Title (croatian) Kirurško zbrinjavanje kasnih komplikacija nakon endovaskularnog liječenja aneurizme abdominalne aorte Title (english) Surgical Management of Late Complications After Endovascular Treatment of Abdominal Aortic Aneurysm Author Miljenko Kovačević Author Lovro Kovač Author Lovro Tkalčić Author's institution University of Rijeka Scientific / art field, BIOMEDICINE AND HEALTHCARE Abstract (croatian) Aneurizma abdominalne aorte (AAA) čest je problem u starije populacije, a rizik rupture korelira s promjerom aneurizme. Tradicionalno su se bolesnici s aneurizmom abdominalne aorte većeg promjera liječili otvorenim kirurškim tehnikama, dok u posljednjih 20 godina pratimo porast korištenja tehnike endovaskularnog popravka aneurizme aorte (EVAR-a), koja uključuje postavljanje prostetskog nepropusnog grafta unutar lumena abdominalne aorte s ciljem isključenja aneurizme iz protoka i sprječavanja rupture. Sigurnosni profil i dugoročni podatci metode EVAR rezultirali su značajnim porastom korištenja EVAR-a, unatoč studijama koje dugoročnim praćenjem nisu pokazale bolje preživljavanje ili kvalitetu života. Zbog porasta broja bolesnika liječenih EVAR-om, očekujemo porast broja komplikacija i potrebu za sekundarnim intervencijama. U najčešće komplikacije nakon EVAR-a ubrajamo endoleak, migraciju stent-grafta, kinking-proteze, trombozu te infekciju grafta. Sekundarne komplikacije prvenstveno treba zbrinjavati endovaskularno, no kasne komplikacije koje zahtijevaju otvorenu kiruršku operaciju možemo očekivati u do 9 % bolesnika kojima je učinjen EVAR. Operacije aneurizme abdominalne aorte nakon nezadovoljavajućeg rezultata EVAR-a prati veći broj komplikacija, zbog atrofije zida aorte, periaortalne upale i fibroze te otežanog postizanja proksimalne i distalne vaskularne kontrole zbog pozicije stent-grafta, što često zahtijeva suprarenalno klemanje. Otvorena kirurgija gotovo je uvijek potrebna kod sekundarne rupture AAA, ako endovaskularne opcije odmah nisu dostupne ili tehnički moguće, kao i kod infekcije grafta, gdje je poželjna potpuna ekstrakcija protetskog materijala. Ključno je praćenje bolesnika nakon EVAR-a te pravovremeno i elektivno zbrinjavanje komplikacija.
Abstract (english) Abdominal aortic aneurysm (AAA) is more common in the elderly population, and the risk of rupture correlates with the diameter of the aneurysm. Traditionally, patients with larger AAA were treated with open surgical techniques, but over the last 20 years, there has been an increase in the use of the endovascular aneurysm repair technique (EVAR), which involves placing a prosthetic impermeable graft within the lumen of the abdominal aorta to exclude the aneurysm from circulation and prevent rupture. The safety profile and long-term data of the EVAR method have resulted in a significant increase in the use of EVAR, despite studies that have not shown better survival or quality of life with long-term follow-up. Due to the increasing number of patients treated with EVAR, we expect an increase in the number of complications and the need for secondary interventions. The most common complications after EVAR include endoleak, stent graft migration, kinking of the prosthesis, thrombosis, and graft infection. Complications secondary to EVAR should primarily be managed endovascularly, but late complications requiring open surgery can be expected in up to 9% of patients who have undergone EVAR. Surgeries of the abdominal aorta secondary to failed EVAR are accompanied by a greater number of complications than the primary open procedures. Open surgery is almost always necessary for secondary rupture of AAA if endovascular options are not immediately available or technically feasible, as well as for graft infection, where complete extraction of the prosthetic material is desirable. The monitoring of patients after EVAR and the timely and elective management of complications are crucial.
Keywords (croatian)
aneurizma abdominalne aorte
endoleak
endovaskularni popravak aneurizme
kompjutorizirana tomografska angiografija
stent
Keywords (english)
Aortic Aneurysm, Abdominal
Computed Tomography Angiography
Endoleak
Endovascular Aneurysm Repair
Stents
Language croatian Language english Publication type Scientific paper - Review paper Publication status Published Peer review Peer review Publication version Published version Journal title Medicina Fluminensis : Medicina Fluminensis Numbering vol. 60, no. 2, pp. 136-143 p-ISSN 1847-6864 e-ISSN 1848-820X DOI https://doi.org/10.21860/medflum2024_316228 URN:NBN urn:nbn:hr:184:603852 Publication 2024-06-01 Document URL https://hrcak.srce.hr/316228 Type of resource Text Access conditions Open access Terms of use Created on 2024-06-06 07:41:05
