>\u017eari\u0161ta<\/span> <\/span>preoperativno,<\/span><\/li>\n
    • Restriktivan<\/span> <\/span>stav<\/span> <\/span>u<\/span> <\/span>indikacionom<\/span> <\/span>razmi\u0161ljanju<\/span> <\/span>kod<\/span> <\/span>kahekti\u010dnih,<\/span> <\/span>anemi\u010dnih<\/span> <\/span>i<\/span> <\/span>hipoproteinemi\u010dnih<\/span> <\/span>pacijenata,<\/span><\/li>\n
    • Ozbiljna<\/span> <\/span>antisepti\u010dka<\/span> <\/span>priprema<\/span> <\/span>hirurga,<\/span> <\/span>pacijenta<\/span> <\/span>i<\/span> <\/span>operacionog<\/span> <\/span>polja.<\/span><\/li>\n
    • Izbor<\/span> <\/span>najmanje<\/span> <\/span>traumatiziraju\u0107eg<\/span> <\/span>hiru\u0161kog<\/span> <\/span>pristupa<\/span> <\/span>arteriji,<\/span><\/li>\n
    • Disekcija<\/span> <\/span>bez<\/span> <\/span>lezija<\/span> <\/span>okolnih<\/span> <\/span>struktura<\/span> <\/span>(limfatici,<\/span> <\/span>abdominalni<\/span> <\/span>organi),<\/span><\/li>\n
    • Brza<\/span> <\/span>i<\/span> <\/span>tehni\u010dki<\/span> <\/span>precizno<\/span> <\/span>izvedena<\/span> <\/span>arterijska<\/span> <\/span>rekonstrukcija<\/span> <\/span>uz<\/span> <\/span>pravilno<\/span> <\/span>odabranu<\/span> <\/span>vrstu<\/span> <\/span>grafta.<\/span><\/li>\n
    • Pa\u017eljiva<\/span> <\/span> <\/span>hemostaza<\/span> <\/span> <\/span>na <\/span> <\/span>kraju<\/span> <\/span> <\/span>operacije<\/span> <\/span> <\/span>da <\/span> <\/span>bi <\/span> <\/span>se <\/span> <\/span>izbeglo<\/span> <\/span> <\/span>formiranje<\/span> <\/span>periarterijskog<\/span> <\/span>hematoma<\/span> <\/span>koji<\/span> <\/span>je<\/span> <\/span>podloga<\/span> <\/span>za<\/span> <\/span>infekciju.<\/span><\/li>\n
    • Intra<\/span> <\/span>i<\/span> <\/span>postoperativna<\/span> <\/span>antibiotska<\/span> <\/span>(ako<\/span> <\/span>je<\/span> <\/span>potrebno<\/span> <\/span>i<\/span> <\/span>antimikoti\u010dna)<\/span> <\/span>pro<\/span>fi<\/span>laksa.<\/span><\/li>\n
    • Agresivna<\/span> <\/span>dijagnostika<\/span> <\/span>i<\/span> <\/span>za\u0161tita<\/span> <\/span>u<\/span> <\/span>slu\u010daju<\/span> <\/span>najmanjeg<\/span> <\/span>klini\u010dkog<\/span> <\/span>nagove\u0161taja<\/span> <\/span>infekcije.<\/span><\/li>\n<\/ul>\n

      Najre\u0111e<\/span> <\/span>su<\/span> <\/span>infekcije<\/span> <\/span>pri<\/span> <\/span>rekonstrukcijama<\/span> <\/span>supraaortalnih<\/span> <\/span>grana.<\/span> <\/span>Autovenski<\/span> <\/span>i<\/span> <\/span>autoarterijski<\/span> <\/span>graftovi<\/span> <\/span>su<\/span> <\/span>otporniji<\/span> <\/span>na<\/span> <\/span>infekciju<\/span> <\/span>od<\/span> <\/span>raznih<\/span> <\/span>vrsta<\/span> <\/span>sintetskih<\/span> <\/span>graftova<\/span> <\/span>koji<\/span> <\/span>se<\/span> <\/span>pona\u0161aju<\/span> <\/span>kao<\/span> <\/span>strano<\/span> <\/span>telo.<\/span> <\/span>Me\u0111u<\/span> <\/span>sintetskim<\/span> <\/span>graftovima<\/span> <\/span>Dacron<\/span> <\/span>sa<\/span> <\/span>velour<\/i><\/span> <\/i><\/span>tkanjem<\/span> <\/span>najbolje<\/span> <\/span>se<\/span> <\/span>inkorporira<\/span> <\/span>i<\/span> <\/span>ima<\/span> <\/span>najmanju<\/span> <\/span>sklonost<\/span> <\/span>ka<\/span> <\/span>infekciji.<\/span> <\/span>Sintetski<\/span> <\/span>graft<\/span> <\/span>impregniran<\/span> <\/span>srebroacetaton<\/span> <\/span>(<\/span>Silver<\/b><\/i><\/span> <\/b><\/i><\/span>graft<\/b><\/i><\/span>)<\/span> <\/span>uz<\/span> <\/span>lokalnu<\/span> <\/span>primenu<\/span> <\/span>spororesorptivnih<\/span> <\/span>antibiotika<\/span> <\/span>suprimira<\/span> <\/span>infektivne<\/span> <\/span>komplikacije.<\/span><\/p>\n

      Pseudoaneurizma<\/b><\/span> <\/b><\/span>(<\/span>aneurysma<\/b><\/i><\/span> <\/b><\/i><\/span>spuria<\/b><\/i><\/span>)<\/span> <\/span>u<\/span> <\/span>postoperativnom<\/span> <\/span>toku<\/span> <\/span>nastaje<\/span> <\/span>zbog<\/span> <\/span>popu\u0161tanja<\/span> <\/span>\u0161ava<\/span> <\/span>ili<\/span> <\/span>arterijskog<\/span> <\/span>zida.<\/span> <\/span>Javlja<\/span> <\/span>se<\/span> <\/span>retko.<\/span><\/p>\n

      Uzroci<\/span> <\/span>nastanka<\/span> <\/span>la\u017ene<\/span> <\/span>aneurizme<\/span> <\/span>su:<\/span><\/p>\n

        \n
      • Popu\u0161tanje<\/span> <\/span>ili<\/span> <\/span>cepanje<\/span> <\/span>arterijskog<\/span> <\/span>zida<\/span> <\/span>na<\/span> <\/span>mestu<\/span> <\/span>suture<\/span> <\/span>(anastomoze),<\/span><\/li>\n
      • Pucanje<\/span> <\/span>suture<\/span> <\/span>(atraumatski,<\/span> <\/span>sintetski,<\/span> <\/span>neresorptivni<\/span> <\/span>\u0161av),<\/span><\/li>\n
      • Degeneracija<\/span> <\/span>ili<\/span> <\/span>cepanje<\/span> <\/span>grafta<\/span> <\/span>na<\/span> <\/span>mestu<\/span> <\/span>suture,<\/span><\/li>\n
      • Slaba<\/span> <\/span>inkorporacija<\/span> <\/span>grafta<\/span> <\/span>(periarterijska<\/span> <\/span>kolekcija<\/span> <\/span>krvi<\/span> <\/span>ili<\/span> <\/span>limfe<\/span> <\/span>sa<\/span> <\/span>ili<\/span> <\/span>bez<\/span> <\/span>lokalne<\/span> <\/span>infekcije).<\/span><\/li>\n<\/ul>\n

        Dodatni<\/span> <\/span>faktori<\/span> <\/span>rizika<\/span> <\/span>su:<\/span> <\/span>turbulentni<\/span> <\/span>protok<\/span> <\/span>kod<\/span> <\/span>termino-lateralne<\/span> <\/span>anastomoze,<\/span> <\/span>arterijska<\/span> <\/span>hipertenzija,<\/span> <\/span>suvi\u0161e<\/span> <\/span>kratak<\/span> <\/span>graft<\/span> <\/span>koji<\/span> <\/span>je<\/span> <\/span>implantiran<\/span> <\/span>pod<\/span> <\/span>tenzijom.<\/span> <\/span>Autovenski<\/span> <\/span>graft<\/span> <\/span>u<\/span> <\/span>svim<\/span> <\/span>pozicijama<\/span> <\/span>nosi<\/span> <\/span>najmanji<\/span> <\/span>rizik<\/span> <\/span>od<\/span> <\/span>pojave<\/span> <\/span>pseudoaneurizme.<\/span> <\/span>Biograftovi<\/span> <\/span>su<\/span> <\/span>veoma<\/span> <\/span>skloni<\/span> <\/span>anastomotskim<\/span> <\/span>aneurizmama.<\/span> <\/span>In<\/span>fi<\/span>cirani<\/span> <\/span>sintetski<\/span> <\/span>graft<\/span> <\/span>skloniji<\/span> <\/span>je<\/span> <\/span>razvoju<\/span> <\/span>komplikovane<\/span> <\/span>pseudoaneurizme<\/span> <\/span>nego<\/span> <\/span>graft od autologog materijala.<\/p>\n<\/div>\n


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

        OP\u0160TI PRINCIPI REKONSTRUKCIJA SUPRAAORTALNIH GRANA 10.4. FORMIRANJE ARTERIJSKE ANASTOMOZE FORMIRANJE ARTERIJSKE ANASTOMOZE Anastomoza: spajanje dve arterije ili arterije sa graftom je op\u0161te mesto mnogih arterijskih rekonstrukcija. Postoje tri vrste arterijskih anastomoza: termino-terminalna, termino-lateralna i latero-lateralna. Sutura arterije, kao i anastomoziranje arterije sa graftom izvodi se produ\u017enim, atraumatskim, evertiraju\u0107im \u0161avom (Prolen). Ako se radi o arteriji […]<\/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-3528","page","type-page","status-publish","hentry"],"acf":[],"yoast_head":"\n10.4. FORMIRANJE ARTERIJSKE ANASTOMOZE - KAROTIDNA HIRURGIJA<\/title>\n<meta name=\"description\" content=\"Anastomoza: spajanje dve arterije ili arterije sa graftom je op\u0161te mesto mnogih arterijskih rekonstrukcija. Postoje tri vrste arterijskih anastomoza: termino-terminalna, termino-lateralna i latero-lateralna.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.karotidnahirurgija.com\/?page_id=3528\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"10.4. FORMIRANJE ARTERIJSKE ANASTOMOZE - KAROTIDNA HIRURGIJA\" \/>\n<meta property=\"og:description\" content=\"Anastomoza: spajanje dve arterije ili arterije sa graftom je op\u0161te mesto mnogih arterijskih rekonstrukcija. 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