{"id":3664,"date":"2023-02-12T19:40:51","date_gmt":"2023-02-12T19:40:51","guid":{"rendered":"https:\/\/www.karotidnahirurgija.com\/?page_id=3664"},"modified":"2023-02-25T14:13:17","modified_gmt":"2023-02-25T14:13:17","slug":"12-1-standardna-karotidna-endarterektomija","status":"publish","type":"page","link":"https:\/\/www.karotidnahirurgija.com\/?page_id=3664","title":{"rendered":"12.1. OPERATIVNA TEHNIKA EVERZIONE KAROTIDNE ENDARTEREKTOMIJE"},"content":{"rendered":"<p><a href=\"\/index.php?page_id=3656\"><img decoding=\"async\" src=\"\/wp-content\/uploads\/2023\/02\/12.png\" alt=\"\"><\/a><\/p>\n<h1><a href=\"\/index.php?page_id=1408\"><\/p>\n<h1 class=\"western\">REKONSTRUKCIJA KAROTIDNE ARTERIJE<\/h1>\n<p><\/a><\/h1>\n<div>\n<h3>\n<h2>12.1. OPERATIVNA TEHNIKA EVERZIONE KAROTIDNE ENDARTEREKTOMIJE<\/p>\n<h2><\/h3>\n<\/div>\n<div>\n<h4 class=\"western\">OPERATIVNA TEHNIKA EVERZIONE KAROTIDNE ENDARTEREKTOMIJE<\/h4>\n<p class=\"western\" align=\"JUSTIFY\">Everziona karotidna endarterektomija se mo\u017ee uraditi u op\u0161toj endotrahealnoj ili regionalnoj anesteziji.<\/p>\n<p class=\"western\" align=\"JUSTIFY\"><b>Preparisanje<\/b><b> <\/b><b>karotidnih<\/b><b> <\/b><b>arterija<\/b><b> <\/b>odvija se na standardan na\u010din. Kad se eksponira dovoljan segment karotidnih arterija, a to zna\u010di da imamo proksimalno i distalno oko 1 cm arterije koja je po\u0161te\u0111ena ateroskleroti\u010dnog plaka, mo\u017ee se pristupiti klemovanju. Intravenski se prethodno daje 5000 ij. Heparina. Nakon klemovanja na\u010dini se kosa\/transverzalna transsekcija unutra\u0161nje karotidne arterije u predelu bifurkacije. U slu\u010daju kinknga ili coiling-a arterija se resecira njenim dodatnim otvaranjem sa medijalne strane, tako da reinplantiranjem bude adekvatno skra\u0107ena.<\/p>\n<\/div>\n<p><img decoding=\"async\" src=\"\/wp-content\/uploads\/2023\/02\/KNJIGA-Karotidna-hirurgija-152.png\" alt=\"\"><\/p>\n<div>\n<p align=\"CENTER\"><em>Everziona karotidna endarterektomija:<br \/><\/em><em>Popre\u010dna transekcija unutra\u0161nje karotidne arterije u nivou karotidne bifurkacije. Detalj: zapo\u010dinjanje everzione endarterektomije unutra\u0161nje karotidne arterije ulaskom u sloj izmedju obolele medije i o\u010duvane adventicije sa spolja\u0161njom elasti\u010dnom laminom.<\/em><\/p>\n<\/div>\n<p><img decoding=\"async\" src=\"\/wp-content\/uploads\/2023\/02\/KNJIGA-Karotidna-hirurgija-153.png\" alt=\"\"><\/p>\n<div>\n<p align=\"CENTER\"><em>Endarterektomija zajedni\u010dke i spolja\u0161nje karotidne arterije, nakon zavr\u0161ene everzione procedure unutra\u0161nje karotidne arterije.<\/em><\/p>\n<p align=\"CENTER\">\n<\/div>\n<div>\n<p class=\"western\" align=\"JUSTIFY\"><b>Endarterektomija<\/b><b> <\/b><b>unutra\u0161nje<\/b><b> <\/b><b>karotidne<\/b><b> <\/b><b>arterije<\/b>: nakon presecanja karotidne arterije se identifikuje sloj za izvo\u0111enje endarterektomije (<i>lamina<\/i><i> <\/i><i>elastica<\/i><i> <\/i><i>externa<\/i>). U sloju gde se ateroskleroti\u010dni plak sam odvaja od adventicije (<i>cleavage<\/i><i> <\/i><i>plane<\/i>) odstranjuje se plak posuvrtanjem unutra\u0161nje karotidne arterije uz istovremenu trakciju ateroskleroti\u010dnog cilindra.<\/p>\n<p class=\"western\" align=\"JUSTIFY\">Naro\u010dita pa\u017enja se obra\u0107a da se distalno, gde prestaje ateroskleroti\u010dni plak, endarterektomija zavr\u0161i glatkom povr\u0161inom (bez intimalnih ili medijalnih <i>fl<\/i><i>ap<\/i>-ova). Ako se plak prostire distalnije, nego obi\u010dno, neophodno je da se pri disekciji isprepari\u0161e ne\u0161to vi\u0161i segment arterije karotis interne.<\/p>\n<p class=\"western\" align=\"JUSTIFY\">Nije potrebno mobilisanje du\u017eeg arterijskog segmenta nego za standardnu karotidnu endarterektomiju. Tokom everzione endarterektomije centralnog plaka treba istovremeno pa\u017eljivo odstranjivati zaostale fragmente medijalnog arterijskog sloja i debris sa \u010ditave arterijske cirkumferencije.<\/p>\n<p class=\"western\" align=\"JUSTIFY\">Bitna je preglednost unutra\u0161nje strane arterije. Nakon \u0161to je odstranjen \u010ditav plak treba proveriti ivicu distalnog odlubljivanja. Ako na postoje zaostali <i>fl<\/i><i>ap<\/i>-ovi i neravnine treba ih odstraniti tako da unutra\u0161nja povr\u0161ina bude potpuno glatka.<\/p>\n<\/div>\n<p><img decoding=\"async\" src=\"\/wp-content\/uploads\/2023\/02\/KNJIGA-Karotidna-hirurgija-154.png\" alt=\"\"><\/p>\n<div>\n<p style=\"text-align: left;\" align=\"CENTER\"><em>Zavr\u0161avanje everzione karotidne endarterektomije reimplantacijom unutra\u0161nje karotidne arterije. Ako je ona preduga\u010dka (kinking, coiling) treba je adekvatno <\/em><em>resecirati. Ponekad je zgodno transponirati arteriju ispred n.hypoglossus-a, da bi se izbegla kompresija.<\/em><\/p>\n<\/div>\n<div>\n<h3 class=\"western\" style=\"text-align: left;\" align=\"JUSTIFY\"><b>Reimnplantacija<\/b><b> <\/b>se izvodi pod blagom tenzijom kontinuiranim evertiraju\u0107im \u0161avom sa Prolen-om (polypropylene) 6-0.<br \/>Sutura zadnjeg zida anastomoze radi se plasiranjem \u0161avova iznuta, a na prednjem zidu spolja.<\/h3>\n<p class=\"western\" style=\"text-align: left;\" align=\"JUSTIFY\"><b>Protektivna<\/b><b> <\/b><b>primena<\/b><b> <\/b><b>privremenog<\/b><b> <\/b><b>intraluminalnog<\/b><b> <\/b><b>shunt-a<\/b><b> <\/b>tokom everzione endarterektomije je mogu\u0107a. Plasiranje shunta mogu\u0107e je: (1) pre po\u010detka endarterektomije, ali je u tom slu\u010daju ote\u017eana vizuelizacija arterijskog lumena, ili (2) nakon endarterektomije, a pre po\u010detka reimplantacije. Indikacije za primenu intraluminalnog shunt-a su iste kao i kod standardne metode. Obzirom da everziona endarterektomija zahteva znatno kra\u0107e vreme klemovanja (8min.) nego standardna (12 do 20min.), mo\u017ee se re\u0107i da je mogu\u0107nost racionalnog izbegavanja primene shunta velika.<\/p>\n<\/div>\n<ul>\n<li>\n<p>        <img decoding=\"async\" src=\"\/wp-content\/uploads\/2023\/02\/153.jpg\" alt=\"\"><\/p>\n<div>\n<p align=\"CENTER\"><em>Sterilna priprema operativnog polja za cervikalnu inciziju du\u017e sternokleidomastoidnog mi\u0161i\u0107a.<\/em><\/p>\n<\/div>\n<\/li>\n<li>\n<p>        <img decoding=\"async\" src=\"\/wp-content\/uploads\/2023\/02\/KNJIGA-Karotidna-hirurgija-156.png\" alt=\"\"><\/p>\n<div>\n<p align=\"CENTER\"><em>Rez po prednjoj ivici sternokleidomastoidnog mi\u0161i\u0107a i presecanje platizme termokauterom.<\/em><\/p>\n<\/div>\n<\/li>\n<li>\n<p>        <img decoding=\"async\" src=\"\/wp-content\/uploads\/2023\/02\/KNJIGA-Karotidna-hirurgija-157.png\" alt=\"\"><\/p>\n<div>\n<p align=\"CENTER\"><em>Disekcija facijalne vene.<\/em><\/p>\n<\/div>\n<\/li>\n<li>\n<p>        <img decoding=\"async\" src=\"\/wp-content\/uploads\/2023\/02\/KNJIGA-Karotidna-hirurgija-158.png\" alt=\"\"><\/p>\n<div>\n<p align=\"CENTER\"><em>Presecanje facijalne vene.<\/em><\/p>\n<\/div>\n<\/li>\n<li>\n<p>        <img decoding=\"async\" src=\"\/wp-content\/uploads\/2023\/02\/KNJIGA-Karotidna-hirurgija-159.png\" alt=\"\"><\/p>\n<div>\n<p align=\"CENTER\"><em>Ligatura facijalne vene.<\/em><\/p>\n<\/div>\n<\/li>\n<li>\n<p>        <img decoding=\"async\" src=\"\/wp-content\/uploads\/2023\/02\/KNJIGA-Karotidna-hirurgija-160.png\" alt=\"\"><\/p>\n<div>\n<p align=\"CENTER\"><em>Disekcija zajedni\u010dke karotidne arterije, koju ne treba pomerati.<\/em><\/p>\n<\/div>\n<\/li>\n<li>\n<p>        <img decoding=\"async\" src=\"\/wp-content\/uploads\/2023\/02\/KNJIGA-Karotidna-hirurgija-161.png\" alt=\"\"><\/p>\n<div>\n<p align=\"CENTER\"><em>Zauzdavanje zajedni\u010dke karotidne arterije.<\/em><\/p>\n<\/div>\n<\/li>\n<li>\n<p>        <img decoding=\"async\" src=\"\/wp-content\/uploads\/2023\/02\/KNJIGA-Karotidna-hirurgija-162.png\" alt=\"\"><\/p>\n<div>\n<p align=\"CENTER\"><em>Zauzdavanje gornje tireoidne arterije <\/em><em>uz identifikaciju n. hypoglossus-a<\/em><\/p>\n<\/div>\n<\/li>\n<li>\n<p>        <img decoding=\"async\" src=\"\/wp-content\/uploads\/2023\/02\/KNJIGA-Karotidna-hirurgija-163.png\" alt=\"\"><\/p>\n<div>\n<p align=\"CENTER\"><em>Zauzdavanje spolja\u0161nje karotidne arterije.<\/em><\/p>\n<\/div>\n<\/li>\n<li>\n<p>        <img decoding=\"async\" src=\"\/wp-content\/uploads\/2023\/02\/KNJIGA-Karotidna-hirurgija-164.png\" alt=\"\"><\/p>\n<div>\n<p align=\"CENTER\"><em>Zauzdavanje unutra\u0161nje karotidne arterije.<\/em><\/p>\n<\/div>\n<\/li>\n<li>\n<p>        <img decoding=\"async\" src=\"\/wp-content\/uploads\/2023\/02\/KNJIGA-Karotidna-hirurgija-165.png\" alt=\"\"><\/p>\n<div>\n<p align=\"CENTER\"><em>Transekcija unutra\u0161nje karotidne arterije u nivou bifurkacije.<\/em><\/p>\n<\/div>\n<\/li>\n<li>\n<p>        <img decoding=\"async\" src=\"\/wp-content\/uploads\/2023\/02\/KNJIGA-Karotidna-hirurgija-166.png\" alt=\"\"><\/p>\n<div>\n<p align=\"CENTER\"><em>Incizija du\u017e unutra\u0161nje ivice unutra\u0161nje karotidne arterije, toliko da se dovoljno skrati ACI.<\/em><\/p>\n<\/div>\n<\/li>\n<li>\n<p>        <img decoding=\"async\" src=\"\/wp-content\/uploads\/2023\/02\/KNJIGA-Karotidna-hirurgija-167.png\" alt=\"\"><\/p>\n<div>\n<p align=\"CENTER\"><em>Everziona endarterektomija ACI .<\/em><\/p>\n<\/div>\n<\/li>\n<li>\n<p>        <img decoding=\"async\" src=\"\/wp-content\/uploads\/2023\/02\/KNJIGA-Karotidna-hirurgija-168.png\" alt=\"\"><\/p>\n<div>\n<p align=\"CENTER\"><em>Kontrola mesta gde se zavr\u0161ava endarterektomija ACI .<\/em><\/p>\n<\/div>\n<\/li>\n<li>\n<p>        <img decoding=\"async\" src=\"\/wp-content\/uploads\/2023\/02\/KNJIGA-Karotidna-hirurgija-170.png\" alt=\"\"><\/p>\n<div>\n<p align=\"CENTER\"><em>Ispiranje mesta gde se zavr\u0161ava endarterektomija ACI. Provera glatke povr\u0161ine. Otklanjanje neravnina.<\/em><\/p>\n<\/div>\n<\/li>\n<li>\n<p>        <img decoding=\"async\" src=\"\/wp-content\/uploads\/2023\/02\/KNJIGA-Karotidna-hirurgija-171.png\" alt=\"\"><\/p>\n<div>\n<p align=\"CENTER\"><em>Po\u010detak reimplantacije unutra\u0161nje karotidne arterije. Prolen 5\/0 ili 6\/0.<\/em><\/p>\n<\/div>\n<\/li>\n<li>\n<p>        <img decoding=\"async\" src=\"\/wp-content\/uploads\/2023\/02\/KNJIGA-Karotidna-hirurgija-172.png\" alt=\"\"><\/p>\n<div>\n<p align=\"CENTER\"><em>Plasiranje \u0161avova u predelu \u2018pete\u2019 anastomoze.<\/em><\/p>\n<\/div>\n<\/li>\n<li>\n<p>        <img decoding=\"async\" src=\"\/wp-content\/uploads\/2023\/02\/KNJIGA-Karotidna-hirurgija-174.png\" alt=\"\"><\/p>\n<div>\n<p align=\"CENTER\"><em>Rekonstrukcija orificijuma unutra\u0161nje karotidne arterije. Sutura zadnjeg zida \u0161avovima iznutra.<\/em><\/p>\n<\/div>\n<\/li>\n<li>\n<p>        <img decoding=\"async\" src=\"\/wp-content\/uploads\/2023\/02\/KNJIGA-Karotidna-hirurgija-174.png\" alt=\"\"><\/p>\n<div>\n<p align=\"CENTER\"><em>Sutura prednjeg zida anastomoze unutra\u0161nje karotidne arterije, \u0161avovima spolja.<\/em><\/p>\n<\/div>\n<\/li>\n<li>\n<p>        <img decoding=\"async\" src=\"\/wp-content\/uploads\/2023\/02\/KNJIGA-Karotidna-hirurgija-175.png\" alt=\"\"><\/p>\n<div>\n<p align=\"CENTER\"><em>Sutura prednjeg zida i vrha anastomoze \u0161avovima spolja.<\/em><\/p>\n<\/div>\n<\/li>\n<li>\n<p>        <img decoding=\"async\" src=\"\/wp-content\/uploads\/2023\/02\/KNJIGA-Karotidna-hirurgija-176.png\" alt=\"\"><\/p>\n<div>\n<p align=\"CENTER\"><em>Sutura zadnjeg zida anastomoze \u0161avovima spolja.<\/em><\/p>\n<\/div>\n<\/li>\n<li>\n<p>        <img decoding=\"async\" src=\"\/wp-content\/uploads\/2023\/02\/KNJIGA-Karotidna-hirurgija-177.png\" alt=\"\"><\/p>\n<div>\n<p align=\"CENTER\"><em>Sutura zadnjeg zida prema vrhu anastomoze \u0161avovima spolja.<\/em><\/p>\n<\/div>\n<\/li>\n<li>\n<p>        <img decoding=\"async\" src=\"\/wp-content\/uploads\/2023\/02\/KNJIGA-Karotidna-hirurgija-178.png\" alt=\"\"><\/p>\n<div>\n<p align=\"CENTER\"><em>Zavr\u0161etak anastomoze na prednjem zidu ACI. Sutura spolja ka unutra.<\/em><\/p>\n<\/div>\n<\/li>\n<li>\n<p>        <img decoding=\"async\" src=\"\/wp-content\/uploads\/2023\/02\/KNJIGA-Karotidna-hirurgija-179.png\" alt=\"\"><\/p>\n<div>\n<p align=\"CENTER\"><em>Zavr\u0161etak anastomoze na prednjem zidu ACI. Lijatura produ\u017enog evertiraju\u0107eg \u0161ava.<\/em><\/p>\n<\/div>\n<\/li>\n<li>\n<p>        <img decoding=\"async\" src=\"\/wp-content\/uploads\/2023\/02\/KNJIGA-Karotidna-hirurgija-180.png\" alt=\"\"><\/p>\n<div>\n<p align=\"CENTER\"><em>Cirkulacija se prvo pu\u0161ta u spolja\u0161nju a potom u unutra\u0161nju karotidnu arteriju.<\/em><\/p>\n<\/div>\n<\/li>\n<li>\n<p>        <img decoding=\"async\" src=\"\/wp-content\/uploads\/2023\/02\/KNJIGA-Karotidna-hirurgija-181.png\" alt=\"\"><\/p>\n<div>\n<p align=\"CENTER\"><em>Provera suturne linije unutra\u0161nje karotidne arterije.<\/em><\/p>\n<\/div>\n<\/li>\n<li>\n<p>        <img decoding=\"async\" src=\"\/wp-content\/uploads\/2023\/02\/KNJIGA-Karotidna-hirurgija-182.png\" alt=\"\"><\/p>\n<div>\n<p align=\"CENTER\"><em>Provera hemostaze u predelu platizme.<\/em><\/p>\n<\/div>\n<\/li>\n<li>\n<p>        <img decoding=\"async\" src=\"\/wp-content\/uploads\/2023\/02\/KNJIGA-Karotidna-hirurgija-183.png\" alt=\"\"><\/p>\n<div>\n<p align=\"CENTER\"><em>Provera hemostaze i pogled na urednu anastomozu.<\/em><\/p>\n<\/div>\n<\/li>\n<li>\n<p>        <img decoding=\"async\" src=\"\/wp-content\/uploads\/2023\/02\/KNJIGA-Karotidna-hirurgija-184.png\" alt=\"\"><\/p>\n<div>\n<p style=\"text-align: left;\" align=\"RIGHT\"><em>Ako je potrebno postavlja se lokalno prokoagulantna gaza.<\/em><\/p>\n<\/div>\n<\/li>\n<li>\n<p>        <img decoding=\"async\" src=\"\/wp-content\/uploads\/2023\/02\/KNJIGA-Karotidna-hirurgija-185.png\" alt=\"\"><\/p>\n<div>\n<p align=\"CENTER\"><em>Sutura platizme ne zahvataju\u0107i sternokleidomastoidni mi\u0161i\u0107.<\/em><\/p>\n<\/div>\n<\/li>\n<li>\n<p>        <img decoding=\"async\" src=\"\/wp-content\/uploads\/2023\/02\/KNJIGA-Karotidna-hirurgija-186.png\" alt=\"\"><\/p>\n<div>\n<p align=\"CENTER\"><em>Aspiracioni dren. Sutura ko\u017ee pojedina\u010dnim atraumatskim \u0161avom, Prolen 50<\/em><\/p>\n<\/div>\n<\/li>\n<\/ul>\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\\\/12.png\",\"image_svg_color\":\"emphasis\",\"link\":\"index.php?page_id=3656\",\"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 class=\\\"western\\\">REKONSTRUKCIJA KAROTIDNE ARTERIJE<\\\/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>12.1. OPERATIVNA TEHNIKA EVERZIONE KAROTIDNE ENDARTEREKTOMIJE\n\n<h2>\"}}]}]}]}]},{\"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\",\"width_medium\":\"1-4\"},\"children\":[]},{\"type\":\"column\",\"props\":{\"image_position\":\"center-center\",\"media_overlay_gradient\":\"\",\"position_sticky_breakpoint\":\"m\",\"width_medium\":\"3-4\"},\"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\":56,\"parent\":\"\",\"heading\":\"\",\"include_heading\":true,\"ids\":[\"3743\"]}},\"props\":{\"type\":{\"filters\":{\"search\":\"\"},\"name\":\"title\"},\"active\":{\"filters\":{\"search\":\"\"},\"name\":\"active\"},\"content\":{\"filters\":{\"search\":\"\"},\"name\":\"title\"},\"link\":{\"filters\":{\"search\":\"\"},\"name\":\"url\"}}}}],\"name\":\"submeni\"}]}],\"props\":{\"layout\":\"1-4,3-4\"}}]},{\"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\",\"children\":[{\"type\":\"column\",\"props\":{\"image_position\":\"center-center\",\"media_overlay_gradient\":\"\",\"position_sticky_breakpoint\":\"m\"},\"children\":[{\"type\":\"text\",\"props\":{\"column\":\"1-2\",\"column_breakpoint\":\"m\",\"column_divider\":true,\"content\":\"\n\n<h4 class=\\\"western\\\">OPERATIVNA TEHNIKA EVERZIONE KAROTIDNE ENDARTEREKTOMIJE<\\\/h4>\\n\n\n<p class=\\\"western\\\" align=\\\"JUSTIFY\\\">Everziona karotidna endarterektomija se mo\\u017ee uraditi u op\\u0161toj endotrahealnoj ili regionalnoj anesteziji.<\\\/p>\\n\n\n<p class=\\\"western\\\" align=\\\"JUSTIFY\\\"><b>Preparisanje<\\\/b><b> <\\\/b><b>karotidnih<\\\/b><b> <\\\/b><b>arterija<\\\/b><b> <\\\/b>odvija se na standardan na\\u010din. Kad se eksponira dovoljan segment karotidnih arterija, a to zna\\u010di da imamo proksimalno i distalno oko 1 cm arterije koja je po\\u0161te\\u0111ena ateroskleroti\\u010dnog plaka, mo\\u017ee se pristupiti klemovanju. Intravenski se prethodno daje 5000 ij. Heparina. Nakon klemovanja na\\u010dini se kosa\\\/transverzalna transsekcija unutra\\u0161nje karotidne arterije u predelu bifurkacije. U slu\\u010daju kinknga ili coiling-a arterija se resecira njenim dodatnim otvaranjem sa medijalne strane, tako da reinplantiranjem bude adekvatno skra\\u0107ena.<\\\/p>\",\"margin\":\"default\"}}]}]}]},{\"type\":\"section\",\"props\":{\"image_position\":\"center-center\",\"padding\":\"xsmall\",\"padding_remove_top\":true,\"style\":\"default\",\"title_breakpoint\":\"xl\",\"title_position\":\"top-left\",\"title_rotation\":\"left\",\"vertical_align\":\"middle\",\"width\":\"default\"},\"children\":[{\"type\":\"row\",\"props\":{\"layout\":\"1-2,1-2\"},\"children\":[{\"type\":\"column\",\"props\":{\"image_position\":\"center-center\",\"media_overlay_gradient\":\"\",\"position_sticky_breakpoint\":\"m\",\"width_medium\":\"1-2\"},\"children\":[{\"type\":\"image\",\"props\":{\"image\":\"wp-content\\\/uploads\\\/2023\\\/02\\\/KNJIGA-Karotidna-hirurgija-152.png\",\"image_svg_color\":\"emphasis\",\"image_width\":\"460\",\"margin\":\"default\"}},{\"type\":\"text\",\"props\":{\"column_breakpoint\":\"m\",\"content\":\"\n\n<p align=\\\"CENTER\\\"><em>Everziona karotidna endarterektomija:<br \\\/><\\\/em><em>Popre\\u010dna transekcija unutra\\u0161nje karotidne arterije u nivou karotidne bifurkacije. Detalj: zapo\\u010dinjanje everzione endarterektomije unutra\\u0161nje karotidne arterije ulaskom u sloj izmedju obolele medije i o\\u010duvane adventicije sa spolja\\u0161njom elasti\\u010dnom laminom.<\\\/em><\\\/p>\",\"margin\":\"default\"}}]},{\"type\":\"column\",\"props\":{\"image_position\":\"center-center\",\"media_overlay_gradient\":\"\",\"position_sticky_breakpoint\":\"m\",\"width_medium\":\"1-2\"},\"children\":[{\"type\":\"image\",\"props\":{\"image\":\"wp-content\\\/uploads\\\/2023\\\/02\\\/KNJIGA-Karotidna-hirurgija-153.png\",\"image_svg_color\":\"emphasis\",\"image_width\":\"370\",\"margin\":\"default\"}},{\"type\":\"text\",\"props\":{\"column_breakpoint\":\"m\",\"content\":\"\n\n<p align=\\\"CENTER\\\"><em>Endarterektomija zajedni\\u010dke i spolja\\u0161nje karotidne arterije, nakon zavr\\u0161ene everzione procedure unutra\\u0161nje karotidne arterije.<\\\/em><\\\/p>\\n\n\n<p align=\\\"CENTER\\\"><\\\/p>\",\"margin\":\"default\"}}]}]}]},{\"type\":\"section\",\"props\":{\"image_position\":\"center-center\",\"padding\":\"xsmall\",\"padding_remove_top\":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\",\"width_medium\":\"1-2\",\"width_small\":\"1-1\"},\"children\":[{\"type\":\"text\",\"props\":{\"column_breakpoint\":\"m\",\"column_divider\":true,\"content\":\"\n\n<p class=\\\"western\\\" align=\\\"JUSTIFY\\\"><b>Endarterektomija<\\\/b><b> <\\\/b><b>unutra\\u0161nje<\\\/b><b> <\\\/b><b>karotidne<\\\/b><b> <\\\/b><b>arterije<\\\/b>: nakon presecanja karotidne arterije se identifikuje sloj za izvo\\u0111enje endarterektomije (<i>lamina<\\\/i><i> <\\\/i><i>elastica<\\\/i><i> <\\\/i><i>externa<\\\/i>). U sloju gde se ateroskleroti\\u010dni plak sam odvaja od adventicije (<i>cleavage<\\\/i><i> <\\\/i><i>plane<\\\/i>) odstranjuje se plak posuvrtanjem unutra\\u0161nje karotidne arterije uz istovremenu trakciju ateroskleroti\\u010dnog cilindra.<\\\/p>\\n\n\n<p class=\\\"western\\\" align=\\\"JUSTIFY\\\">Naro\\u010dita pa\\u017enja se obra\\u0107a da se distalno, gde prestaje ateroskleroti\\u010dni plak, endarterektomija zavr\\u0161i glatkom povr\\u0161inom (bez intimalnih ili medijalnih <i>fl<\\\/i><i>ap<\\\/i>-ova). Ako se plak prostire distalnije, nego obi\\u010dno, neophodno je da se pri disekciji isprepari\\u0161e ne\\u0161to vi\\u0161i segment arterije karotis interne.<\\\/p>\\n\n\n<p class=\\\"western\\\" align=\\\"JUSTIFY\\\">Nije potrebno mobilisanje du\\u017eeg arterijskog segmenta nego za standardnu karotidnu endarterektomiju. Tokom everzione endarterektomije centralnog plaka treba istovremeno pa\\u017eljivo odstranjivati zaostale fragmente medijalnog arterijskog sloja i debris sa \\u010ditave arterijske cirkumferencije.<\\\/p>\\n\n\n<p class=\\\"western\\\" align=\\\"JUSTIFY\\\">Bitna je preglednost unutra\\u0161nje strane arterije. Nakon \\u0161to je odstranjen \\u010ditav plak treba proveriti ivicu distalnog odlubljivanja. Ako na postoje zaostali <i>fl<\\\/i><i>ap<\\\/i>-ovi i neravnine treba ih odstraniti tako da unutra\\u0161nja povr\\u0161ina bude potpuno glatka.<\\\/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-154.png\",\"image_svg_color\":\"emphasis\",\"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\":\"text\",\"props\":{\"column_breakpoint\":\"m\",\"content\":\"\n\n<p style=\\\"text-align: left;\\\" align=\\\"CENTER\\\"><em>Zavr\\u0161avanje everzione karotidne endarterektomije reimplantacijom unutra\\u0161nje karotidne arterije. Ako je ona preduga\\u010dka (kinking, coiling) treba je adekvatno <\\\/em><em>resecirati. Ponekad je zgodno transponirati arteriju ispred n.hypoglossus-a, da bi se izbegla kompresija.<\\\/em><\\\/p>\",\"margin\":\"default\"}}]}],\"props\":{\"layout\":\"1-2,1-4,1-4|1-1,1-2,1-2\"}}]},{\"type\":\"section\",\"props\":{\"image_position\":\"center-center\",\"padding\":\"xsmall\",\"padding_remove_top\":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_breakpoint\":\"m\",\"content\":\"\n\n<h3 class=\\\"western\\\" style=\\\"text-align: left;\\\" align=\\\"JUSTIFY\\\"><b>Reimnplantacija<\\\/b><b> <\\\/b>se izvodi pod blagom tenzijom kontinuiranim evertiraju\\u0107im \\u0161avom sa Prolen-om (polypropylene) 6-0.<br \\\/>Sutura zadnjeg zida anastomoze radi se plasiranjem \\u0161avova iznuta, a na prednjem zidu spolja.<\\\/h3>\\n\n\n<p class=\\\"western\\\" style=\\\"text-align: left;\\\" align=\\\"JUSTIFY\\\"><b>Protektivna<\\\/b><b> <\\\/b><b>primena<\\\/b><b> <\\\/b><b>privremenog<\\\/b><b> <\\\/b><b>intraluminalnog<\\\/b><b> <\\\/b><b>shunt-a<\\\/b><b> <\\\/b>tokom everzione endarterektomije je mogu\\u0107a. Plasiranje shunta mogu\\u0107e je: (1) pre po\\u010detka endarterektomije, ali je u tom slu\\u010daju ote\\u017eana vizuelizacija arterijskog lumena, ili (2) nakon endarterektomije, a pre po\\u010detka reimplantacije. Indikacije za primenu intraluminalnog shunt-a su iste kao i kod standardne metode. Obzirom da everziona endarterektomija zahteva znatno kra\\u0107e vreme klemovanja (8min.) nego standardna (12 do 20min.), mo\\u017ee se re\\u0107i da je mogu\\u0107nost racionalnog izbegavanja primene shunta velika.<\\\/p>\",\"margin\":\"default\"}}]}]}]},{\"type\":\"section\",\"props\":{\"image_position\":\"center-center\",\"padding\":\"xsmall\",\"padding_remove_top\":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\":\"gallery\",\"props\":{\"container_padding_remove\":true,\"filter\":false,\"filter_align\":\"left\",\"filter_all\":true,\"filter_animation\":\"fade\",\"filter_grid_breakpoint\":\"m\",\"filter_grid_width\":\"auto\",\"filter_position\":\"top\",\"filter_reverse\":false,\"filter_style\":\"tab\",\"grid_column_gap\":\"small\",\"grid_default\":\"3\",\"grid_divider\":false,\"grid_masonry\":false,\"grid_medium\":\"3\",\"grid_row_align\":false,\"grid_row_gap\":\"medium\",\"image_border\":\"rounded\",\"image_box_decoration\":\"mask\",\"image_loading\":false,\"image_transition_border\":false,\"item_animation\":true,\"lightbox\":false,\"lightbox_image_orientation\":true,\"link_style\":\"default\",\"link_text\":\"Read more\",\"margin\":\"default\",\"meta_align\":\"below-title\",\"meta_element\":\"div\",\"meta_style\":\"text-meta\",\"overlay_hover\":true,\"overlay_link\":false,\"overlay_mode\":\"caption\",\"overlay_padding\":\"small\",\"overlay_position\":\"bottom\",\"overlay_style\":\"overlay-primary\",\"overlay_transition\":\"slide-bottom\",\"show_content\":true,\"show_hover_image\":true,\"show_link\":true,\"show_meta\":true,\"show_title\":true,\"text_align\":\"left\",\"text_color\":\"dark\",\"title_element\":\"h3\",\"title_hover_style\":\"reset\",\"title_link\":true,\"title_transition\":\"fade\"},\"children\":[{\"type\":\"gallery_item\",\"props\":{\"content\":\"\n\n<p align=\\\"CENTER\\\"><em>Sterilna priprema operativnog polja za cervikalnu inciziju du\\u017e sternokleidomastoidnog mi\\u0161i\\u0107a.<\\\/em><\\\/p>\",\"image\":\"wp-content\\\/uploads\\\/2023\\\/02\\\/153.jpg\"}},{\"type\":\"gallery_item\",\"props\":{\"content\":\"\n\n<p align=\\\"CENTER\\\"><em>Rez po prednjoj ivici sternokleidomastoidnog mi\\u0161i\\u0107a i presecanje platizme termokauterom.<\\\/em><\\\/p>\",\"hover_image\":\"\",\"image\":\"wp-content\\\/uploads\\\/2023\\\/02\\\/KNJIGA-Karotidna-hirurgija-156.png\"}},{\"type\":\"gallery_item\",\"props\":{\"content\":\"\n\n<p align=\\\"CENTER\\\"><em>Disekcija facijalne vene.<\\\/em><\\\/p>\",\"image\":\"wp-content\\\/uploads\\\/2023\\\/02\\\/KNJIGA-Karotidna-hirurgija-157.png\"}},{\"type\":\"gallery_item\",\"props\":{\"content\":\"\n\n<p align=\\\"CENTER\\\"><em>Presecanje facijalne vene.<\\\/em><\\\/p>\",\"image\":\"wp-content\\\/uploads\\\/2023\\\/02\\\/KNJIGA-Karotidna-hirurgija-158.png\"}},{\"type\":\"gallery_item\",\"props\":{\"content\":\"\n\n<p align=\\\"CENTER\\\"><em>Ligatura facijalne vene.<\\\/em><\\\/p>\",\"image\":\"wp-content\\\/uploads\\\/2023\\\/02\\\/KNJIGA-Karotidna-hirurgija-159.png\"}},{\"type\":\"gallery_item\",\"props\":{\"content\":\"\n\n<p align=\\\"CENTER\\\"><em>Disekcija zajedni\\u010dke karotidne arterije, koju ne treba pomerati.<\\\/em><\\\/p>\",\"image\":\"wp-content\\\/uploads\\\/2023\\\/02\\\/KNJIGA-Karotidna-hirurgija-160.png\"}},{\"type\":\"gallery_item\",\"props\":{\"content\":\"\n\n<p align=\\\"CENTER\\\"><em>Zauzdavanje zajedni\\u010dke karotidne arterije.<\\\/em><\\\/p>\",\"image\":\"wp-content\\\/uploads\\\/2023\\\/02\\\/KNJIGA-Karotidna-hirurgija-161.png\"}},{\"type\":\"gallery_item\",\"props\":{\"content\":\"\n\n<p align=\\\"CENTER\\\"><em>Zauzdavanje gornje tireoidne arterije <\\\/em><em>uz identifikaciju n. hypoglossus-a<\\\/em><\\\/p>\",\"image\":\"wp-content\\\/uploads\\\/2023\\\/02\\\/KNJIGA-Karotidna-hirurgija-162.png\"}},{\"type\":\"gallery_item\",\"props\":{\"content\":\"\n\n<p align=\\\"CENTER\\\"><em>Zauzdavanje spolja\\u0161nje karotidne arterije.<\\\/em><\\\/p>\",\"image\":\"wp-content\\\/uploads\\\/2023\\\/02\\\/KNJIGA-Karotidna-hirurgija-163.png\"}},{\"type\":\"gallery_item\",\"props\":{\"content\":\"\n\n<p align=\\\"CENTER\\\"><em>Zauzdavanje unutra\\u0161nje karotidne arterije.<\\\/em><\\\/p>\",\"image\":\"wp-content\\\/uploads\\\/2023\\\/02\\\/KNJIGA-Karotidna-hirurgija-164.png\"}},{\"type\":\"gallery_item\",\"props\":{\"content\":\"\n\n<p align=\\\"CENTER\\\"><em>Transekcija unutra\\u0161nje karotidne arterije u nivou bifurkacije.<\\\/em><\\\/p>\",\"image\":\"wp-content\\\/uploads\\\/2023\\\/02\\\/KNJIGA-Karotidna-hirurgija-165.png\"}},{\"type\":\"gallery_item\",\"props\":{\"content\":\"\n\n<p align=\\\"CENTER\\\"><em>Incizija du\\u017e unutra\\u0161nje ivice unutra\\u0161nje karotidne arterije, toliko da se dovoljno skrati ACI.<\\\/em><\\\/p>\",\"image\":\"wp-content\\\/uploads\\\/2023\\\/02\\\/KNJIGA-Karotidna-hirurgija-166.png\"}},{\"type\":\"gallery_item\",\"props\":{\"content\":\"\n\n<p align=\\\"CENTER\\\"><em>Everziona endarterektomija ACI .<\\\/em><\\\/p>\",\"image\":\"wp-content\\\/uploads\\\/2023\\\/02\\\/KNJIGA-Karotidna-hirurgija-167.png\"}},{\"type\":\"gallery_item\",\"props\":{\"content\":\"\n\n<p align=\\\"CENTER\\\"><em>Kontrola mesta gde se zavr\\u0161ava endarterektomija ACI .<\\\/em><\\\/p>\",\"image\":\"wp-content\\\/uploads\\\/2023\\\/02\\\/KNJIGA-Karotidna-hirurgija-168.png\"}},{\"type\":\"gallery_item\",\"props\":{\"content\":\"\n\n<p align=\\\"CENTER\\\"><em>Ispiranje mesta gde se zavr\\u0161ava endarterektomija ACI. Provera glatke povr\\u0161ine. Otklanjanje neravnina.<\\\/em><\\\/p>\",\"image\":\"wp-content\\\/uploads\\\/2023\\\/02\\\/KNJIGA-Karotidna-hirurgija-170.png\"}},{\"type\":\"gallery_item\",\"props\":{\"content\":\"\n\n<p align=\\\"CENTER\\\"><em>Po\\u010detak reimplantacije unutra\\u0161nje karotidne arterije. Prolen 5\\\/0 ili 6\\\/0.<\\\/em><\\\/p>\",\"image\":\"wp-content\\\/uploads\\\/2023\\\/02\\\/KNJIGA-Karotidna-hirurgija-171.png\"}},{\"type\":\"gallery_item\",\"props\":{\"content\":\"\n\n<p align=\\\"CENTER\\\"><em>Plasiranje \\u0161avova u predelu \\u2018pete\\u2019 anastomoze.<\\\/em><\\\/p>\",\"image\":\"wp-content\\\/uploads\\\/2023\\\/02\\\/KNJIGA-Karotidna-hirurgija-172.png\"}},{\"type\":\"gallery_item\",\"props\":{\"content\":\"\n\n<p align=\\\"CENTER\\\"><em>Rekonstrukcija orificijuma unutra\\u0161nje karotidne arterije. Sutura zadnjeg zida \\u0161avovima iznutra.<\\\/em><\\\/p>\",\"image\":\"wp-content\\\/uploads\\\/2023\\\/02\\\/KNJIGA-Karotidna-hirurgija-174.png\"}},{\"type\":\"gallery_item\",\"props\":{\"content\":\"\n\n<p align=\\\"CENTER\\\"><em>Sutura prednjeg zida anastomoze unutra\\u0161nje karotidne arterije, \\u0161avovima spolja.<\\\/em><\\\/p>\",\"image\":\"wp-content\\\/uploads\\\/2023\\\/02\\\/KNJIGA-Karotidna-hirurgija-174.png\"}},{\"type\":\"gallery_item\",\"props\":{\"content\":\"\n\n<p align=\\\"CENTER\\\"><em>Sutura prednjeg zida i vrha anastomoze \\u0161avovima spolja.<\\\/em><\\\/p>\",\"image\":\"wp-content\\\/uploads\\\/2023\\\/02\\\/KNJIGA-Karotidna-hirurgija-175.png\"}},{\"type\":\"gallery_item\",\"props\":{\"content\":\"\n\n<p align=\\\"CENTER\\\"><em>Sutura zadnjeg zida anastomoze \\u0161avovima spolja.<\\\/em><\\\/p>\",\"image\":\"wp-content\\\/uploads\\\/2023\\\/02\\\/KNJIGA-Karotidna-hirurgija-176.png\"}},{\"type\":\"gallery_item\",\"props\":{\"content\":\"\n\n<p align=\\\"CENTER\\\"><em>Sutura zadnjeg zida prema vrhu anastomoze \\u0161avovima spolja.<\\\/em><\\\/p>\",\"image\":\"wp-content\\\/uploads\\\/2023\\\/02\\\/KNJIGA-Karotidna-hirurgija-177.png\"}},{\"type\":\"gallery_item\",\"props\":{\"content\":\"\n\n<p align=\\\"CENTER\\\"><em>Zavr\\u0161etak anastomoze na prednjem zidu ACI. Sutura spolja ka unutra.<\\\/em><\\\/p>\",\"image\":\"wp-content\\\/uploads\\\/2023\\\/02\\\/KNJIGA-Karotidna-hirurgija-178.png\"}},{\"type\":\"gallery_item\",\"props\":{\"content\":\"\n\n<p align=\\\"CENTER\\\"><em>Zavr\\u0161etak anastomoze na prednjem zidu ACI. Lijatura produ\\u017enog evertiraju\\u0107eg \\u0161ava.<\\\/em><\\\/p>\",\"image\":\"wp-content\\\/uploads\\\/2023\\\/02\\\/KNJIGA-Karotidna-hirurgija-179.png\"}},{\"type\":\"gallery_item\",\"props\":{\"content\":\"\n\n<p align=\\\"CENTER\\\"><em>Cirkulacija se prvo pu\\u0161ta u spolja\\u0161nju a potom u unutra\\u0161nju karotidnu arteriju.<\\\/em><\\\/p>\",\"image\":\"wp-content\\\/uploads\\\/2023\\\/02\\\/KNJIGA-Karotidna-hirurgija-180.png\"}},{\"type\":\"gallery_item\",\"props\":{\"content\":\"\n\n<p align=\\\"CENTER\\\"><em>Provera suturne linije unutra\\u0161nje karotidne arterije.<\\\/em><\\\/p>\",\"image\":\"wp-content\\\/uploads\\\/2023\\\/02\\\/KNJIGA-Karotidna-hirurgija-181.png\"}},{\"type\":\"gallery_item\",\"props\":{\"content\":\"\n\n<p align=\\\"CENTER\\\"><em>Provera hemostaze u predelu platizme.<\\\/em><\\\/p>\",\"image\":\"wp-content\\\/uploads\\\/2023\\\/02\\\/KNJIGA-Karotidna-hirurgija-182.png\"}},{\"type\":\"gallery_item\",\"props\":{\"content\":\"\n\n<p align=\\\"CENTER\\\"><em>Provera hemostaze i pogled na urednu anastomozu.<\\\/em><\\\/p>\",\"image\":\"wp-content\\\/uploads\\\/2023\\\/02\\\/KNJIGA-Karotidna-hirurgija-183.png\"}},{\"type\":\"gallery_item\",\"props\":{\"content\":\"\n\n<p style=\\\"text-align: left;\\\" align=\\\"RIGHT\\\"><em>Ako je potrebno postavlja se lokalno prokoagulantna gaza.<\\\/em><\\\/p>\",\"image\":\"wp-content\\\/uploads\\\/2023\\\/02\\\/KNJIGA-Karotidna-hirurgija-184.png\"}},{\"type\":\"gallery_item\",\"props\":{\"content\":\"\n\n<p align=\\\"CENTER\\\"><em>Sutura platizme ne zahvataju\\u0107i sternokleidomastoidni mi\\u0161i\\u0107.<\\\/em><\\\/p>\",\"image\":\"wp-content\\\/uploads\\\/2023\\\/02\\\/KNJIGA-Karotidna-hirurgija-185.png\"}},{\"type\":\"gallery_item\",\"props\":{\"content\":\"\n\n<p align=\\\"CENTER\\\"><em>Aspiracioni dren. Sutura ko\\u017ee pojedina\\u010dnim atraumatskim \\u0161avom, Prolen 50<\\\/em><\\\/p>\",\"image\":\"wp-content\\\/uploads\\\/2023\\\/02\\\/KNJIGA-Karotidna-hirurgija-186.png\"}}]}]}]}]}],\"version\":\"3.0.25\"} --><\/p>\n","protected":false},"excerpt":{"rendered":"<p>REKONSTRUKCIJA KAROTIDNE ARTERIJE 12.1. OPERATIVNA TEHNIKA EVERZIONE KAROTIDNE ENDARTEREKTOMIJE OPERATIVNA TEHNIKA EVERZIONE KAROTIDNE ENDARTEREKTOMIJE Everziona karotidna endarterektomija se mo\u017ee uraditi u op\u0161toj endotrahealnoj ili regionalnoj anesteziji. Preparisanje karotidnih arterija odvija se na standardan na\u010din. Kad se eksponira dovoljan segment karotidnih arterija, a to zna\u010di da imamo proksimalno i distalno oko 1 cm arterije koja je [&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-3664","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>12.1. 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