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master's thesis
Usporedba kirurškog i endovaskularnog liječenja rupturiranih aneurizmi abdominalne aorte

Mariam El-Barq (2016)
Metadata
TitleUsporedba kirurškog i endovaskularnog liječenja rupturiranih aneurizmi abdominalne aorte
AuthorMariam El-Barq
Mentor(s)Miljenko Kovačević (thesis advisor)
Abstract
AAA su ograničena proširenja abdominalne aorte, a aneurizma se definira kao promjer infrarenalne aorte veći od 3 cm. Većinom su asimptomatske i otkriju se slučajno, a ukoliko daju simptome, najčešće je to bol. Ruptura aneurizme je glavna komplikacija AAA. Incidencija je povećana kod muškaraca, pušača, starijih od 60 godina. Nastanak AAA je multifaktorijalni, sistemni proces koji nastaje zbog promjena u biologiji stijenke aorte što rezultira progresivnim stanjenjem i slabljenjem stijenke te povećanjem promjera aorte. Ključan mehanizam u patofiziologiji rupture je biomehanički stres na stijenku. Više od 90% AAA je lokalizirano infrarenalno, a dijagnosticiraju se slikovnim metodama. Klinički AAA dijelimo na: asimptomatske, simptomatske i rupturirane. Klasični trijas simptoma rAAA je hipotenzija, bol i pulsirajuća masa u abdomenu. Smrtnost rAAA je i dalje vrlo visoka i doseže 90%. Dva glavna pristupa liječenju AAA su kirurško i endovaskularno liječenje. Liječenje ovisi o promjeru aneurizme, simptomima, procjeni rizika za rupturu te procjeni mortaliteta uzrokovanog operativnim zahvatom. Kod pacijenata sa rAAA randomiziranim studijama nije utvrđena značajna razlika u stopi mortaliteta između ova dva principa liječenja. EVAR pokazuje nešto manji perioperativni mortalitet i broj komplikacija te može biti metoda izbora za hemodinamski stabilne pacijente sa zadovoljenim anatomskim kriterijima. Dugoročno preživljenje je jednako u obje metode. Kod rAAA OR i EVAR se izvode na sličan način kao kod elektivnih zahvata uz minimalne izmjene koje hitnoća zahtijeva. Komplikacije nakon intervencije kod pacijenata sa rAAA su slične onima nakon elektivnih zahvata, ali sa većom incidencijom infarkta miokarda, zatajenja respiracije, ishemije crijeva, zdjelice i donjih ekstremiteta te akutne bubrežne ozljede.
KeywordsAbdominal aortic aneurysm Management of AAA Open repair (OR) EVAR
Committee MembersIgor Medved (committee chairperson)
Harry Grbas (committee member)
Alen Ružić (committee member)
GranterSveučilište u Rijeci
Medicinski fakultet
Lower level organizational unitsKatedra za kirurgiju
PlaceRijeka
StateCroatia
Scientific field, discipline, subdisciplineBIOMEDICINE AND HEALTHCARE
Clinical Medical Sciences
Surgery
Study programme typeuniversity
Study levelintegrated undergraduate and graduate
Study programmeMedicine
Academic title abbreviationdr. med.
Genremaster's thesis
Language Croatian
Defense date2016-07-15
Parallel abstract (English)
An AAA is a focal dilatation of an aorta, and aneurysm is considered if infrarenal aorta is >3 cm in diameter. AAAs are mostly asymptomatic and found incidentally, but if symptoms do occur, most often is about pain. Rupture of the AAA is a main complication. The incidence of AAA is higher in men, individuals older than 60 years and smokers. Development of the AAA is a multifactorial, systemic process due to alterations in aortal wall biology which results with progressive thinning and weakening of the aortic wall as well as increased aortic diameter. The main mechanism of the rupture is biomechanical wall stress. More than 90% of aneurysms originate infrarenal and are diagnosed by imaging modalities. Clinical AAA is divided into: asymptomatic, symptomatic and ruptured. The classic triad of symptoms is hypotension, acute pain and pulsatile abdominal mass. Mortality rate of rAAA is still very high and reaches 90%. Two main principles in management are open repair (OR) and EVAR. Management depends on aortic diameter, symptoms, rupture risk assessment and perioperative mortality evaluation. Benefits of EVAR compared with OR include reduced hospital stay, less blood loss and lower ischemia of visceral organs. Randomized trials didn’t show a significant difference in a perioperative mortality rate between those two methods in patients with rAAA. EVAR is associated with slightly lower perioperative mortality so as less complications and is suggested as a method of choice for hemodynamic stable patients that fulfill the anatomic criteria. Long-term surveillance is no difference between the two methods. Repair of rAAA using an OR or EVAR is similar to elective AAA repair with some modifications due to urgency of the repair. Complications of rAAA repair are similar to those appearing after elective repair, just there is a higher incidence of complications such as myocardial infarction, respiratory failure, bowel, pelvic and peripheral ischemia and acute kidney injury.
Parallel keywords (Croatian)Aneurizma abdominalne aorte Liječenje AAA Otvorena rekonstrukcija (OR) EVAR
Resource typetext
Access conditionAccess restricted to higher education institution's students and staff
Terms of usehttp://rightsstatements.org/vocab/InC/1.0/
URN:NBNhttps://urn.nsk.hr/urn:nbn:hr:184:061731
CommitterBosa Licul