{"id":4866,"date":"2023-02-17T19:57:09","date_gmt":"2023-02-17T19:57:09","guid":{"rendered":"https:\/\/www.karotidnahirurgija.com\/?page_id=4866"},"modified":"2023-02-24T10:19:31","modified_gmt":"2023-02-24T10:19:31","slug":"22-3-neinvazivna-dijagnostika","status":"publish","type":"page","link":"https:\/\/www.karotidnahirurgija.com\/?page_id=4866","title":{"rendered":"22.3. NEINVAZIVNA DIJAGNOSTIKA"},"content":{"rendered":"

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

<\/p>\n

ENDOVASKULARNA HIRURGIJA<\/h1>\n

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

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22.3. NEINVAZIVNA DIJAGNOSTIKA<\/h2>\n<\/h1>\n
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NEINVAZIVNA DIJAGNOSTIKA<\/strong><\/p>\n

Duplex sonogra<\/b>f<\/b>i<\/b>j<\/b>a <\/b>Cervikalni segmenti supraaortalnih grana se mogu precizno morfolo\u0161ki da analiziraju, posebno \u0161to se ti\u010de kompozicije arterioskleroti\u010dnih lezija. Indirektno se mo\u017ee proceniti stanje nedostupnih proksimalnih segmenata (orificijum) supraaortalnih stabala. Vizuelizacija retrogradnog protoka kroz vertebralnu arteriju je dovoljan uslov za pouzdanu dijagnozu okluzije (ili te\u0161ke stenoze) po\u010detnog dela subklavijalne arterije, tj. steal syndrom-a.<\/p>\n

Transkranijalna<\/b> <\/b>Doppler-sonogra<\/b>fi<\/b>ja:<\/b> <\/b>Karakteristi\u010dni nalaz u ACM u slu\u010daju proksimalnih karotidnih stenoti\u010dnih lezija podrazumeva sni\u017eenje brzine, sni\u017een pulsatilni indeks i prigu\u0161enost talasa. Omogu\u0107ava ispitivanje intrakranijalnog kolateralnog krvotoka.<\/p>\n

Oftalmolo\u0161ki<\/b> <\/b>nalaz: <\/b>Arterioskleroza supraortalnih grana dovodi do ishemije retine sa ili bez Hollenhorstovih embolusa. Kod aorto-arteritisa na o\u010dnom dnu se otkrivaju arteriovenske anastomoze, nalik vencu, koje odgovaraju originalnom opisu Takayasu-a. Pregledom o\u010dnog dna otkrivaju se otok i bledilo papile o\u010dnog \u017eivca.<\/p>\n

Kompjuterizovana<\/b> <\/b>tomogra<\/b>fi<\/b>ja<\/b> <\/b>(CT)<\/b> <\/b>i<\/b> <\/b>magnetna<\/b> <\/b>rezonansa<\/b> <\/b>(MRI)<\/b> <\/b>mozga<\/b> <\/b>pru\u017ea mogu\u0107nost da u simptomatskih pacijenata isklju\u010dimo druge intrakranijalne bolesti koje bi mogle biti uzrok neurolo\u0161kih problema ili postoje kao prate\u0107e oboljenje.<\/p>\n

Ako na CT ili MRI mozga postoji sve\u017ea zona ishemi\u010dke infarkcije, a indikovan je rekonstruktivni zahvat na arterijama, on se mora odlo\u017eiti mesec dana. Ova vremenska granica se mora po\u0161tovati ozbilnije nego u karotidnoj hirurgiji, po\u0161to je pojava reperfuzionog sindroma, reperfuzionog edema, reaktivacije ishemi\u010dnih \u017eari\u0161ta, hernijacije mozga i konverzije ishemi\u010dnog i hemoragi\u010dki infarkt od daleko ve\u0107eg zna\u010daja (oko 50% ukupnog mortaliteta).<\/p>\n

Arteriogra<\/b>fi<\/b>ja<\/b> <\/b>aortnog<\/b> <\/b>luka<\/b> <\/b>i<\/b> <\/b>njegovih<\/b> <\/b>grana<\/b> <\/b>(arkografija)<\/p>\n

Arkografija se smatra zlatnim standardom u dijagnostici supraaortalnih grana za postavljanje indikacija i planiranje rekonstruktivnog zahvata. Za dobre indikacione odluke neophodan je, prikaz intratorakalnog, ekstrakranijalnog i intrakranijalnog arterijskog segmenta. \u010cesto je te\u0161ko proceniti da li se distalno od okludiranog segmenta arterija ne prikazuje ili je tako\u0111e okludirana. Obi\u010dno treba uraditi arteriografiju da bi se potvrdilo prisustvo prolaznog arterijskog segmenta distalno.<\/p>\n

Multislajs<\/b> <\/b>kompjutetizovana<\/b> <\/b>tomogra<\/b>fi<\/b>ja<\/b> <\/b>(MSCT)<\/b> <\/b>supraaortalnih<\/b> <\/b>grana<\/b> <\/b>je minimalno invazivna radiolo\u0161ka dijagnosti\u010dka metoda pregleda lumena i morfologije. MSCT angiografija nam pokazuje ne samo stepen stenoze i prirodu plakova, ve\u0107 morfologiju arterija i odnos arterija sa ostalim strukturama vrata, kao i uvid u Willisov poligon, \u0161to je veoma va\u017eno kod planiranja kako operativnog le\u010denja, tako i interventne procedure.<\/p>\n

Traumatska<\/span> <\/span>lezija<\/span> <\/span>brahiocefali\u010dnog<\/span> <\/span>trunkusa<\/span> <\/span>je<\/span> <\/span>\u010de\u0161\u0107e<\/span> <\/span>nego<\/span> <\/span>kod<\/span> <\/span>drugih<\/span> <\/span>supraaortalnih<\/span> <\/span> <\/span>grana.<\/span> <\/span> <\/span>Aneurizme<\/span> <\/span> <\/span>brahiocefali\u010dnog<\/span> <\/span> <\/span>trunkusa<\/span> <\/span> <\/span>se <\/span> <\/span>otkrivaju<\/span> <\/span>kao<\/span> <\/span>medijastinalni<\/span> <\/span>tumor<\/span> <\/span>na<\/span> <\/span>rentgenskom<\/span> <\/span>snimku<\/span> <\/span>plu\u0107a.<\/span> <\/span>Slede\u0107i<\/span> <\/span>korak<\/span> <\/span>ka<\/span> <\/span>dijagnozi<\/span> <\/span>je<\/span> <\/span>MSCT<\/span> <\/span>arteriogra<\/span>fi<\/span>ja.<\/span> <\/span>Opasna<\/span> <\/span>gre\u0161ka<\/span> <\/span>je<\/span> <\/span>poku\u0161aj<\/span> <\/span>biopsije<\/span> <\/span>iglom<\/span> <\/span>ili<\/span> <\/span>medijastinoskopija.<\/span> <\/span>Ovi<\/span> <\/span>pacijenti<\/span> <\/span>\u010desto<\/span> <\/span>imaju<\/span> <\/span>i<\/span> <\/span>druge<\/span> <\/span>aneurizme:<\/span> <\/span>descedentne<\/span> <\/span>torakalne<\/span> <\/span>ili<\/span> <\/span>abdominalne<\/span> <\/span>aorte<\/span> <\/span>za<\/span> <\/span>kojima<\/span> <\/span>treba<\/span> <\/span>tragati.<\/span><\/p>\n

Digitalna<\/b><\/span> <\/b><\/span>subtrakciona<\/b><\/span> <\/b><\/span>arteriogra<\/b><\/span>fi<\/b><\/span>ja<\/b><\/span> <\/b><\/span>(DSA)<\/b><\/span> <\/b><\/span>ima<\/span> <\/span>prednost<\/span> <\/span>ubrizgavanja<\/span> <\/span>manje<\/span> <\/span>koli\u010dine<\/span> <\/span>kontrasta,<\/span> <\/span>ali<\/span> <\/span>se<\/span> <\/span>ponekad<\/span> <\/span>javljaju<\/span> <\/span>problemi<\/span> <\/span>sa<\/span> <\/span>interpretacijom<\/span> <\/span>nalaza.<\/span> <\/span>Intraarterijska<\/b><\/span> <\/b><\/span>digitalna<\/span> <\/span>arteriogra<\/span>fi<\/span>ja<\/span> <\/span>ima<\/span> <\/span>speci<\/span>fi<\/span>\u010dnost<\/span> <\/span>i<\/span> <\/span>senzitivnost<\/span> <\/span>blizu<\/span> <\/span>klasi\u010dne<\/span> <\/span>arkogra<\/span>fi<\/span>je.<\/span> <\/span>Najbolje<\/span> <\/span>rezultate<\/span> <\/span>daje<\/span> <\/span>pri<\/span> <\/span>vizuelizaciji<\/span> <\/span>distalnih<\/span> <\/span>cerebralnih<\/span> <\/span>arterija.<\/span> <\/span>Intravenska<\/b><\/span> <\/b><\/span>digitalna<\/span> <\/span>arkogra<\/span>fi<\/span>ja<\/span> <\/span>daje<\/span> <\/span>vrlo<\/span> <\/span>diskutabilne<\/span> <\/span>rezultate<\/span> <\/span>i<\/span> <\/span>sve<\/span> <\/span>se<\/span> <\/span>re\u0111e<\/span> <\/span>koristi.<\/span><\/p>\n

Nuklearna<\/b><\/span> <\/b><\/span>magnetska<\/b><\/span> <\/b><\/span>rezonanasa<\/b><\/span> <\/b><\/span>(MRI<\/b><\/span>)<\/span> <\/span>arteriogra<\/b><\/span>fi<\/b><\/span>ja<\/b><\/span> <\/b><\/span>omogu\u0107ava<\/span> <\/span>hemodinamsku<\/span> <\/span>procenu.<\/span> <\/span>Mogu\u0107nost<\/span> <\/span>funkcionalne<\/span> <\/span>procene<\/span> <\/span>obezbe\u0111uje<\/span> <\/span>otkrivanje<\/span> <\/span>znakova<\/span> <\/span>kolateralnog<\/span> <\/span>krvotoka<\/span> i <\/span>kra\u0111e<\/span> <\/span>krvi.<\/span> <\/span>Me\u0111utim,<\/span> <\/span>slaba<\/span> <\/span>rezolucija<\/span> u <\/span>slu\u010daju<\/span> <\/span>te\u0161kih<\/span> <\/span>(multiplih)<\/span> <\/span>lezija<\/span> <\/span>intratorakalnog<\/span> <\/span>dela<\/span> <\/span>supraaortalnih<\/span> <\/span>grana,<\/span> <\/span>zna\u010dajno<\/span> <\/span>limitira<\/span> <\/span>njenu<\/span> <\/span>primenu.<\/span><\/p>\n

Selektivna<\/b><\/span> <\/b><\/span>arteriogra<\/b><\/span>fi<\/b><\/span>ja<\/b><\/span>.<\/span> <\/span>Transfemoralna<\/span> <\/span>kateterizacija<\/span> <\/span>aortnog<\/span> <\/span>luka<\/span> <\/span>sa<\/span> <\/span>ubrizgavanjem<\/span> <\/span>kontrasta<\/span> <\/span>pru\u017ea<\/span> <\/span>mogu\u0107nost<\/span> <\/span>za<\/span> <\/span>selektivno<\/span> <\/span>vizueliziranje<\/span> <\/span>pojedinih<\/span> <\/span>arterijskih<\/span> <\/span>stabala,<\/span> <\/span>ako<\/span> <\/span>je<\/span> <\/span>potrebno<\/span> <\/span>i<\/span> <\/span>u<\/span> <\/span>forsiranim<\/span> <\/span>polo\u017eajima<\/span> <\/span>glave<\/span> <\/span>i<\/span> <\/span>vrata.<\/span> <\/span>Potrebno <\/span>je da <\/span>snimanje<\/span> <\/span>bude<\/span> <\/span>u <\/b><\/span>dva<\/b><\/span> <\/b><\/span>pravca<\/b><\/span> <\/b><\/span>(pod<\/span> <\/span>pravim<\/span> <\/span>uglom)<\/span> sa <\/span>selektivnim<\/span> <\/span>ubrizgavanjem<\/span> <\/span>kontrasta.<\/span><\/p>\n<\/div>\n


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

ENDOVASKULARNA HIRURGIJA 22.3. NEINVAZIVNA DIJAGNOSTIKA NEINVAZIVNA DIJAGNOSTIKA Duplex sonografija Cervikalni segmenti supraaortalnih grana se mogu precizno morfolo\u0161ki da analiziraju, posebno \u0161to se ti\u010de kompozicije arterioskleroti\u010dnih lezija. Indirektno se mo\u017ee proceniti stanje nedostupnih proksimalnih segmenata (orificijum) supraaortalnih stabala. Vizuelizacija retrogradnog protoka kroz vertebralnu arteriju je dovoljan uslov za pouzdanu dijagnozu okluzije (ili te\u0161ke stenoze) po\u010detnog dela […]<\/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-4866","page","type-page","status-publish","hentry"],"acf":[],"yoast_head":"\n22.3. 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