{"id":4104,"date":"2023-02-15T08:50:11","date_gmt":"2023-02-15T08:50:11","guid":{"rendered":"https:\/\/www.karotidnahirurgija.com\/?page_id=4104"},"modified":"2023-02-24T09:15:02","modified_gmt":"2023-02-24T09:15:02","slug":"16-1-prava-i-pseudo-aneurizma","status":"publish","type":"page","link":"https:\/\/www.karotidnahirurgija.com\/?page_id=4104","title":{"rendered":"16.1. PRAVE I PSEUDO ANEURIZME"},"content":{"rendered":"

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<\/p>\n

ANEURIZMA KAROTIDNE ARTERIJE<\/h1>\n

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16.1. PRAVE I PSEUDO ANEURIZME<\/p>\n

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PRAVA ANEURIZMA<\/h3>\n

Ateroskleroza<\/b> <\/b>je danas daleko naj\u010de\u0161\u0107i uzrok aneurizme karotidne arterije (50%).<\/p>\n

In<\/b>fl<\/b>amatorna<\/b> <\/b>(mikoti\u010dna aneurizma) nastaje infekcijom arterijskog zida (4%). Naziv mikoti\u010dna aneurizma je opstao, iako su gljivice znatno re\u0111i uzro\u010dnik no \u0161to se mislilo. Infektivni agens mo\u017ee dospeti kroz intimu iz lumena arterije posle septi\u010dne embolije, ili iz vasa<\/i> <\/i>vasorum<\/i> <\/i>(sifilis) ili direktno iz okoline (iz tuberkulozom promenjene limfne \u017elezde vrata). U sva tri slu\u010daja u organizmu pos- toji neko \u017eari\u0161te infekcije, kao na primer bakterijski endokarditis, limfadenopatija vrata. Povrede vrata, mogu biti izvor infekcije, koja inicira razvoj inflamatorne aneurizme.<\/p>\n

Arteritisi<\/b> <\/b>mogu izazvati aneurizmu karotidne arterije: kako nespecifi\u010dni (na primer, gigantocelulni), tako i postiradijacioni ali su retki.<\/p>\n

Fibromuskulna<\/b> <\/b>displazija<\/b>. Obi\u010dno se radi o tipu fibroplazije medije (4%).<\/p>\n

Cisti\u010dna<\/b> <\/b>medionekroza:<\/b> <\/b>Samo se patohistolo\u0161ki mo\u017ee razlikovati cisti\u010dna nekroza medije od fibromuskularne displazije.<\/p>\n

Kongenitalne<\/b> <\/b>aneurizme<\/b> <\/b>(agenezija intime i medije). Intrakranijalne aneurizme su uglavnom kongenitalne a aneurizme ekstrakranijalnog dela karotidnih arterija su ve\u0107inom ste\u010dene.<\/p>\n<\/div>\n

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Aneurizma unutra\u0161nje karotidne arterije. <\/em>MSCT<\/em><\/p>\n<\/div>\n

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PSEUDOANEURIZMA<\/h3>\n

Posttraumatske<\/b> <\/b>pseudoaneurizme:<\/b> <\/b>Naj\u010de\u0161\u0107i tip la\u017enih aneurizmi karotidnih arterija su postraumske pseudoaneurizme (28%). Pored \u201cdirektne\u201d arterijske traume (dejstvo vatrenog ili hladnog oru\u017eja), postraumske pseudoaneurizma<\/p>\n

mo\u017ee nastati i \u201cindirektnom\u201d traumatskom hiperekstenzijom vrata, kompresijom karotidne arterije izme\u0111u atlasa i ugla mandibule pri hiperrotaciji vrata i pri frakturi baze lobanje.<\/p>\n

Anastomoti\u010dne<\/b> <\/b>pseudoaneurizme<\/b> <\/b>nastaju posle operacionih zahvata na karotidnim arterijama zbog lokalne infekcije i pucanja \u0161ava.<\/p>\n

Jatrogeni<\/b> <\/b>razlozi<\/b> <\/b>pseudoaneurizme<\/b> <\/b>mogu se javiti nakon punkcije jugularne vene ili hirur\u0161kih zahvata na vratu (napr. tumor maksilarne regije).<\/p>\n

Disekcija<\/b> <\/b>karotidnih<\/b> <\/b>arterija<\/b> <\/b>sa pojavom la\u017ene aneurizme mo\u017ee se razviti kao spontana, izolovana lezija. Ne mora biti povezana sa disekcijom celog aortnog luka. Disekcija karotidne arterije mo\u017ee i bez formiranja pseudoaneurizme dovesti do mo\u017edanog udara.<\/p>\n

Prirodan<\/b> <\/b>tok<\/b> <\/b>bolesti<\/b> <\/b>podrazumeva komplikacije (ruptura, tromboza, distalna embolizacija, kompresija). Asimptomska pulsiraju\u0107a masa na vratu je prvi stadijum u progresiji bolesti.<\/p>\n

Neurolo\u0161ki<\/b> <\/b>de<\/b>fi<\/b>cit<\/b> <\/b>usled distalne embolizacije delovima parijetalnog tromba. TIA (uklju\u010duju\u0107i amaurosis fugax, zbog embolije a.centralis retine) se javlja \u010de\u0161\u0107e nego mo\u017edani udar.<\/p>\n

Kompresija<\/b> <\/b>okolnih<\/b> <\/b>organa<\/b> <\/b>je \u010desta. Naj\u010de\u0161\u0107e je komprimiran n.hypoglosus<\/i>, \u0161to za posledicu ima razli\u010dite stepene dizartrije. Istovremena kompresija na n.hypoglosus<\/i> <\/i>i n.vagus<\/i> <\/i>daje ipsilateralnu hemiplegija larinksa i jezika, promuklost i tikove uz smanjenu pokretljivost mekog nepca. Pritisak na vratni simpatikus Hornerov sindrom. Disekantna aneurizma karotidne arterije mo\u017ee dovesti do okulosimpatikusne paralize usled lezije gornjeg cervikalnog simpati\u010dkog gangliona.<\/p>\n

Ruptura<\/b> <\/b>aneurizme<\/b> <\/b>karotidne<\/b> <\/b>arterije<\/b> <\/b>je retka, ali obi\u010dno fatalna. Obi\u010dno se zapazi bolna pulsiraju\u0107a masa na vratu pre nego \u0161to dostignu \u201ekriti\u010dnu\u201d veli\u010dinu za rupturu. Kad krene ruptura, razvija se pulsiraju\u0107i hematom koji raste, asfiksija zbog kompresije na larinks i traheju sa progrediraju\u0107im \u0161okom, ponekad hematotoraksom, epistaksom, otoragijom itd.<\/p>\n<\/div>\n


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

ANEURIZMA KAROTIDNE ARTERIJE 16.1. PRAVE I PSEUDO ANEURIZME PRAVA ANEURIZMA Ateroskleroza je danas daleko naj\u010de\u0161\u0107i uzrok aneurizme karotidne arterije (50%). Inflamatorna (mikoti\u010dna aneurizma) nastaje infekcijom arterijskog zida (4%). Naziv mikoti\u010dna aneurizma je opstao, iako su gljivice znatno re\u0111i uzro\u010dnik no \u0161to se mislilo. Infektivni agens mo\u017ee dospeti kroz intimu iz lumena arterije posle septi\u010dne embolije, […]<\/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-4104","page","type-page","status-publish","hentry"],"acf":[],"yoast_head":"\n16.1. 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