Léčebná taktika ruptury výdutí břišní aorty

English version

Autoři: L. Davidovic ^1,2
Působiště autorů: Faculty of Medicine, University of Belgrade ¹; Clinic for vascular and endovascular surgery, Clinical Center of Serbia, Belgrade ²
Vyšlo v časopise: Rozhl. Chir., 2014, roč. 93, č. 7, s. 357-365.
Kategorie: Souhrnné sdělení

Souhrn

Ruptura je nejzávažnější a smrtící komplikací aneurysmatu abdominální aorty. I přes zlepšení situace za posledních 50 let jsou ruptury aneurysmat abdominální aorty spojeny s vysokou mortalitou. Mortalita z ruptury aneurysmatu abdominální aorty je 90 %, zejména se zahrnutím pacientů, kteří zemřou dříve než jsou transportováni do nemocnice. Na druhé straně počet aneurysmat abdominální aorty se za posledních 20 let výrazně zvýšil. Jeden z důvodů je stárnutí populace ve většině zemí, a proto počet degenerativních AAA se zvyšuje. Stejně tak je tomu u pacientů s rupturou aneurysmatu břišní aorty. Věk nesmí být důvodem odmítnutí léčby. Je nutné nalézt optimální léčebné možnosti.

Následující práce je založena na analýze literatury včetně součaných doporučení, ale také na významných zkušenostech naší kliniky. Tento článek dále představuje možnosti vaskulární medicíny v rozvojových zemích, kde nelze aplikovat endovaskulární metody na dostačující úrovni a v dostatečném rozsahu. V tuto chvíli je jasné následující. 30denní mortalita po ošetření ruptur AAA je významně nižší v tzv. high-volume nemocnicích. Z odlišných důvodů nejsou všechny ruptury aneurysmat břišní aorty vhodné k EVAR. Otevřené řešení ruptur aneurysmat břišní aorty by mělo být operováno zkušeným cévním chirurgem pro otevřené výkony. Stejné by mělo platit pro léčbu endovaskulárních komplikací, které vyžadují konverzi v otevřený chirurgický výkon.

Neexistuje ideální výkon pro léčbu AAA. Každý výkon má své výhody a nevýhody, své limity a komplikace, a také indikace a kontraindikace. Další snížení mortality u ruptur AAA bude záležet na zavedení populačně založeného skríningu, na strategii prevence pooperačního poškození orgánů, a také na pokroku nové lékařské technologie. Z toho důvodu je vzdělávání nových mladých cévních chirurgů nejen v endovaskulární, ale i v otevřené aortální chirurgii nesmírně důležité.

Klíčová slova:
břišní aorta – výduť – ruptura

Zdroje

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