{"id":4289,"date":"2023-02-15T12:55:02","date_gmt":"2023-02-15T12:55:02","guid":{"rendered":"https:\/\/www.karotidnahirurgija.com\/?page_id=4289"},"modified":"2023-02-24T09:24:46","modified_gmt":"2023-02-24T09:24:46","slug":"18-komplikacije-u-karotidnoj-hirurgiji","status":"publish","type":"page","link":"https:\/\/www.karotidnahirurgija.com\/?page_id=4289","title":{"rendered":"18. KOMPLIKACIJE U KAROTIDNOJ HIRURGIJI"},"content":{"rendered":"

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

<\/p>\n

KOMPLIKACIJE U KAROTIDNOJ HIRURGIJI<\/h1>\n

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

\n

Na sudnji dan vaga\u0107e se samo suze.<\/p>\n

Emil Sioran<\/em><\/p>\n<\/div>\n

\n

Karotidna<\/span> <\/span>hirurgija<\/span> <\/span>zahteva<\/span> <\/span>veliku<\/span> <\/span>defanzivnost<\/span> <\/span>u<\/span> <\/span>indikacionim<\/span> <\/span>razmi\u0161ljanjima<\/span> <\/span>a<\/span> <\/span>ofanzivnost<\/span> <\/span>u<\/span> <\/span>dijagnostikovanju<\/span> <\/span>i<\/span> <\/span>le\u010denju<\/span> <\/span>komplikacija,<\/span> <\/span>koje<\/span> <\/span>su<\/span> <\/span>retke<\/span> <\/span>ali<\/span> <\/span>opasne.<\/span> <\/span>Dugoro\u010dni<\/span> <\/span>rezultati<\/span> <\/span>u<\/span> <\/span>ovoj<\/span> <\/span>oblasti<\/span> <\/span>su<\/span> <\/span>bolji<\/span> <\/span>nego<\/span> <\/span>prilikom<\/span> <\/span>operacija<\/span> <\/span>na<\/span> <\/span>drugim,<\/span> <\/span>distalnijim<\/span> <\/span>arterijama.<\/span> <\/span>Komplikacije<\/span> <\/span>rekonstrukcija<\/span> <\/span>arterija<\/span> <\/span>mogu<\/span> <\/span>biti:<\/span><\/p>\n

Vaskularne<\/b><\/span> <\/b><\/span>komplikacije<\/b><\/span> <\/b><\/span>sa<\/span> <\/span>ishemijom<\/span> <\/span>ili<\/span> <\/span>krvarenjem<\/span> <\/span>u<\/span> <\/span>regionu<\/span> <\/span>rekonstruisanog<\/span> <\/span>krvnog<\/span> <\/span>suda.<\/span><\/p>\n

Komplikacije<\/b><\/span> <\/b><\/span>op\u0161teg<\/b><\/span> <\/b><\/span>tipa<\/b><\/span> <\/b><\/span>(infarkt<\/span> <\/span>miokarda,<\/span> <\/span>respiratorna<\/span> <\/span>insu<\/span>fi<\/span>cijencija,<\/span> <\/span>operativni<\/span> <\/span>\u0161ok<\/span> <\/span>itd.).<\/span> <\/span>Komplikacije<\/span> <\/span>op\u0161teg<\/span> <\/span>tipa<\/span> <\/span>se<\/span> <\/span>\u010de\u0161\u0107e<\/span> <\/span>javljaju<\/span> <\/span>nakon<\/span> <\/span>ektenzivnijih<\/span> <\/span>vaskularnih<\/span> <\/span>rekonstrukcija.<\/span> <\/span><\/p>\n

Zavise<\/span> <\/span>od<\/span> <\/span>starosti,<\/span> <\/span>op\u0161teg<\/span> <\/span>stanja<\/span> <\/span>i<\/span> <\/span>uzgrednih<\/span> <\/span>oboljenja.<\/span> <\/span>Preveniraju<\/span> <\/span>se<\/span> <\/span>po\u0161tovanjem<\/span> <\/span>kriterijuma<\/span> <\/span>op\u0161teg<\/span> <\/span>operabiliteta<\/span> <\/span>prilikom<\/span> <\/span>postavljanja<\/span> <\/span>indikacija<\/span> <\/span>i<\/span> <\/span>operativnom<\/span> <\/span>tehnike<\/span> <\/span>koja<\/span> <\/span>najmanje<\/span> <\/span>traumatizira<\/span> <\/span>bolesnika.<\/span><\/p>\n

V<\/span>askularn<\/span>e<\/span> <\/span>komplikacij<\/span>e<\/span> <\/span>s<\/span>e<\/span> <\/span>razvijaj<\/span>u<\/span> <\/span>dramati\u010dno<\/span>:<\/span><\/p>\n

    \n
  • ishemijom<\/b><\/span> <\/b><\/span>mozga.<\/b><\/span><\/li>\n
  • krvarenjem<\/b><\/span> <\/b><\/span>u<\/span> <\/span>predelu<\/span> <\/span>rekonstrukcije,<\/span><\/li>\n
  • infekcijom<\/b><\/span> <\/b><\/span>rane<\/span> <\/span>ili<\/span> <\/span>grafta.<\/span><\/li>\n<\/ul>\n

    Prema vremenu nastanka vaskularne kompikacije mogu biti:<\/p>\n

      \n
    • perioperativne<\/b><\/span> <\/b><\/span>(intraoperativne<\/span> <\/span>i<\/span> <\/span>neposredne<\/span> <\/span>postoperativne),<\/span><\/li>\n
    • rane<\/b><\/span> <\/b><\/span>postoperativne<\/b><\/span> <\/b><\/span>(tokom<\/span> <\/span>hospitalizacije<\/span> <\/span>ili<\/span> <\/span>do<\/span> <\/span>30<\/span> <\/span>dana)<\/span> <\/span>i<\/span><\/li>\n
    • kasne<\/b><\/span> <\/b><\/span>komplikacije.<\/span><\/li>\n<\/ul>\n

      Najbolja prevencija komplikacija u vaskularnoj hirurgiji je dobro izvedena primarna operacija, a to podrazumeva: dobre indikacije (po\u0161tovanje kriterijuma lokalnog i op\u0161teg operabiliteta) i kvalitetna rekonstrukcija (tehni\u010dka preciznost i brzina tokom operacije).<\/p>\n

      Perioperativna<\/b><\/span> <\/b><\/span>ishemija<\/b><\/span> <\/b><\/span>mozga<\/b><\/span> <\/b><\/span>(<\/span>Perioperative<\/i><\/span> <\/i><\/span>stroke,<\/i><\/span> <\/i><\/span>TIA<\/i><\/span>)<\/span> <\/span>je<\/span> <\/span>pojava<\/span> <\/span>neurolo\u0161kog<\/span> <\/span>de<\/span>fi<\/span>cita<\/span> <\/span>neposredno<\/span> <\/span>nakon<\/span> <\/span>rekonstrukcije<\/span> <\/span>karotidne<\/span> <\/span>arterije.<\/span> <\/span>Perioperativni<\/span> <\/span>mo\u017edani<\/span> <\/span>udar<\/span> <\/span>je<\/span> <\/span>najte\u017ea<\/span> <\/span>komplikacija<\/span> <\/span>rekonstruktivnih<\/span> <\/span>zahvata<\/span> <\/span>na<\/span> <\/span>karotidnim<\/span> <\/span>arterijama<\/span> <\/span>i<\/span> <\/span>supraaortalnim<\/span> <\/span>granama<\/span> <\/span>uop\u0161te.<\/span> <\/span>Radi<\/span> <\/span>se<\/span> <\/span>o<\/span> <\/span>komplikaciji<\/span> <\/span>sa<\/span> <\/span>velikim<\/span> <\/span>mortalitetom<\/span> <\/span>i<\/span> <\/span>te\u0161kim<\/span> <\/span>morbiditetom<\/span> <\/span>(invalidno\u0161\u0107u).<\/span> <\/span>De\u0161ava<\/span> <\/span>se<\/span> <\/span>upravo<\/span> <\/span>kod<\/span> <\/span>pacijenta<\/span> <\/span>koji<\/span> <\/span>se<\/span> <\/span>operi\u0161e<\/span> <\/span>da<\/span> <\/span>bi<\/span> <\/span>mo\u017edani<\/span> <\/span>udar<\/span> <\/span>bio<\/span> <\/span>preveniran.<\/span> <\/span>Javlja<\/span> <\/span>se<\/span> <\/span>u<\/span> <\/span>oko <\/span>1% pacijenata kod kojih je ura\u0111ena karotidna ekdarterektomija.<\/p>\n

      Opisano je vi\u0161e od 20 razli\u010ditih scenarija koji mogu izazvati perioperativnu ishemiju mozga:<\/p>\n

        \n
      • Ishemija mozga tokom klemovanja karotidnih arterija,<\/li>\n
      • Intra\/postoperativna tromboza rekonstruisane (karotidne) arterije<\/li>\n
      • Intra\/postoperativna embolizacija,<\/li>\n
      • Intracerebralna hemoragija,<\/li>\n
      • Ostali mehanizmi vezani za rekonstruktivni zahvat (hiperperfuzija, edem mozga itd.) i<\/li>\n
      • Incidenti koji nisu vezani za rekonstruisani arterijski segment.<\/li>\n<\/ul>\n

        U neposrednom postoperativnom toku nakon rekonstrukcije arterija koje dovode krv do moga podrazumeva se intenzivno pra\u0107enje pacijenta. Po\u017eeljno je da se pacijent probudi na operacionom stolu, ili \u0161to pre da bi bio neurolo\u0161ki evaluiran. Monitoring traje 24h<\/span><\/sup> <\/span><\/sup>i podrazumeva: inicijalni i kontrolni neurolo\u0161ki pregled, opservaciju od strane vaskularnog hirurga, kontinuirani monitoring krvnig pritiska i EKG.<\/p>\n<\/div>\n

        \"\"<\/p>\n

        \n

        Intimalni flap.zaostao na proksimalnom kraju karotidne endarterektomije. B mod.<\/em><\/p>\n

        \n<\/div>\n

        \"\"<\/p>\n

        \n

        Pojava neurolo\u0161kog deficita nakon rekonstrukcije arterije koja dovodi krv do mozga tra\u017ei brzo i sistemati\u010dno dono\u0161enje odluka. Da li treba odmah uraditi reoperaciju? Da bi ova odluka bila ispravna treba razlikovati<\/h4>\n<\/div>\n
        \n

        Perioperativni<\/b> <\/b>mo\u017edani<\/b> <\/b>udar<\/b> <\/b>kao akutni neurolo\u0161ki deficit sa (fokalnim ili globalnim) simptomima koji traju du\u017ee od 24 \u010dasa, a mo\u017ee se klasifikovati kao veliki (majo<\/i>r<\/i>,<\/i> <\/i>disablin<\/i>g<\/i> <\/i>st<\/i>r<\/i>oke<\/i>, Rankin ve\u0107i od 3) i mali (mino<\/i>r<\/i>,<\/i> <\/i>nondisablin<\/i>g<\/i> <\/i>st<\/i>r<\/i>oke<\/i>, <\/i>Rankin manji od 3).<\/p>\n

        Perioperativni<\/b> <\/b>tranzitorni<\/b> <\/b>ishemi\u010dki<\/b> <\/b>atak<\/b> <\/b>je akutni, reverzibilni, poreme\u0107aj neurolo\u0161kih funkcija sa simptomima koji traju manje od 24 \u010dasa, a izazvani su cerebralnom ishemijom.<\/p>\n

        \n<\/div>\n

        \n

        Perioperativni<\/span> <\/span>mo\u017edani<\/span> <\/span>udar<\/span> <\/span>se<\/span> <\/span>prema<\/span> <\/span>vremenu<\/span> <\/span>javljanja<\/span> <\/span>deli<\/span> <\/span>na:<\/span><\/p>\n

          \n
        • \n

          Intraoperativni<\/b><\/span> <\/b><\/span>mo\u017edani<\/b><\/span> <\/b><\/span>udar<\/b><\/span> <\/b><\/span>je<\/span> <\/span>o\u010digledan<\/span> <\/span>odmah<\/span> <\/span>nakon<\/span> <\/span>zavr\u0161etka<\/span> <\/span>operacija<\/span> <\/span>(prilikom<\/span> <\/span>bu\u0111enja<\/span> <\/span>iz<\/span> <\/span>anestezije).<\/span> <\/span>Uzrok<\/span> <\/span>je<\/span> <\/span>u<\/span> <\/span>intraoperartivnom<\/span> <\/span>incidentu.<\/span><\/p>\n<\/li>\n

        • \n

          Rani<\/b><\/span> <\/b><\/span> <\/b><\/span>postoperativni<\/b><\/span> <\/b><\/span> <\/b><\/span>mo\u017edani<\/b><\/span> <\/b><\/span> <\/b><\/span>udar<\/b><\/span> <\/b><\/span> <\/b><\/span>je <\/span> <\/span>pojava<\/span> <\/span> <\/span>neurolo\u0161kog<\/span> <\/span> <\/span>de<\/span>fi<\/span>cita u<\/span> <\/span>pacijenta<\/span> <\/span>koji<\/span> <\/span>se<\/span> <\/span>nakon<\/span> <\/span>operacije<\/span> <\/span>probudio<\/span> <\/span>neurolo\u0161ki<\/span> <\/span>intaktan<\/span> <\/span> <\/span>(do<\/span> <\/span>tre\u0107eg<\/span> <\/span>dana<\/span> <\/span>nakon<\/span> <\/span>operacaije).<\/span> <\/span>Uzrok<\/span> <\/span>mo\u017ee<\/span> <\/span>biti<\/span> <\/span>tehni\u010dka<\/span> <\/span>gre\u0161ka<\/span> <\/span>koja<\/span> <\/span>se<\/span> <\/span>manifestovala<\/span> <\/span>u<\/span> <\/span>ranom<\/span> <\/span>postoperativnom<\/span> <\/span>toku<\/span> <\/span>ili<\/span> <\/span>postoperativni<\/span> <\/span>doga\u0111aj.<\/span><\/p>\n<\/li>\n<\/ul>\n<\/div>\n


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

          KOMPLIKACIJE U KAROTIDNOJ HIRURGIJI Na sudnji dan vaga\u0107e se samo suze. Emil Sioran Karotidna hirurgija zahteva veliku defanzivnost u indikacionim razmi\u0161ljanjima a ofanzivnost u dijagnostikovanju i le\u010denju komplikacija, koje su retke ali opasne. Dugoro\u010dni rezultati u ovoj oblasti su bolji nego prilikom operacija na drugim, distalnijim arterijama. Komplikacije rekonstrukcija arterija mogu biti: Vaskularne komplikacije sa […]<\/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-4289","page","type-page","status-publish","hentry"],"acf":[],"yoast_head":"\n18. 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