{"id":4080,"date":"2023-02-15T08:19:13","date_gmt":"2023-02-15T08:19:13","guid":{"rendered":"https:\/\/www.karotidnahirurgija.com\/?page_id=4080"},"modified":"2023-02-24T09:10:21","modified_gmt":"2023-02-24T09:10:21","slug":"15-1-hirurska-korekcija-elongacije","status":"publish","type":"page","link":"https:\/\/www.karotidnahirurgija.com\/?page_id=4080","title":{"rendered":"15.1. HIRUR\u0160KA KOREKCIJA ELONGACIJE"},"content":{"rendered":"

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

<\/p>\n

KINKING I COILING KAROTIDNIH ARTERIJA<\/h1>\n

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

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15.1. HIRUR\u0160KA KOREKCIJA ELONGACIJE<\/p>\n

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HIRUR\u0160KA KOREKCIJA ELONGACIJE<\/h3>\n<\/div>\n<\/div>\n

Cilj hirur\u0161ke terapije je eliminacija simptomatskog kinking<\/i>-a (coiling<\/i>-a), sa uzgrednom endarterektomijom ako postoje pridru\u017eene arterioskleroti\u010dne lezije.<\/h4>\n

Resekcija<\/b><\/span> <\/b><\/span>elongiranog<\/b><\/span> <\/b><\/span>segmenta<\/b><\/span> <\/b><\/span>arterije<\/b><\/span> <\/b><\/span>sa<\/b><\/span> <\/b><\/span>reanastomoziranjem<\/b><\/span> <\/b><\/span>daje<\/span> <\/span>odli\u010dne<\/span> <\/span>rezultate<\/span> <\/span>i<\/span> <\/span>postala<\/span> <\/span>je<\/span> <\/span>metoda<\/span> <\/span>izbora.<\/span> <\/span>Uzgredno<\/span> <\/span>se<\/span> <\/span>mo\u017ee,<\/span> <\/span>ako<\/span> <\/span>je<\/span> <\/span>potrebno,<\/span> <\/span>uraditi<\/span> <\/span>endarterektomija.<\/span><\/p>\n

By pass procedure se rade da bi se kinking premostio autovenskim ili sintetskim graftom. U slu\u010daju da se redundantni konglomerat karotidne arterije ne mo\u017ee ispraviti, izvodi se resekcija sa interpozicijom grafta.<\/p>\n

Operacija se mo\u017ee izvesti u regionalnoj ili op\u0161toj anesteziji. Obi\u010dno je neophodan visoki pristup distalnom delu unutra\u0161nje karotidne arterije. Uvek treba mobilisati \u010ditavu unutra\u0161nju karotidnu arteriju, do baze lobanje (foramen caroticum), da bi smo bili sigurni da ne zaostaje dodatni kinking na vi\u0161em nivou. Elongiranu arteriju treba resecirati tako da se njenim reimplantiranjem u nivou karotidne bifurkacije elimini\u0161e elongacija. Mnogi pacijenti sa arterioskleroti\u010dnom stenozom imaju kinking (oko 40%). Mnogi pacijenti sa kinkingom imaju uzgredno ateroskleroti\u010dnu stenozu karotidne arterije (20-40%). Everziona endarterektomija zna\u010dajno pojednostavljuje operaciju.<\/p>\n

Ako postoji sumnja na fibromuskularnu displaziju intraluminalni dilatator, odgovaraju\u0107eg promera (4-5mm) treba plasirati u unutra\u0161nju karotidnu arteriju do nivoa ko\u0161tanog kanala. Tako \u0107e se osloboditi sve eventualne membranozne tvorevine po tipu intimalne ili miointimalne displazije.<\/p>\n

Protektivni intraluminalni shunt prilikom resekcije (endarterektomije) i reimplantacije treba primenjivati selektivno. To zna\u010di:
(1) raniji ipsilateralni cerebrovaskularni insult,
(2) kontralateralna karotidna okluzija,
(3) intraoperativni znaci cerebralne ishemije prilikom klemovanja karotidne arterije.<\/p>\n

Reimplantaciju skra\u0107ene unutra\u0161nje karotidne arterije najbolje je uraditi tako da se sa\u010duva anatomski integritet karotidne bifurkacije. Evertiraju\u0107a produ\u017ena sutura atraumatskim \u0161avom (Prolen 6-0) treba da ostavi za sobom glatku unutra\u0161nju povr\u0161inu arterije. Ovo je najdelikatniji deo operacije. Po\u0161to je patolo\u0161ka elongacija nastala zbog kongenitalne slabosti zida ili degenerativnog procesa arterije, ona je fragilna. Zato je ova jednostavna operacija delikatna i zahteva tehni\u010dku perfekciju.<\/p>\n

Rezultati<\/h3>\n

Peroperativni mortalitetom je ispod 1%, a postoperativni morbiditet neznatan. Neurolo\u0161ki simptomi mo\u017edane ishemije povla\u010de se u oko 85% <\/span><\/span>pacijenata.<\/span> <\/span>U<\/span> <\/span>preostalih<\/span> <\/span>15%<\/span> <\/span>pacijenata<\/span> <\/span>perzistira<\/span> <\/span>simptomatologija.<\/span> <\/span>Najmanji<\/span> <\/span>procenat<\/span> <\/span>pobolj\u0161anja<\/span> <\/span>javlja<\/span> <\/span>se<\/span> <\/span>kod<\/span> <\/span>pacijenata<\/span> <\/span>sa<\/span> <\/span>globalnom<\/span> <\/span>(nespeci<\/span>fi<\/span>\u010dnom)<\/span> <\/span>neurolo\u0161kom<\/span> <\/span>simptomatologijom,<\/span> <\/span>kao<\/span> <\/span>i<\/span> <\/span>u<\/span> <\/span>slu\u010daju<\/span> <\/span>te\u017eeg<\/span> <\/span>preoperativnog<\/span> <\/span>neurolo\u0161kog<\/span> <\/span>de<\/span>fi<\/span>cita.<\/span> <\/span>Najbolji<\/span> <\/span>rezultati<\/span> <\/span>posti\u017eu<\/span> <\/span>se<\/span> <\/span>kod<\/span> <\/span>bolesnika<\/span> <\/span>sa<\/span> <\/span>epizodama<\/span> <\/span>fokalnih<\/span> <\/span>TIA,<\/span> <\/span>sa<\/span> <\/span>pozitivnim<\/span> <\/span>testom<\/span> <\/span>izazivanja<\/span> <\/span>simptoma<\/span> <\/span>forsiranim<\/span> <\/span>pokretima<\/span> <\/span>glave<\/span> <\/span>i<\/span> <\/span>vrata.<\/span> <\/span>Recidiv<\/span> <\/span>kinking<\/i><\/span>-a<\/span> <\/span>i<\/span> <\/span>coiling<\/i><\/span>-a<\/span> <\/span>je<\/span> <\/span>retka<\/span> <\/span>pojava,<\/span> <\/span>a<\/span> <\/span>mo\u017ee<\/span> <\/span>se<\/span> <\/span>desiti<\/span> <\/span>kod<\/span> <\/span>bolesnika<\/span> <\/span>sa<\/span> <\/span>nekontrolisanom<\/span> <\/span>hipertenzijom.<\/span> <\/span>Udaljeni<\/span> <\/span>rezultati<\/span> <\/span>govore<\/span> <\/span>u<\/span> <\/span>prilog<\/span> <\/span>hirur\u0161kom<\/span> <\/span>le\u010denju.<\/span><\/p>\n<\/p>\n<\/div>\n

\"\"<\/p>\n

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Visoki kinking unutra\u0161nje karotidne arterije sa aneurizmom i subadventicijalnim hematomom.<\/em><\/p>\n<\/p>\n<\/div>\n

\"\"<\/p>\n

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Termino-terminalna anastomoza nakon resekcije i intraluminalne dilatacije (Prolen 6\/0;7\/0).<\/em><\/p>\n<\/div>\n


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

KINKING I COILING KAROTIDNIH ARTERIJA 15.1. HIRUR\u0160KA KOREKCIJA ELONGACIJE HIRUR\u0160KA KOREKCIJA ELONGACIJE Cilj hirur\u0161ke terapije je eliminacija simptomatskog kinking-a (coiling-a), sa uzgrednom endarterektomijom ako postoje pridru\u017eene arterioskleroti\u010dne lezije. Resekcija elongiranog segmenta arterije sa reanastomoziranjem daje odli\u010dne rezultate i postala je metoda izbora. Uzgredno se mo\u017ee, ako je potrebno, uraditi endarterektomija. By pass procedure se rade […]<\/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-4080","page","type-page","status-publish","hentry"],"acf":[],"yoast_head":"\n15.1. 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