{"id":2125,"date":"2013-04-07T09:03:15","date_gmt":"2013-04-07T09:03:15","guid":{"rendered":"https:\/\/eportal.chirurgie.upol.cz\/portal_final\/?page_id=2125"},"modified":"2013-06-11T12:02:41","modified_gmt":"2013-06-11T12:02:41","slug":"5-tepenna-aneuryzmata","status":"publish","type":"page","link":"https:\/\/eportal.chirurgie.upol.cz\/portal_final\/?page_id=2125","title":{"rendered":"5 Tepenn\u00e1 aneuryzmata"},"content":{"rendered":"<p style=\"text-align: justify;\">V\u00fddu\u0165 se m\u016f\u017ee vyskytnout kdekoliv na arteri\u00e1ln\u00edm \u0159e\u010di\u0161ti. Etiologicky m\u016f\u017ee b\u00fdt vrozen\u00e1, aterosklerotick\u00e1, traumatick\u00e1, infek\u010dn\u00ed (z\u00e1n\u011btliv\u00e1, mykotick\u00e1) a poststenotick\u00e1. Nejb\u011b\u017en\u011bj\u0161\u00ed je v\u00fddu\u0165 aterosklerotick\u00e1 p\u0159i dilata\u010dn\u00edm typu ateroskler\u00f3zy. Typickou lokalizac\u00ed je abdomin\u00e1ln\u00ed aorta, p\u00e1nevn\u00ed tepny a poplite\u00e1ln\u00ed arterie. Mykotick\u00e1 v\u00fddu\u0165 vznik\u00e1 nej\u010dast\u011bji zanesen\u00edm infekce krevn\u00edm proudem do st\u011bny arterie, etiologicky je \u010dasto p\u0159\u00ed\u010dinou salmonelov\u00e1 infekce. Z praktick\u00e9ho hlediska je nutn\u00e1 znalost problematiky v\u00fddut\u00ed aorty, p\u00e1nevn\u00edho \u0159e\u010di\u0161t\u011b a v\u00fddut\u011b arteria poplitea.<\/p>\n<h3>5.1 V\u00fddu\u0165 b\u0159i\u0161n\u00ed aorty a v\u00fddu\u0165 p\u00e1nevn\u00ed tepny (aneurysma aortae abdominalis \u2013 AAA, aneurysma <strong>arteriae<\/strong> iliacae)<\/h3>\n<h6>EPIDEMIOLOGIE<\/h6>\n<p style=\"text-align: justify;\">Infraren\u00e1ln\u00ed aneuryzma p\u0159edstavuje 60% v\u0161ech aneuryzmatick\u00fdch onemocn\u011bn\u00ed a je nej\u010dast\u011bj\u0161\u00edm aneuryzmatem na velk\u00fdch c\u00e9v\u00e1ch. Postihuje mu\u017ee 6\u00d7 \u010dast\u011bji ne\u017e \u017eeny.Izolovan\u00e1 v\u00fddu\u0165 p\u00e1nevn\u00ed tepny p\u0159edstavuje asi1,3% v\u0161ech v\u00fddut\u00ed. Je mnohem \u010dast\u011bj\u0161\u00ed v korelacis v\u00fddut\u00ed b\u0159i\u0161n\u00ed aorty. Rizikov\u00e9 faktory v\u00fddut\u011b jsou mu\u017esk\u00e9 pohlav\u00ed, kou\u0159en\u00ed, v\u011bk nad 65 let.<\/p>\n<ul>\n<li style=\"text-align: justify;\"><strong>Morfologie a lokalizace<br \/>\n<\/strong>Z morfologick\u00e9ho hlediska jsou infraren\u00e1ln\u00ed v\u00fddut\u011b v\u0159etenovit\u00e9, vakovit\u00e9 a z\u00e1n\u011btliv\u00e9. Je t\u0159eba odli\u0161it neprav\u00e9 v\u00fddut\u011b, jako jsou v\u00fddut\u011b v anastom\u00f3z\u00e1ch(po c\u00e9vn\u00edch rekonstrukc\u00edch), traumatick\u00e9 v\u00fddut\u011b nebo penetruj\u00edc\u00ed aort\u00e1ln\u00ed ulcerace.V\u00fddut\u011b jsou v 95% lokalizov\u00e1ny pod odstupem ren\u00e1ln\u00edch arteri\u00ed, ve 3% odstupuj\u00ed z v\u00fddut\u011b ren\u00e1ln\u00ed arterie a ve 2% viscer\u00e1ln\u00ed arterie (tzv. juxtaren\u00e1ln\u00ed v\u00fddut\u011b).Izolovan\u00e9 v\u00fddut\u011b p\u00e1nevn\u00edch tepen postihuj\u00ed spole\u010dnou a vnit\u0159n\u00ed ilickou arterii. Aneuryzmatick\u00e9 zm\u011bny na zevn\u00ed ilick\u00e9 arterii jsou velmi vz\u00e1cn\u00e9. V\u00fddut\u011b jsou na aterosklerotick\u00e9m podklad\u011b a jsou v\u0159etenovit\u00e9 nebo vakovit\u00e9.U n\u011bkter\u00fdch nemocn\u00fdch lze prok\u00e1zat mnoho\u010detn\u00e9 v\u00fddut\u011b s pestrou symptomatologi\u00ed \u2013 krv\u00e1cen\u00edm, embolizac\u00ed do periferie nebo oboj\u00edm (fotogalerie 5a).<\/li>\n<li style=\"text-align: justify;\"><strong>Definice<br \/>\n<\/strong>jako v\u00fddu\u0165 je hodnoceno roz\u0161\u00ed\u0159en\u00ed aorty nebo p\u00e1nevn\u00ed tepny na dvojn\u00e1sobek jej\u00edho norm\u00e1ln\u00edhopr\u016fm\u011bru.<\/li>\n<li style=\"text-align: justify;\"><strong>Klinika<\/strong>\n<ul>\n<li style=\"text-align: justify;\"><em>Asymptomatick\u00e1 v\u00fddu\u0165<br \/>\n<\/em>Pod t\u00edmto pojmem rozum\u00edme n\u00e1hodn\u011b nalezenou v\u00fddu\u0165 p\u0159i fyzik\u00e1ln\u00edm vy\u0161et\u0159en\u00ed b\u0159icha nebo p\u0159i ultrazvukov\u00e9m vy\u0161et\u0159en\u00ed b\u0159icha. V\u00fddu\u0165 je zcela bezp\u0159\u00edznakov\u00e1. Prokazujeme pulzuj\u00edc\u00ed resistenci v lev\u00e9 polovin\u011b b\u0159icha.<\/li>\n<li style=\"text-align: justify;\"><em>Symptomatick\u00e1 v\u00fddu\u0165<br \/>\n<\/em>Zp\u016fsobuje v\u011bt\u0161inou bolesti v z\u00e1dech nebo v t\u0159\u00edslech. Jin\u00fdm p\u0159\u00edznakem mohou b\u00fdt difuzn\u00ed bolesti b\u0159icha. V\u00fddu\u0165 m\u016f\u017ee p\u016fsobit \u00fatlak okoln\u00edch org\u00e1n\u016f, a t\u00edm vyvol\u00e1vat pot\u00ed\u017ee odpov\u00eddaj\u00edc\u00ed jejich onemocn\u011bn\u00ed \u2013 nap\u0159. onemocn\u011bn\u00ed ledvin nebo vertebrogenn\u00ed pot\u00ed\u017ee.<\/li>\n<li style=\"text-align: justify;\"><em>Ruptura v\u00fddut\u011b<br \/>\n<\/em>Kryt\u00e1 ruptura v\u00fddut\u011b vyvol\u00e1v\u00e1 trval\u00e9, \u010dasto pulzuj\u00edc\u00ed bolesti b\u0159icha s vyza\u0159ov\u00e1n\u00edm do zad a do t\u0159\u00edsel. Typick\u00fd je n\u00e1hl\u00fd po\u010d\u00e1tek pot\u00ed\u017e\u00ed. Nemocn\u00fd b\u00fdv\u00e1 ob\u011bhov\u011b stabiln\u00ed, ale \u010dasto b\u00fdv\u00e1 pokles hodnot hemoglobinu a sn\u00ed\u017een\u00ed hodnot hematokritu. Ruptura do voln\u00e9 dutiny b\u0159i\u0161n\u00ed je spojena s n\u00e1hlou bolest\u00ed a rychl\u00fdm selh\u00e1n\u00edm ob\u011bhu.\u00a0Zvl\u00e1\u0161tnost\u00ed\u00a0je perforace do gastrointestin\u00e1ln\u00edho traktu s projevy krv\u00e1cen\u00ed nebo perforace do doln\u00ed dut\u00e9 \u017e\u00edly s pravostrannou srde\u010dn\u00ed nedostate\u010dnost\u00ed.<\/li>\n<\/ul>\n<\/li>\n<li style=\"text-align: justify;\"><strong>Diagnostika<\/strong>\n<ul>\n<li style=\"text-align: justify;\"><em>Ultrazvuk<\/em><br \/>\nVysoce sensitivn\u00ed metoda k pr\u016fkazu infraren\u00e1ln\u00ed v\u00fddut\u011b aorty. V\u00fdt\u011b\u017enost metody je v\u00fdrazn\u011b ni\u017e\u0161\u00ed u v\u00fddut\u00ed, z nich\u017e odstupuj\u00ed ren\u00e1ln\u00ed arterie nebo arteria mesenterica superior. Tato metoda je tak\u00e9 dostate\u010dn\u011b v\u00fdt\u011b\u017en\u00e1 p\u0159i pr\u016fkazu kryt\u00fdch ruptur. V\u00fdznam ultrazvukov\u00e9ho vy\u0161et\u0159en\u00ed je z\u00e1sadn\u00ed p\u0159i monitoraci progrese velikosti v\u00fddut\u011b.<\/li>\n<li style=\"text-align: justify;\"><em>Angiografie<\/em><br \/>\nP\u0159i angiografii se zobrazuje lumen v\u00fddut\u011b a o vlastn\u00ed velikosti lze uva\u017eovat jen na z\u00e1klad\u011b nep\u0159\u00edm\u00fdch zn\u00e1mek. Jej\u00ed v\u00fdznam spo\u010d\u00edv\u00e1 ve zhodnocen\u00ed odstupu arteri\u00ed u komplikovan\u00fdch v\u00fddut\u00ed p\u0159i pl\u00e1nov\u00e1n\u00ed chirurgick\u00e9ho nebo endovaskul\u00e1rn\u00edho v\u00fdkonu. D\u00e1le je vhodn\u00e1 ke kontrole v\u00fdsledk\u016f endovaskul\u00e1rn\u00edch v\u00fdkon\u016f (endoleak).<\/li>\n<li style=\"text-align: justify;\"><em>Magnetick\u00e1 rezonance<\/em><br \/>\nZobrac\u00ed spolehliv\u011b v\u00fddu\u0165 a lze ji tak\u00e9 pou\u017e\u00edt ke zm\u011b\u0159en\u00ed velikosti v\u00fddut\u011b. M\u011b\u0159en\u00ed v\u0161ak nen\u00ed natolik dokonal\u00e9, aby dle jeho v\u00fdsledk\u016f bylo mo\u017eno jednozna\u010dn\u011b pl\u00e1novat endovaskul\u00e1rn\u00ed v\u00fdkon. Tak\u00e9 k n\u00e1sledn\u00e9mu sledov\u00e1n\u00ed endovaskul\u00e1rn\u00edch v\u00fdkon\u016f nen\u00ed tato metoda vhodn\u00e1 (stentgrafty a odrazy).<\/li>\n<li style=\"text-align: justify;\"><em>CT<\/em><br \/>\nV sou\u010dasn\u00e9 dob\u011b nejkvalitn\u011bj\u0161\u00ed diagnostick\u00e1 metoda ke zhodnocen\u00ed v\u00fddut\u011b aorty nebo v\u00fddut\u011b p\u00e1nevn\u00edho \u0159e\u010di\u0161t\u011b. Dokonale zhodnot\u00ed morfologii v\u00fddut\u011b. Sou\u010dasn\u00e1 CT umo\u017en\u00ed multiplan\u00e1rn\u00ed rekonstrukci a p\u0159esn\u00e9 zm\u011b\u0159en\u00ed nejenom d\u00e9lky a pr\u016fm\u011bru v\u00fddut\u011b, ale tak\u00e9 rozm\u011bry c\u00e9vn\u00edho svazku nad a pod v\u00fddut\u00ed. Metoda je oblig\u00e1tn\u00ed p\u0159i pl\u00e1nov\u00e1n\u00ed endovaskul\u00e1rn\u00edch v\u00fdkon\u016f. CT je tak\u00e9 vhodn\u00e9 k monitoraci nebo n\u00e1sledn\u00e9mu (po opera\u010dn\u00edm nebo po endovaskul\u00e1rn\u00edm v\u00fdkonu) sledov\u00e1n\u00ed. Metoda je nenahraditeln\u00e1 p\u0159i zhodnocen\u00ed symptomatick\u00e9 v\u00fddut\u011b (fotogalerie 5b).<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<table style=\"width: 100%;\" border=\"0\" cellspacing=\"0\" cellpadding=\"0\">\n<tbody>\n<tr>\n<td style=\"width: 50%; border: 1px solid #ffffff;\" colspan=\"2\" align=\"center\" valign=\"top\">\n<h6>Fotogalerie 5a:<\/h6>\n<h6>CT ag AAA (aneuryzma AA, CT ag) \u2013 ostr\u00fd \u00fahel kr\u010dku v\u00fddut\u011b, nevhodn\u00e9 k endovaskul\u00e1rn\u00ed l\u00e9\u010db\u011b, v\u00fddut\u011b aorty a p\u00e1nevn\u00edch tepen<\/h6>\n<\/td>\n<\/tr>\n<tr>\n<td style=\"border: 1px solid #ffffff;\" align=\"center\" valign=\"top\">\n<p><div style=\"width: 210px\" class=\"wp-caption alignnone\"><a href=\"https:\/\/eportal.chirurgie.upol.cz\/portal_final\/wp-content\/uploads\/2013\/04\/Image_177.jpg\"><img decoding=\"async\" title=\"Zadop\u0159edn\u00ed projekce\" alt=\"Zadop\u0159edn\u00ed projekce\" src=\"https:\/\/eportal.chirurgie.upol.cz\/portal_final\/wp-content\/uploads\/2013\/04\/Image_177.jpg\" width=\"200\" \/><\/a><p class=\"wp-caption-text\">Zadop\u0159edn\u00ed projekce<\/p><\/div><\/td>\n<td style=\"width: 50%; border: 1px solid #ffffff;\" align=\"center\" valign=\"top\">\n<p><div style=\"width: 210px\" class=\"wp-caption alignnone\"><a href=\"https:\/\/eportal.chirurgie.upol.cz\/portal_final\/wp-content\/uploads\/2013\/04\/Image_176.jpg\"><img decoding=\"async\" title=\"\u0160ikm\u00e1 projekce\" alt=\"\u0160ikm\u00e1 projekce\" src=\"https:\/\/eportal.chirurgie.upol.cz\/portal_final\/wp-content\/uploads\/2013\/04\/Image_176.jpg\" width=\"200\" \/><\/a><p class=\"wp-caption-text\">\u0160ikm\u00e1 projekce<\/p><\/div><\/td>\n<\/tr>\n<tr>\n<td style=\"border: 1px solid #ffffff;\" align=\"center\" valign=\"top\">\n<p><div style=\"width: 210px\" class=\"wp-caption alignnone\"><a href=\"https:\/\/eportal.chirurgie.upol.cz\/portal_final\/wp-content\/uploads\/2013\/04\/Image_179.jpg\"><img decoding=\"async\" title=\"Bo\u010dn\u00ed projekce\" alt=\"Bo\u010dn\u00ed projekce\" src=\"https:\/\/eportal.chirurgie.upol.cz\/portal_final\/wp-content\/uploads\/2013\/04\/Image_179.jpg\" width=\"200\" \/><\/a><p class=\"wp-caption-text\">Bo\u010dn\u00ed projekce<\/p><\/div><\/td>\n<td style=\"width: 50%; border: 1px solid #ffffff;\" align=\"center\" valign=\"top\">\n<p><div style=\"width: 210px\" class=\"wp-caption alignnone\"><a href=\"https:\/\/eportal.chirurgie.upol.cz\/portal_final\/wp-content\/uploads\/2013\/04\/Image_178.jpg\"><img decoding=\"async\" title=\"Zadn\u00ed projekce\" alt=\"Zadn\u00ed projekce\" src=\"https:\/\/eportal.chirurgie.upol.cz\/portal_final\/wp-content\/uploads\/2013\/04\/Image_178.jpg\" width=\"200\" \/><\/a><p class=\"wp-caption-text\">Zadn\u00ed projekce<\/p><\/div><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<ul>\n<li>Indikace k l\u00e9\u010db\u011b\n<ul>\n<li style=\"text-align: justify;\"><em>Asymptomatick\u00e1 v\u00fddu\u0165<br \/>\n<\/em>O\u0161et\u0159en\u00ed v\u00fddut\u011b m\u00e1 zabr\u00e1nit jej\u00ed ruptu\u0159e nebo relativn\u011b vz\u00e1cn\u00e9 komplikaci v\u00fddut\u011b \u2013 embolizaci trombotick\u00e9ho materi\u00e1lu do periferie. U v\u00fddut\u011b se sleduj\u00ed 3 parametry: pr\u016fm\u011br v\u00fddut\u011b, tvar v\u00fddut\u011b a r\u016fst v\u00fddut\u011b. Riziko ruptury v\u00fddut\u011b o pr\u016fm\u011bru do 5 cm je 3%, u v\u00fddut\u011b nad 7 cm je riziko 60%. V\u00fddut\u011b, kter\u00e9 rostou o v\u00edce jak 0,5 cm za rok, jsou vysoce rizikov\u00e9. Riziko ruptury v\u0159etenovit\u00e9 v\u00fddut\u011b je mal\u00e9, mnohem vy\u0161\u0161\u00ed sklon k ruptu\u0159e maj\u00ed vakovit\u00e9 v\u00fddut\u011b nebo v\u00fddut\u011b s ulceracemi. Vy\u0161\u0161\u00ed riziko ruptury lze o\u010dek\u00e1vat u hypertonik\u016f a u \u017een.<\/li>\n<li style=\"text-align: justify;\"><em>Symptomatick\u00e1 v\u00fddu\u0165<\/em><br \/>\nSymptomatick\u00e1 v\u00fddu\u0165 vy\u017eaduje okam\u017eit\u00e9 \u0159e\u0161en\u00ed.Jen ve v\u00fdjime\u010dn\u00fdch p\u0159\u00edpadech ob\u011bhov\u011b stabiln\u00edho nemocn\u00e9ho lze akceptovat kr\u00e1tkodobou p\u0159edopera\u010dn\u00ed p\u0159\u00edpravu.<\/li>\n<li style=\"text-align: justify;\"><em>Ruptura v\u00fddut\u011b<\/em><br \/>\nKryt\u00e1 ruptura nebo ruptura v\u00fddut\u011b do voln\u00e9 dutiny b\u0159i\u0161n\u00ed jsou akutn\u00ed stavy, kter\u00e9 vy\u017eaduj\u00ed akutn\u00ed \u0159e\u0161en\u00ed. Stejn\u00fd p\u0159\u00edstup vy\u017eaduj\u00ed ruptury do GIT nebo do doln\u00ed dut\u00e9 \u017e\u00edly.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<table style=\"width: 100%;\" border=\"0\" cellspacing=\"0\" cellpadding=\"0\">\n<tbody>\n<tr>\n<td style=\"border: 1px solid #ffffff;\" colspan=\"6\" align=\"center\" valign=\"top\">\n<h6>Fotogalerie 5b:<br \/>\nAAA, CT ag<\/h6>\n<\/td>\n<\/tr>\n<tr>\n<td style=\"border: 1px solid #ffffff;\" colspan=\"3\" align=\"center\" valign=\"top\">\n<p><div style=\"width: 210px\" class=\"wp-caption alignnone\"><a href=\"https:\/\/eportal.chirurgie.upol.cz\/portal_final\/wp-content\/uploads\/2013\/04\/Image_182.jpg\"><img decoding=\"async\" title=\"AAA p\u0159ech\u00e1zej\u00edc\u00ed na AIC\" alt=\"AAA p\u0159ech\u00e1zej\u00edc\u00ed na AIC\" src=\"https:\/\/eportal.chirurgie.upol.cz\/portal_final\/wp-content\/uploads\/2013\/04\/Image_182.jpg\" width=\"200\" \/><\/a><p class=\"wp-caption-text\">AAA p\u0159ech\u00e1zej\u00edc\u00ed na AIC<\/p><\/div><\/td>\n<td style=\"width: 50%; border: 1px solid #ffffff;\" colspan=\"3\" align=\"center\" valign=\"top\">\n<p><div style=\"width: 210px\" class=\"wp-caption alignnone\"><a href=\"https:\/\/eportal.chirurgie.upol.cz\/portal_final\/wp-content\/uploads\/2013\/04\/Image_181.jpg\"><img decoding=\"async\" title=\"Dtto bo\u010dn\u00ed projekce\" alt=\"Dtto bo\u010dn\u00ed projekce\" src=\"https:\/\/eportal.chirurgie.upol.cz\/portal_final\/wp-content\/uploads\/2013\/04\/Image_181.jpg\" width=\"200\" \/><\/a><p class=\"wp-caption-text\">Dtto bo\u010dn\u00ed projekce<\/p><\/div><\/td>\n<\/tr>\n<tr>\n<td style=\"border: 1px solid #ffffff;\" colspan=\"3\" align=\"center\" valign=\"top\">\n<p><div style=\"width: 210px\" class=\"wp-caption alignnone\"><a href=\"https:\/\/eportal.chirurgie.upol.cz\/portal_final\/wp-content\/uploads\/2013\/04\/Image_184.gif\"><img decoding=\"async\" title=\"Dtto b\u011b\u017en\u00e9 zobrazen\u00ed I.\" alt=\"Dtto b\u011b\u017en\u00e9 zobrazen\u00ed I.\" src=\"https:\/\/eportal.chirurgie.upol.cz\/portal_final\/wp-content\/uploads\/2013\/04\/Image_184.gif\" width=\"200\" \/><\/a><p class=\"wp-caption-text\">Dtto b\u011b\u017en\u00e9 zobrazen\u00ed I.<\/p><\/div><\/td>\n<td style=\"width: 50%; border: 1px solid #ffffff;\" colspan=\"3\" align=\"center\" valign=\"top\">\n<p><div style=\"width: 210px\" class=\"wp-caption alignnone\"><a href=\"https:\/\/eportal.chirurgie.upol.cz\/portal_final\/wp-content\/uploads\/2013\/04\/Image_183.gif\"><img decoding=\"async\" title=\"Dtto b\u011b\u017en\u00e9 zobrazen\u00ed II.\" alt=\"Dtto b\u011b\u017en\u00e9 zobrazen\u00ed II.\" src=\"https:\/\/eportal.chirurgie.upol.cz\/portal_final\/wp-content\/uploads\/2013\/04\/Image_183.gif\" width=\"200\" \/><\/a><p class=\"wp-caption-text\">Dtto b\u011b\u017en\u00e9 zobrazen\u00ed II.<\/p><\/div><\/td>\n<\/tr>\n<tr>\n<td style=\"border: 1px solid #ffffff;\" colspan=\"6\" align=\"center\" valign=\"top\">\n<h6>Fotogalerie 5c:<br \/>\nstentgraft I<\/h6>\n<\/td>\n<\/tr>\n<tr>\n<td style=\"border: 1px solid #ffffff;\" colspan=\"6\" align=\"center\" valign=\"top\"><b>CT ag<\/b><\/td>\n<\/tr>\n<tr>\n<td style=\"border: 1px solid #ffffff;\" colspan=\"2\" align=\"center\" valign=\"top\">\n<p><div style=\"width: 110px\" class=\"wp-caption alignnone\"><a href=\"https:\/\/eportal.chirurgie.upol.cz\/portal_final\/wp-content\/uploads\/2013\/04\/Image_186.jpg\"><img decoding=\"async\" class=\"  \" title=\"A\" alt=\"A\" src=\"https:\/\/eportal.chirurgie.upol.cz\/portal_final\/wp-content\/uploads\/2013\/04\/Image_186.jpg\" width=\"100\" \/><\/a><p class=\"wp-caption-text\">A<\/p><\/div><\/td>\n<td style=\"width: 33%; border: 1px solid #ffffff;\" colspan=\"2\" align=\"center\" valign=\"top\">\n<p><div style=\"width: 110px\" class=\"wp-caption alignnone\"><a href=\"https:\/\/eportal.chirurgie.upol.cz\/portal_final\/wp-content\/uploads\/2013\/04\/Image_188.jpg\"><img decoding=\"async\" class=\"  \" title=\"B\" alt=\"B\" src=\"https:\/\/eportal.chirurgie.upol.cz\/portal_final\/wp-content\/uploads\/2013\/04\/Image_188.jpg\" width=\"100\" \/><\/a><p class=\"wp-caption-text\">B<\/p><\/div><\/td>\n<td style=\"width: 33%; border: 1px solid #ffffff;\" colspan=\"2\" align=\"center\" valign=\"top\">\n<p><div style=\"width: 110px\" class=\"wp-caption alignnone\"><a href=\"https:\/\/eportal.chirurgie.upol.cz\/portal_final\/wp-content\/uploads\/2013\/04\/Image_187.jpg\"><img decoding=\"async\" class=\"  \" title=\"C\" alt=\"C\" src=\"https:\/\/eportal.chirurgie.upol.cz\/portal_final\/wp-content\/uploads\/2013\/04\/Image_187.jpg\" width=\"100\" \/><\/a><p class=\"wp-caption-text\">C<\/p><\/div><\/td>\n<\/tr>\n<tr>\n<td style=\"border: 1px solid #ffffff;\" colspan=\"6\" align=\"center\" valign=\"top\"><b>Zaveden\u00ed stentgraftu<\/b><\/td>\n<\/tr>\n<tr>\n<td style=\"border: 1px solid #ffffff;\" colspan=\"3\" align=\"center\" valign=\"top\"><\/td>\n<td style=\"width: 50%; border: 1px solid #ffffff;\" colspan=\"3\" align=\"center\" valign=\"top\"><\/td>\n<\/tr>\n<tr>\n<td style=\"border: 1px solid #ffffff;\" colspan=\"3\" align=\"center\" valign=\"top\">\n<p><div style=\"width: 210px\" class=\"wp-caption alignnone\"><a href=\"https:\/\/eportal.chirurgie.upol.cz\/portal_final\/wp-content\/uploads\/2013\/04\/Image_191.gif\"><img decoding=\"async\" title=\"A\" alt=\"A\" src=\"https:\/\/eportal.chirurgie.upol.cz\/portal_final\/wp-content\/uploads\/2013\/04\/Image_191.gif\" width=\"200\" \/><\/a><p class=\"wp-caption-text\">A<\/p><\/div><\/td>\n<td style=\"width: 50%; border: 1px solid #ffffff;\" colspan=\"3\" align=\"center\" valign=\"top\">\n<p><div style=\"width: 210px\" class=\"wp-caption alignnone\"><a href=\"https:\/\/eportal.chirurgie.upol.cz\/portal_final\/wp-content\/uploads\/2013\/04\/Image_189.gif\"><img decoding=\"async\" title=\"B\" alt=\"B\" src=\"https:\/\/eportal.chirurgie.upol.cz\/portal_final\/wp-content\/uploads\/2013\/04\/Image_189.gif\" width=\"200\" \/><\/a><p class=\"wp-caption-text\">B<\/p><\/div><\/td>\n<\/tr>\n<tr>\n<td style=\"border: 1px solid #ffffff;\" colspan=\"3\" align=\"center\" valign=\"top\">\n<p><div style=\"width: 210px\" class=\"wp-caption alignnone\"><a href=\"https:\/\/eportal.chirurgie.upol.cz\/portal_final\/wp-content\/uploads\/2013\/04\/Image_192.gif\"><img decoding=\"async\" title=\"C\" alt=\"C\" src=\"https:\/\/eportal.chirurgie.upol.cz\/portal_final\/wp-content\/uploads\/2013\/04\/Image_192.gif\" width=\"200\" \/><\/a><p class=\"wp-caption-text\">C<\/p><\/div><\/td>\n<td style=\"width: 50%; border: 1px solid #ffffff;\" colspan=\"3\" align=\"center\" valign=\"top\">\n<p><div style=\"width: 210px\" class=\"wp-caption alignnone\"><a href=\"https:\/\/eportal.chirurgie.upol.cz\/portal_final\/wp-content\/uploads\/2013\/04\/Image_190.gif\"><img decoding=\"async\" title=\"D\" alt=\"D\" src=\"https:\/\/eportal.chirurgie.upol.cz\/portal_final\/wp-content\/uploads\/2013\/04\/Image_190.gif\" width=\"200\" \/><\/a><p class=\"wp-caption-text\">D<\/p><\/div><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<ul>\n<li><strong>Terapie<\/strong>\n<ul>\n<li style=\"text-align: justify;\"><em>Asymptomatick\u00e1 v\u00fddu\u0165<\/em><br \/>\nZ\u00e1kladn\u00edm krit\u00e9riem p\u0159i \u0159e\u0161en\u00ed asymptomatick\u00e9 v\u00fddut\u011b b\u0159i\u0161n\u00ed aorty je riziko ruptury v korelaci s p\u0159edpokl\u00e1danou d\u00e9lkou \u017eivota. Dal\u0161\u00edm faktorem je mortalita spojen\u00e1 s v\u00fdkonem. Rizikov\u011bj\u0161\u00ed jsou v\u00fddut\u011b p\u00e1nevn\u00edch tepen, proto je indikace k jejich \u0159e\u0161en\u00ed d\u00e1na pr\u016fm\u011brem v\u00fddut\u011b 3 cm. Letalita opera\u010dn\u00edho \u0159e\u0161en\u00ed by m\u011bla b\u00fdt pod 5%,p\u0159i endovaskul\u00e1rn\u00edm o\u0161et\u0159en\u00ed v\u00fddut\u011b pod 2%.K o\u0161et\u0159en\u00ed asymptomatick\u00e9 v\u00fddut\u011b jsou v sou\u010dasn\u00e9 dob\u011b k dispozici dv\u011b stejn\u011b hodnotn\u00e9 metody.<\/li>\n<li style=\"text-align: justify;\"><em>Opera\u010dn\u00ed \u0159e\u0161en\u00ed \u2013 chirugick\u00e9<\/em><br \/>\nChirurgick\u00e9 o\u0161et\u0159en\u00ed je z technick\u00e9ho hlediska prakticky v\u017edy mo\u017en\u00e9. V\u00fddu\u0165 je resekov\u00e1na a nahrazena tub\u00e1rn\u00ed prot\u00e9zou (70%) (fotogalerie 5a + d) nebo je n\u00e1hrada provedena Y prot\u00e9zou (30%). P\u0159i nutnosti implantovat ram\u00e9nka Y prot\u00e9zy do femor\u00e1ln\u00edho \u0159e\u010di\u0161t\u011b v t\u0159\u00edsle nar\u016fst\u00e1 riziko p\u0159edev\u0161\u00edm infek\u010dn\u00edch komplikac\u00ed, kter\u00e9 vypl\u00fdvaj\u00ed z anatomie t\u0159\u00edsla.Chirurgick\u00e9 o\u0161et\u0159en\u00ed v\u00fddut\u011b p\u00e1nevn\u00ed arterie je technicky slo\u017eit\u011bj\u0161\u00ed. Je snahou zachovat prokrven\u00ed vnit\u0159n\u00ed p\u00e1nevn\u00ed tepny.<\/li>\n<li style=\"text-align: justify;\"><em>Endovaskul\u00e1rn\u00ed l\u00e9\u010dba \u2013 stentgraft, EVAR<\/em><br \/>\nMo\u017enost endovaskul\u00e1rn\u00edho o\u0161et\u0159en\u00ed infraren\u00e1ln\u00ed v\u00fddut\u011b je d\u00e1na anatomi\u00ed v\u00fddut\u011b, a nen\u00ed tedy u v\u0161ech nemocn\u00fdch mo\u017en\u00e1. Ukotven\u00ed stentgraftu vy\u017eaduje p\u0159\u00edstupn\u00fd kr\u010dek v\u00fddut\u011b. Jeho doporu\u010den\u00e1 d\u00e9lka je 15 mm a jeho \u0161\u00ed\u0159e nem\u016f\u017ee b\u00fdt v\u011bt\u0161\u00ed ne\u017e 32 mm. Dal\u0161\u00edm po\u017eadavkem je kvalitn\u00ed st\u011bna aorty bez v\u011bt\u0161\u00edch sklerotick\u00fdch zm\u011bn a bez v\u00fdrazn\u011bj\u0161\u00edho zalomen\u00ed kr\u010dku. Dist\u00e1ln\u00ed z\u00f3na (na p\u00e1nevn\u00edm \u0159e\u010di\u0161ti) k ukotven\u00ed by nem\u011bla p\u0159ekro\u010dit \u0161\u00ed\u0159i 20 mm a jej\u00ed d\u00e9lka by m\u011bla b\u00fdt nejm\u00e9n\u011b 30 mm. Je t\u0159eba zajistit prokrven\u00ed vnit\u0159n\u00edch p\u00e1nevn\u00edch tepen.P\u0159\u00edstup do arteri\u00e1ln\u00edho \u0159e\u010di\u0161t\u011b vy\u017eaduje 8mm kalibr femor\u00e1ln\u00edch arteri\u00ed, p\u00e1nevn\u00ed \u0159e\u010di\u0161t\u011b by nem\u011blo b\u00fdt vinut\u00e9 a v\u00fdrazn\u011b kalcifikovan\u00e9.V endovaskul\u00e1rn\u00ed l\u00e9\u010db\u011b v\u00fddut\u00ed b\u0159i\u0161n\u00ed aorty a p\u00e1nevn\u00edho \u0159e\u010di\u0161t\u011b jsou v sou\u010dasn\u00e9m dob\u011b k dispozici dv\u011b dal\u0161\u00ed metody. Tzv. hybridn\u00ed v\u00fdkony p\u0159edstavuj\u00ed kombinaci endovaskul\u00e1rn\u00edho a chirurgick\u00e9ho v\u00fdkonu (nap\u0159. chirurgick\u00e1 revaskularizace vnit\u0159n\u00ed p\u00e1nevn\u00ed tepny p\u0159i implantaci stentgraftu). Druhou metodu p\u0159estavuj\u00ed speci\u00e1ln\u011b na m\u00edru vyroben\u00e9 fenestrovan\u00e9 stentgrafty, kter\u00e9 jsou indikov\u00e1ny k o\u0161et\u0159en\u00ed v\u00fddut\u00ed, ze kter\u00fdch odstupuj\u00ed ren\u00e1ln\u00ed arterie. Jedn\u00e1 se o vysoce specializovan\u00e9 v\u00fdkony prov\u00e1d\u011bn\u00e9 jen v n\u011bkter\u00fdch centrech. Mo\u017enosti klasick\u00e9 chirurgie a sou\u010dasn\u00e9 hybridn\u00ed v\u00fdkony jsou z\u0159ejm\u00e9 z fotogalerie 5c, 5e. U nemocn\u00e9ho byla p\u016fvodn\u011b pro obliteraci aorty a spole\u010dn\u00fdch ilik provedena n\u00e1hrada aortobiilick\u00e1 (bifurka\u010dn\u00ed prot\u00e9za). V n\u00e1sledn\u00e9m n\u011bkolikalet\u00e9m obdob\u00ed vznikly na p\u016fvodn\u00edm zevn\u00edm ilick\u00e9m \u0159e\u010di\u0161ti v\u00fddut\u011b. V\u00fddu\u0165 vpravo se stala symptomatickou krv\u00e1cen\u00edm p\u0159i antikoagula\u010dn\u00ed terapii pro srde\u010dn\u00ed arytmii. Stav byl vy\u0159e\u0161en zaveden\u00edm stentgraftu do prav\u00e9ho ram\u00e9nka prot\u00e9zy, p\u0159ekryl v\u00fddu\u0165 a doln\u00edm okrajem byl ukotven do arterie pod v\u00fddut\u00ed (AIE).<\/li>\n<li style=\"text-align: justify;\"><em>Symptomatick\u00e1 v\u00fddu\u0165<\/em><br \/>\nPro terapii symptomatick\u00fdch v\u00fddut\u00ed plat\u00ed v\u00fd\u0161euveden\u00e1 pravidla. Z\u00e1sadn\u00ed je neodkladn\u00e9 proveden\u00ed v\u00fdkonu.<\/li>\n<li style=\"text-align: justify;\"><em>Kryt\u00e1 ruptura v\u00fddut\u011b<\/em><br \/>\nJak\u00e1koliv \u010dasov\u00e1 prodleva zhor\u0161uje progn\u00f3zu nemocn\u00e9ho. Ke stanoven\u00ed diagn\u00f3zy je nejvhodn\u011bj\u0161\u00ed CT do\u0161et\u0159en\u00ed. Snaha stabilizovat nemocn\u00e9ho do normotenze nen\u00ed prakticky mo\u017en\u00e1 a je t\u0159eba ji pova\u017eovat za chybn\u00fd postup. Je nutn\u00e9 rychl\u00e9 opera\u010dn\u00ed \u0159e\u0161en\u00ed, prakticky v\u017edy je mo\u017en\u00e9 chirurgick\u00e9 \u0159e\u0161en\u00ed. P\u0159i vhodn\u00e9 anatomii v\u00fddut\u011b a p\u0159i adekv\u00e1tn\u00edm vybaven\u00ed pracovi\u0161t\u011b je stejn\u011b kvalitn\u00ed l\u00e9\u010dba endovaskul\u00e1rn\u00ed. V pr\u016fb\u011bhu kardiopulmon\u00e1ln\u00ed resuscitace nen\u00ed opera\u010dn\u00ed v\u00fdkon indikov\u00e1n.<\/li>\n<\/ul>\n<\/li>\n<li style=\"text-align: justify;\"><strong>N\u00e1sledn\u00e1 p\u00e9\u010de<\/strong>\n<ul>\n<li style=\"text-align: justify;\"><em>Opera\u010dn\u00ed \u0159e\u0161en\u00ed<\/em><br \/>\nV poopera\u010dn\u00edm obdob\u00ed po chirurgick\u00e9m \u0159e\u0161en\u00ed AAA se mohou jako \u010dasn\u00e9 komplikace vyskytnout krv\u00e1cen\u00ed (3%), trombembolick\u00e9 perifern\u00ed uz\u00e1v\u011bry (1%), kolorekt\u00e1ln\u00ed ischemie (1%), ren\u00e1ln\u00ed komplikace (1%) a funk\u010dn\u00ed poruchy CNS (1%). Vz\u00e1cn\u011b se vyskytuje poran\u011bn\u00ed mo\u010dovodu nebo p\u00e1nevn\u00edch \u017eil s jejich n\u00e1slednou tromb\u00f3zou. \u010cast\u00e9 (60%) jsou poruchy potence. V dal\u0161\u00ed poopera\u010dn\u00edm pr\u016fb\u011bhu se lze setkat s uz\u00e1v\u011bry ram\u00e9nka prot\u00e9zy (3%), poruchami hojen\u00ed r\u00e1ny (3%) a k\u00fdlami v jizv\u011b (16%).<\/li>\n<li style=\"text-align: justify;\"><em>Endovaskul\u00e1rn\u00ed l\u00e9\u010dba<\/em><br \/>\nKomplikace jsou sv\u00fdm charakterem a rozsahem podobn\u00e9 jako u l\u00e9\u010dby chirurgick\u00e9. V\u00fdskyt poruch potence je ni\u017e\u0161\u00ed (30%). P\u0159istupuj\u00ed v\u0161ak probl\u00e9my vypl\u00fdvaj\u00edc\u00ed z metody. Je mo\u017en\u00e1 migrace stentgraft u (5%) a uz\u00e1v\u011br ram\u00e9nka (6%). V\u00fdskyt endoleaku se popisuje v 8\u201335%. Endoleak v m\u00edst\u011b ukotven\u00ed stentgraft u nebo v m\u00edst\u011b spojen\u00ed \u010d\u00e1st\u00ed stentgraft u (Typ I a III) vy\u017eaduje o\u0161et\u0159en\u00ed. Dojdeli po endovaskul\u00e1rn\u00ed l\u00e9\u010db\u011b k r\u016fstu v\u00fddut\u011b (endotenze, kdy nen\u00ed prok\u00e1z\u00e1n leak), je nutn\u00e1 pravideln\u00e1 kontrola a z\u00e1krok, nap\u0159. punkce vaku v\u00fddut\u011b Endovaskul\u00e1rn\u00ed terapii se pln\u011b v\u011bnuje samostatn\u00e1 kapitola.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<table style=\"width: 100%;\" border=\"0\" cellspacing=\"0\" cellpadding=\"0\">\n<tbody>\n<tr>\n<td style=\"width: 50%; border: 1px solid #ffffff;\" colspan=\"3\" align=\"center\" valign=\"top\">\n<h6>Fotogalerie 5d:<br \/>\naaact ag + operace<\/h6>\n<\/td>\n<\/tr>\n<tr>\n<td style=\"width: 50%; border: 1px solid #ffffff;\" colspan=\"3\" align=\"center\" valign=\"top\"><b>Aneuryzma AA, CT ag<\/b><\/td>\n<\/tr>\n<tr>\n<td style=\"border: 1px solid #ffffff;\" align=\"center\" valign=\"top\">\n<p><div style=\"width: 110px\" class=\"wp-caption alignnone\"><a href=\"https:\/\/eportal.chirurgie.upol.cz\/portal_final\/wp-content\/uploads\/2013\/04\/Image_197.gif\"><img decoding=\"async\" class=\" \" title=\"A\" alt=\"A\" src=\"https:\/\/eportal.chirurgie.upol.cz\/portal_final\/wp-content\/uploads\/2013\/04\/Image_197.gif\" width=\"100\" \/><\/a><p class=\"wp-caption-text\">A<\/p><\/div><\/td>\n<td style=\"width: 33%; border: 1px solid #ffffff;\" align=\"center\" valign=\"top\">\n<p><div style=\"width: 110px\" class=\"wp-caption alignnone\"><a href=\"https:\/\/eportal.chirurgie.upol.cz\/portal_final\/wp-content\/uploads\/2013\/04\/Image_196.gif\"><img decoding=\"async\" class=\" \" title=\"B\" alt=\"B\" src=\"https:\/\/eportal.chirurgie.upol.cz\/portal_final\/wp-content\/uploads\/2013\/04\/Image_196.gif\" width=\"100\" \/><\/a><p class=\"wp-caption-text\">B<\/p><\/div><\/td>\n<td style=\"width: 33%; border: 1px solid #ffffff;\" align=\"center\" valign=\"top\">\n<p><div style=\"width: 110px\" class=\"wp-caption alignnone\"><a href=\"https:\/\/eportal.chirurgie.upol.cz\/portal_final\/wp-content\/uploads\/2013\/04\/Image_195.jpg\"><img decoding=\"async\" class=\" \" title=\"C\" alt=\"C\" src=\"https:\/\/eportal.chirurgie.upol.cz\/portal_final\/wp-content\/uploads\/2013\/04\/Image_195.jpg\" width=\"100\" \/><\/a><p class=\"wp-caption-text\">C<\/p><\/div><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<table style=\"width: 100%;\" border=\"0\" cellspacing=\"0\" cellpadding=\"0\">\n<tbody>\n<tr>\n<td style=\"width: 50%; border: 1px solid #ffffff;\" colspan=\"2\" align=\"center\" valign=\"top\"><strong>N\u00e1hrada aortoaort\u00e1ln\u00ed<\/strong><\/td>\n<\/tr>\n<tr>\n<td style=\"border: 1px solid #ffffff;\" align=\"center\" valign=\"top\">\n<p><div style=\"width: 210px\" class=\"wp-caption alignnone\"><a href=\"https:\/\/eportal.chirurgie.upol.cz\/portal_final\/wp-content\/uploads\/2013\/04\/Image_199.png\"><img decoding=\"async\" title=\"Preparace v\u00fddut\u011b\" alt=\"Preparace v\u00fddut\u011b\" src=\"https:\/\/eportal.chirurgie.upol.cz\/portal_final\/wp-content\/uploads\/2013\/04\/Image_199.png\" width=\"200\" \/><\/a><p class=\"wp-caption-text\">Preparace v\u00fddut\u011b<\/p><\/div><\/td>\n<td style=\"width: 50%; border: 1px solid #ffffff;\" align=\"center\" valign=\"top\">\n<p><div style=\"width: 210px\" class=\"wp-caption alignnone\"><a href=\"https:\/\/eportal.chirurgie.upol.cz\/portal_final\/wp-content\/uploads\/2013\/04\/Image_198.png\"><img decoding=\"async\" title=\"Otev\u0159en\u00ed v\u00fddut\u011b, trombus\" alt=\"Otev\u0159en\u00ed v\u00fddut\u011b, trombus\" src=\"https:\/\/eportal.chirurgie.upol.cz\/portal_final\/wp-content\/uploads\/2013\/04\/Image_198.png\" width=\"200\" \/><\/a><p class=\"wp-caption-text\">Otev\u0159en\u00ed v\u00fddut\u011b, trombus<\/p><\/div><\/td>\n<\/tr>\n<tr>\n<td style=\"border: 1px solid #ffffff;\" align=\"center\" valign=\"top\">\n<p><div style=\"width: 210px\" class=\"wp-caption alignnone\"><a href=\"https:\/\/eportal.chirurgie.upol.cz\/portal_final\/wp-content\/uploads\/2013\/04\/Image_201.png\"><img decoding=\"async\" title=\"Trombus\" alt=\"Trombus\" src=\"https:\/\/eportal.chirurgie.upol.cz\/portal_final\/wp-content\/uploads\/2013\/04\/Image_201.png\" width=\"200\" \/><\/a><p class=\"wp-caption-text\">Trombus<\/p><\/div><\/td>\n<td style=\"width: 50%; border: 1px solid #ffffff;\" align=\"center\" valign=\"top\">\n<p><div style=\"width: 210px\" class=\"wp-caption alignnone\"><a href=\"https:\/\/eportal.chirurgie.upol.cz\/portal_final\/wp-content\/uploads\/2013\/04\/Image_200.png\"><img decoding=\"async\" title=\"Vyjmut\u00fd trombus\" alt=\"Vyjmut\u00fd trombus\" src=\"https:\/\/eportal.chirurgie.upol.cz\/portal_final\/wp-content\/uploads\/2013\/04\/Image_200.png\" width=\"200\" \/><\/a><p class=\"wp-caption-text\">Vyjmut\u00fd trombus<\/p><\/div><\/td>\n<\/tr>\n<tr>\n<td style=\"border: 1px solid #ffffff;\" colspan=\"2\" align=\"center\" valign=\"top\"><\/td>\n<\/tr>\n<tr>\n<td style=\"border: 1px solid #ffffff;\" align=\"center\" valign=\"top\">\n<p><div style=\"width: 210px\" class=\"wp-caption alignnone\"><a href=\"https:\/\/eportal.chirurgie.upol.cz\/portal_final\/wp-content\/uploads\/2013\/04\/Image_203.png\"><img decoding=\"async\" title=\"Vak v\u00fddut\u011b\" alt=\"Vak v\u00fddut\u011b\" src=\"https:\/\/eportal.chirurgie.upol.cz\/portal_final\/wp-content\/uploads\/2013\/04\/Image_203.png\" width=\"200\" \/><\/a><p class=\"wp-caption-text\">Vak v\u00fddut\u011b<\/p><\/div><\/td>\n<td style=\"width: 50%; border: 1px solid #ffffff;\" align=\"center\" valign=\"top\">\n<p><div style=\"width: 210px\" class=\"wp-caption alignnone\"><a href=\"https:\/\/eportal.chirurgie.upol.cz\/portal_final\/wp-content\/uploads\/2013\/04\/Image_207.png\"><img decoding=\"async\" title=\"Tub\u00e1rn\u00ed c\u00e9vn\u00ed prot\u00e9za\" alt=\"Tub\u00e1rn\u00ed c\u00e9vn\u00ed prot\u00e9za\" src=\"https:\/\/eportal.chirurgie.upol.cz\/portal_final\/wp-content\/uploads\/2013\/04\/Image_207.png\" width=\"200\" \/><\/a><p class=\"wp-caption-text\">Tub\u00e1rn\u00ed c\u00e9vn\u00ed prot\u00e9za<\/p><\/div><\/td>\n<\/tr>\n<tr>\n<td style=\"border: 1px solid #ffffff;\" align=\"center\" valign=\"top\">\n<p><div style=\"width: 210px\" class=\"wp-caption alignnone\"><a href=\"https:\/\/eportal.chirurgie.upol.cz\/portal_final\/wp-content\/uploads\/2013\/04\/Image_204.png\"><img decoding=\"async\" title=\"Proxim\u00e1ln\u00ed anastom\u00f3za I.\" alt=\"Proxim\u00e1ln\u00ed anastom\u00f3za I.\" src=\"https:\/\/eportal.chirurgie.upol.cz\/portal_final\/wp-content\/uploads\/2013\/04\/Image_204.png\" width=\"200\" \/><\/a><p class=\"wp-caption-text\">Proxim\u00e1ln\u00ed anastom\u00f3za I.<\/p><\/div><\/td>\n<td style=\"width: 50%; border: 1px solid #ffffff;\" align=\"center\" valign=\"top\">\n<p><div style=\"width: 210px\" class=\"wp-caption alignnone\"><a href=\"https:\/\/eportal.chirurgie.upol.cz\/portal_final\/wp-content\/uploads\/2013\/04\/Image_208.png\"><img decoding=\"async\" title=\"Proxim\u00e1ln\u00ed anastom\u00f3za II.\" alt=\"Proxim\u00e1ln\u00ed anastom\u00f3za II.\" src=\"https:\/\/eportal.chirurgie.upol.cz\/portal_final\/wp-content\/uploads\/2013\/04\/Image_208.png\" width=\"200\" \/><\/a><p class=\"wp-caption-text\">Proxim\u00e1ln\u00ed anastom\u00f3za II.<\/p><\/div><\/td>\n<\/tr>\n<tr>\n<td style=\"border: 1px solid #ffffff;\" align=\"center\" valign=\"top\">\n<p><div style=\"width: 210px\" class=\"wp-caption alignnone\"><a href=\"https:\/\/eportal.chirurgie.upol.cz\/portal_final\/wp-content\/uploads\/2013\/04\/Image_205.png\"><img decoding=\"async\" title=\"Proxim\u00e1ln\u00ed anastom\u00f3za III. Kontrola\" alt=\"Proxim\u00e1ln\u00ed anastom\u00f3za III. Kontrola\" src=\"https:\/\/eportal.chirurgie.upol.cz\/portal_final\/wp-content\/uploads\/2013\/04\/Image_205.png\" width=\"200\" \/><\/a><p class=\"wp-caption-text\">Proxim\u00e1ln\u00ed anastom\u00f3za III.<br \/>Kontrola<\/p><\/div><\/td>\n<td style=\"width: 50%; border: 1px solid #ffffff;\" align=\"center\" valign=\"top\">\n<p><div style=\"width: 210px\" class=\"wp-caption alignnone\"><a href=\"https:\/\/eportal.chirurgie.upol.cz\/portal_final\/wp-content\/uploads\/2013\/04\/Image_209.png\"><img decoding=\"async\" title=\"Ukon\u010den\u00ed proxim\u00e1ln\u00ed anastom\u00f3zy\" alt=\"Ukon\u010den\u00ed proxim\u00e1ln\u00ed anastom\u00f3zy\" src=\"https:\/\/eportal.chirurgie.upol.cz\/portal_final\/wp-content\/uploads\/2013\/04\/Image_209.png\" width=\"200\" \/><\/a><p class=\"wp-caption-text\">Ukon\u010den\u00ed proxim\u00e1ln\u00ed anastom\u00f3zy<\/p><\/div><\/td>\n<\/tr>\n<tr>\n<td style=\"border: 1px solid #ffffff;\" align=\"center\" valign=\"top\">\n<p><div style=\"width: 210px\" class=\"wp-caption alignnone\"><a href=\"https:\/\/eportal.chirurgie.upol.cz\/portal_final\/wp-content\/uploads\/2013\/04\/Image_206.png\"><img decoding=\"async\" title=\"Kontrola t\u011bsnosti proxim\u00e1ln\u00ed anastom\u00f3zy\" alt=\"Kontrola t\u011bsnosti proxim\u00e1ln\u00ed anastom\u00f3zy\" src=\"https:\/\/eportal.chirurgie.upol.cz\/portal_final\/wp-content\/uploads\/2013\/04\/Image_206.png\" width=\"200\" \/><\/a><p class=\"wp-caption-text\">Kontrola t\u011bsnosti proxim\u00e1ln\u00ed anastom\u00f3zy<\/p><\/div><\/td>\n<td style=\"width: 50%; border: 1px solid #ffffff;\" align=\"center\" valign=\"top\">\n<p><div style=\"width: 210px\" class=\"wp-caption alignnone\"><a href=\"https:\/\/eportal.chirurgie.upol.cz\/portal_final\/wp-content\/uploads\/2013\/04\/Image_210.png\"><img decoding=\"async\" title=\"\u0160it\u00ed dist\u00e1ln\u00ed anastom\u00f3zy, lev\u00e1 ilick\u00e1 arterie uzav\u0159en\u00e1 okluzn\u00edm kat\u00e9trem\" alt=\"\u0160it\u00ed dist\u00e1ln\u00ed anastom\u00f3zy, lev\u00e1 ilick\u00e1 arterie uzav\u0159en\u00e1 okluzn\u00edm kat\u00e9trem\" src=\"https:\/\/eportal.chirurgie.upol.cz\/portal_final\/wp-content\/uploads\/2013\/04\/Image_210.png\" width=\"200\" \/><\/a><p class=\"wp-caption-text\">\u0160it\u00ed dist\u00e1ln\u00ed anastom\u00f3zy, lev\u00e1 ilick\u00e1 arterie uzav\u0159en\u00e1 okluzn\u00edm<br \/>kat\u00e9trem<\/p><\/div><\/td>\n<\/tr>\n<tr>\n<td style=\"border: 1px solid #ffffff;\" align=\"center\" valign=\"top\">\n<p><div style=\"width: 210px\" class=\"wp-caption alignnone\"><a href=\"https:\/\/eportal.chirurgie.upol.cz\/portal_final\/wp-content\/uploads\/2013\/04\/Image_213.jpg\"><img decoding=\"async\" title=\"Ukon\u010den\u00e1 dist\u00e1ln\u00ed anastom\u00f3za\" alt=\"Ukon\u010den\u00e1 dist\u00e1ln\u00ed anastom\u00f3za\" src=\"https:\/\/eportal.chirurgie.upol.cz\/portal_final\/wp-content\/uploads\/2013\/04\/Image_213.jpg\" width=\"200\" \/><\/a><p class=\"wp-caption-text\">Ukon\u010den\u00e1 dist\u00e1ln\u00ed anastom\u00f3za<\/p><\/div><\/td>\n<td style=\"width: 50%; border: 1px solid #ffffff;\" align=\"center\" valign=\"top\">\n<p><div style=\"width: 210px\" class=\"wp-caption alignnone\"><a href=\"https:\/\/eportal.chirurgie.upol.cz\/portal_final\/wp-content\/uploads\/2013\/04\/Image_212.jpg\"><img decoding=\"async\" title=\"P\u0159e\u0161it\u00ed prot\u00e9zy vakem v\u00fddut\u011b\" alt=\"P\u0159e\u0161it\u00ed prot\u00e9zy vakem v\u00fddut\u011b\" src=\"https:\/\/eportal.chirurgie.upol.cz\/portal_final\/wp-content\/uploads\/2013\/04\/Image_212.jpg\" width=\"200\" \/><\/a><p class=\"wp-caption-text\">P\u0159e\u0161it\u00ed prot\u00e9zy vakem v\u00fddut\u011b<\/p><\/div><\/td>\n<\/tr>\n<tr>\n<td style=\"border: 1px solid #ffffff;\" colspan=\"2\" align=\"center\" valign=\"top\">\n<p><div style=\"width: 210px\" class=\"wp-caption alignnone\"><a href=\"https:\/\/eportal.chirurgie.upol.cz\/portal_final\/wp-content\/uploads\/2013\/04\/Image_214.gif\"><img decoding=\"async\" title=\"Ag, tub\u00e1rn\u00ed aort\u00e1ln\u00ed n\u00e1hrada\" alt=\"Ag, tub\u00e1rn\u00ed aort\u00e1ln\u00ed n\u00e1hrada\" src=\"https:\/\/eportal.chirurgie.upol.cz\/portal_final\/wp-content\/uploads\/2013\/04\/Image_214.gif\" width=\"200\" \/><\/a><p class=\"wp-caption-text\">Ag, tub\u00e1rn\u00ed aort\u00e1ln\u00ed n\u00e1hrada<\/p><\/div><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>V dal\u0161\u00ed poopera\u010dn\u00edm pr\u016fb\u011bhu se lze setkat s uz\u00e1v\u011bry ram\u00e9nka prot\u00e9zy (3%), poruchami hojen\u00ed r\u00e1ny (3%) a k\u00fdlami v jizv\u011b (16%).<\/p>\n<p>0 Endovaskul\u00e1rn\u00ed l\u00e9\u010dba<\/p>\n<p>Komplikace jsou sv\u00fdm charakterem a rozsahem podobn\u00e9 jako u l\u00e9\u010dby chirurgick\u00e9. V\u00fdskyt poruch potence je ni\u017e\u0161\u00ed (30%). P\u0159istupuj\u00ed v\u0161ak probl\u00e9my vypl\u00fdvaj\u00edc\u00ed z metody. Je mo\u017en\u00e1 migrace stentgraftu (5%) a uz\u00e1v\u011br ram\u00e9nka (6%). V\u00fdskyt endoleaku se popisuje v 8\u201335%. Endoleakv m\u00edst\u011b ukotven\u00ed stentgraftu nebo v m\u00edst\u011b spojen\u00ed \u010d\u00e1st\u00ed stentgraftu (Typ I a III) vy\u017eaduje o\u0161et\u0159en\u00ed. Dojde-li po endovaskul\u00e1rn\u00ed l\u00e9\u010db\u011b k r\u016fstu v\u00fddut\u011b (endotenze, kdy nen\u00ed prok\u00e1z\u00e1n leak), je nutn\u00e1 pravideln\u00e1 kontrola a z\u00e1krok, nap\u0159. punkce vaku v\u00fddut\u011b Endovaskul\u00e1rn\u00ed terapii se pln\u011b v\u011bnuje samostatn\u00e1 kapitola.<\/p>\n<table style=\"width: 100%;\" border=\"0\" cellspacing=\"0\" cellpadding=\"0\">\n<tbody>\n<tr>\n<td style=\"border: 1px solid #ffffff;\" colspan=\"2\" align=\"center\" valign=\"top\">\n<h6>Fotogalerie Se:<br \/>\njuxtaren\u00e1ln\u00ed stentgraft CTag<\/h6>\n<\/td>\n<\/tr>\n<tr>\n<td style=\"border: 1px solid #ffffff;\" align=\"center\" valign=\"top\">\n<p><div style=\"width: 210px\" class=\"wp-caption alignnone\"><a href=\"https:\/\/eportal.chirurgie.upol.cz\/portal_final\/wp-content\/uploads\/2013\/04\/Image_218.jpg\"><img decoding=\"async\" title=\"A\" alt=\"A\" src=\"https:\/\/eportal.chirurgie.upol.cz\/portal_final\/wp-content\/uploads\/2013\/04\/Image_218.jpg\" width=\"200\" \/><\/a><p class=\"wp-caption-text\">A<\/p><\/div><\/td>\n<td style=\"width: 50%; border: 1px solid #ffffff;\" align=\"center\" valign=\"top\">\n<p><div id=\"attachment_2167\" style=\"width: 210px\" class=\"wp-caption alignnone\"><a href=\"https:\/\/eportal.chirurgie.upol.cz\/portal_final\/wp-content\/uploads\/2013\/04\/Image_216.jpg\"><img decoding=\"async\" aria-describedby=\"caption-attachment-2167\" class=\" wp-image-2167\" title=\"B\" alt=\"B\" src=\"https:\/\/eportal.chirurgie.upol.cz\/portal_final\/wp-content\/uploads\/2013\/04\/Image_216.jpg\" width=\"200\" srcset=\"https:\/\/eportal.chirurgie.upol.cz\/portal_final\/wp-content\/uploads\/2013\/04\/Image_216.jpg 308w, https:\/\/eportal.chirurgie.upol.cz\/portal_final\/wp-content\/uploads\/2013\/04\/Image_216-300x291.jpg 300w\" sizes=\"(max-width: 308px) 100vw, 308px\" \/><\/a><p id=\"caption-attachment-2167\" class=\"wp-caption-text\">B<\/p><\/div><\/td>\n<\/tr>\n<tr>\n<td style=\"border: 1px solid #ffffff;\" align=\"center\" valign=\"top\">\n<p><div style=\"width: 210px\" class=\"wp-caption alignnone\"><a href=\"https:\/\/eportal.chirurgie.upol.cz\/portal_final\/wp-content\/uploads\/2013\/04\/Image_219.jpg\"><img decoding=\"async\" title=\"C\" alt=\"C\" src=\"https:\/\/eportal.chirurgie.upol.cz\/portal_final\/wp-content\/uploads\/2013\/04\/Image_219.jpg\" width=\"200\" \/><\/a><p class=\"wp-caption-text\">C<\/p><\/div><\/td>\n<td style=\"width: 50%; border: 1px solid #ffffff;\" align=\"center\" valign=\"top\">\n<p><div style=\"width: 210px\" class=\"wp-caption alignnone\"><a href=\"https:\/\/eportal.chirurgie.upol.cz\/portal_final\/wp-content\/uploads\/2013\/04\/Image_217.jpg\"><img decoding=\"async\" title=\"D\" alt=\"D\" src=\"https:\/\/eportal.chirurgie.upol.cz\/portal_final\/wp-content\/uploads\/2013\/04\/Image_217.jpg\" width=\"200\" \/><\/a><p class=\"wp-caption-text\">D<\/p><\/div><\/td>\n<\/tr>\n<tr>\n<td style=\"border: 1px solid #ffffff;\" colspan=\"2\" align=\"center\" valign=\"top\">\n<p><div style=\"width: 210px\" class=\"wp-caption alignnone\"><a href=\"https:\/\/eportal.chirurgie.upol.cz\/portal_final\/wp-content\/uploads\/2013\/04\/Image_220.jpg\"><img decoding=\"async\" title=\"E\" alt=\"E\" src=\"https:\/\/eportal.chirurgie.upol.cz\/portal_final\/wp-content\/uploads\/2013\/04\/Image_220.jpg\" width=\"200\" \/><\/a><p class=\"wp-caption-text\">E<\/p><\/div><\/td>\n<\/tr>\n<tr>\n<td style=\"border: 1px solid #ffffff;\" colspan=\"2\" align=\"center\" valign=\"top\"><strong>Endovaskul\u00e1rn\u00ed l\u00e9\u010dba + cross over bypass<\/strong><\/td>\n<\/tr>\n<tr>\n<td style=\"border: 1px solid #ffffff;\" align=\"center\" valign=\"top\">\n<p><div style=\"width: 210px\" class=\"wp-caption alignnone\"><a href=\"https:\/\/eportal.chirurgie.upol.cz\/portal_final\/wp-content\/uploads\/2013\/04\/Image_225.jpg\"><img decoding=\"async\" title=\"A\" alt=\"A\" src=\"https:\/\/eportal.chirurgie.upol.cz\/portal_final\/wp-content\/uploads\/2013\/04\/Image_225.jpg\" width=\"200\" \/><\/a><p class=\"wp-caption-text\">A<\/p><\/div><\/td>\n<td style=\"width: 50%; border: 1px solid #ffffff;\" align=\"center\" valign=\"top\">\n<p><div style=\"width: 210px\" class=\"wp-caption alignnone\"><a href=\"https:\/\/eportal.chirurgie.upol.cz\/portal_final\/wp-content\/uploads\/2013\/04\/Image_222.jpg\"><img decoding=\"async\" title=\"B\" alt=\"B\" src=\"https:\/\/eportal.chirurgie.upol.cz\/portal_final\/wp-content\/uploads\/2013\/04\/Image_222.jpg\" width=\"200\" \/><\/a><p class=\"wp-caption-text\">B<\/p><\/div><\/td>\n<\/tr>\n<tr>\n<td style=\"border: 1px solid #ffffff;\" align=\"center\" valign=\"top\">\n<p><div style=\"width: 210px\" class=\"wp-caption alignnone\"><a href=\"https:\/\/eportal.chirurgie.upol.cz\/portal_final\/wp-content\/uploads\/2013\/04\/Image_226.jpg\"><img decoding=\"async\" title=\"C\" alt=\"C\" src=\"https:\/\/eportal.chirurgie.upol.cz\/portal_final\/wp-content\/uploads\/2013\/04\/Image_226.jpg\" width=\"200\" \/><\/a><p class=\"wp-caption-text\">C<\/p><\/div><\/td>\n<td style=\"width: 50%; border: 1px solid #ffffff;\" align=\"center\" valign=\"top\">\n<p><div style=\"width: 210px\" class=\"wp-caption alignnone\"><a href=\"https:\/\/eportal.chirurgie.upol.cz\/portal_final\/wp-content\/uploads\/2013\/04\/Image_223.jpg\"><img decoding=\"async\" title=\"D\" alt=\"D\" src=\"https:\/\/eportal.chirurgie.upol.cz\/portal_final\/wp-content\/uploads\/2013\/04\/Image_223.jpg\" width=\"200\" \/><\/a><p class=\"wp-caption-text\">D<\/p><\/div><\/td>\n<\/tr>\n<tr>\n<td style=\"border: 1px solid #ffffff;\" align=\"center\" valign=\"top\">\n<p><div style=\"width: 210px\" class=\"wp-caption alignnone\"><a href=\"https:\/\/eportal.chirurgie.upol.cz\/portal_final\/wp-content\/uploads\/2013\/04\/Image_227.jpg\"><img decoding=\"async\" title=\"E\" alt=\"E\" src=\"https:\/\/eportal.chirurgie.upol.cz\/portal_final\/wp-content\/uploads\/2013\/04\/Image_227.jpg\" width=\"200\" \/><\/a><p class=\"wp-caption-text\">E<\/p><\/div><\/td>\n<td style=\"width: 50%; border: 1px solid #ffffff;\" align=\"center\" valign=\"top\">\n<p><div style=\"width: 210px\" class=\"wp-caption alignnone\"><a href=\"https:\/\/eportal.chirurgie.upol.cz\/portal_final\/wp-content\/uploads\/2013\/04\/Image_224.jpg\"><img decoding=\"async\" title=\"F\" alt=\"F\" src=\"https:\/\/eportal.chirurgie.upol.cz\/portal_final\/wp-content\/uploads\/2013\/04\/Image_224.jpg\" width=\"200\" \/><\/a><p class=\"wp-caption-text\">F<\/p><\/div><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<h3>\u00a05.2 Aneuryzma poplite\u00e1ln\u00ed arterie (AAP)<\/h3>\n<p style=\"text-align: justify;\">Jedn\u00e1 se po aneuryzmatu abdomin\u00e1ln\u00ed aorty o druh\u00fd nej\u010dast\u011bj\u0161\u00ed typ v\u00fddut\u011b. Asi u poloviny nemocn\u00fdch je v\u00fdskyt AAP oboustrann\u00fd. Asi 40\u201350% nemocn\u00fdch m\u00e1 v\u00fddu\u0165 abdomin\u00e1ln\u00ed aorty. 97% AAP postihuje mu\u017ee.Symptomatick\u00e9 AAP ohro\u017euje kon\u010detinu ischemi\u00ed s vysok\u00fdm rizikem amputace (25\u201350%). Tito nemocn\u00ed maj\u00ed vysokou morbiditu a mortalitu. Asymptomatick\u00e9 AAP m\u00e1 riziko komplikace 24% ji\u017e v prvn\u00edm roce po stanoven\u00ed diagn\u00f3zy. Nep\u0159\u00edzniv\u00e1 progn\u00f3za symptomatick\u00e9ho AAP vypl\u00fdv\u00e1 z recidivuj\u00edc\u00edch okultn\u00edch perifern\u00edch embolizac\u00ed, jejich\u017e zdrojem je AAP. Embolizace v\u00fdrazn\u011b po\u0161kozuj\u00ed v\u00fdtokov\u00fd trakt. Na vlastn\u00ed \u00fapln\u00e9 tromb\u00f3ze AAP se z\u00e1sadn\u011b pod\u00edl\u00ed nekvalitn\u00ed v\u00fdtokov\u00fd trakt. Ruptura AAP se vyskytuje asi u 10% v\u00fddut\u00ed.Standardn\u00ed vy\u0161et\u0159ovac\u00ed metody jsou sonografie, CTa angiografie. Je t\u0159eba vy\u0161et\u0159it ob\u011b kon\u010detiny.<\/p>\n<h6>INDIKACE K V\u00ddKONU A TERAPIE<\/h6>\n<p style=\"text-align: justify;\">Indikace k c\u00e9vn\u00ed rekonstrukci asymptomatick\u00e9 v\u00fddut\u011b vypl\u00fdv\u00e1 z mo\u017en\u00fdch komplikac\u00ed tohoto onemocn\u011bn\u00ed. Akutn\u00ed kritick\u00e1 ischemie n\u00e1sledkem AAP m\u00e1 riziko amputace 25\u201350%. P\u0159\u00ed\u010dinou \u0161patn\u00e9 progn\u00f3zy jsou okultn\u00ed mikroembolizace z v\u00fddut\u011b, kter\u00e9 zp\u016fsobuj\u00ed sukcesivn\u00ed obliterace b\u00e9rcov\u00fdch arteri\u00ed.Opera\u010dn\u00ed terapie je reprezentov\u00e1na nej\u010dast\u011bji \u017eiln\u00edm bypassem. K bypassu lze pou\u017e\u00edt um\u011blou c\u00e9vn\u00ed prot\u00e9zu z ePTFE. P\u0159i akutn\u00ed ischemii kombinovan\u00e1 p\u0159edopera\u010dn\u00ed nebo intraopera\u010dn\u00ed trombolytick\u00e1 terapie p\u0159ed navazuj\u00edc\u00edm bypassem v\u00fdrazn\u011b zlep\u0161\u00ed stav v\u00fdtokov\u00e9ho traktu.<\/p>\n<p style=\"text-align: justify;\">Indikace k \u0159e\u0161en\u00ed asymptomatick\u00e9 v\u00fddut\u011b:<\/p>\n<ul>\n<li>velikost nad 2 cm, ev. elongace arterie,<\/li>\n<li>nemocn\u00ed, kte\u0159\u00ed maj\u00ed jin\u00e1 operovan\u00e1 arteri\u00e1ln\u00ed onemocn\u011bn\u00ed (anastom\u00f3zy, pseudov\u00fddut\u011b).<\/li>\n<\/ul>\n<p>Indikace k \u0159e\u0161en\u00ed symptomatick\u00e9 v\u00fddut\u011b:<\/p>\n<ul>\n<li>emboliza\u010dn\u00ed nebo ischemick\u00e9 komplikace,<\/li>\n<li>lok\u00e1ln\u00ed \u00fatlak,<\/li>\n<li>septick\u00e9 aneuryzma.<\/li>\n<\/ul>\n<p style=\"text-align: justify;\">Opera\u010dn\u00ed \u0159e\u0161en\u00ed: medi\u00e1ln\u00ed (nad a pod kolenem)nebo zadn\u00ed p\u0159\u00edstup, podvaz (exkluze v\u00fddut\u011b) a bypass (AFS \u2013 a. poplitea pod v\u00fddut\u00ed).U rizikov\u00fdch nemocn\u00fdch (a po p\u0159\u00edsn\u00e9m v\u00fdb\u011bru)lze jako potenci\u00e1ln\u00ed alternativu chirurgick\u00e9mu v\u00fdkonu nab\u00eddnout o\u0161et\u0159en\u00ed v\u00fddut\u011b stentgraftem (Viabahn,GORE). Dle liter\u00e1rn\u00edch \u00fadaj\u016f lze dos\u00e1hnout podobn\u00fdch dlouhodob\u00fdch v\u00fdsledk\u016f jako u chirurgick\u00e9 terapie \u2013 75% pr\u016fchodnost stentgraftu po 5 letech.Akutn\u00ed kon\u010detinov\u00e1 ischemie zp\u016fsoben\u00e1 AAP m\u00e1 teoreticky zd\u016fvodn\u011bnou preopera\u010dn\u00ed intraarteri\u00e1ln\u00ed trombolytickou l\u00e9\u010dbu. Ta umo\u017en\u00ed p\u0159edopera\u010dn\u00ed rekanalizaci uzav\u0159en\u00e9ho b\u00e9rcov\u00e9ho \u0159e\u010di\u0161t\u011b, kter\u00e9 by nebylo z\u0159ejm\u011b mo\u017en\u00e9 o\u0161et\u0159it se stejn\u00fdm efektem mechanickou trombembolektomi\u00ed. Teoreticky lze uva\u017eovat o trombolytick\u00e9 l\u00e9\u010db\u011b AAP jako o samostatn\u00e9 terapii uzav\u0159en\u00e9 AP, je v\u0161ak nutno p\u0159ipustit mo\u017en\u00e9 komplikace:<\/p>\n<ul>\n<li style=\"text-align: justify;\">p\u0159i l\u00fdze se uvoln\u00ed emboliza\u010dn\u00ed materi\u00e1l, kter\u00fd uzav\u0159e perifern\u00ed \u0159e\u010di\u0161t\u011b a nen\u00ed d\u00e1le l\u00fdzou odstraniteln\u00fd.<br \/>\nD\u016fsledkem m\u016f\u017ee b\u00fdt amputace kon\u010detiny;<\/li>\n<li style=\"text-align: justify;\">progn\u00f3za \u00fasp\u011bchu trombol\u00fdzy nen\u00ed p\u0159edv\u00eddateln\u00e1, proto\u017ee aneuryzmatick\u00e9 tromby jsou sm\u011bs\u00ed trombotick\u00e9ho materi\u00e1lu r\u016fzn\u00e9ho st\u00e1\u0159\u00ed. Jejich schopnost l\u00fdzy je r\u016fzn\u00e1;<\/li>\n<li style=\"text-align: justify;\">i p\u0159i region\u00e1ln\u00ed trombolytick\u00e9 l\u00e9\u010db\u011b mohou nastat celkov\u00e9 komplikace l\u00fdzy;<\/li>\n<li style=\"text-align: justify;\">p\u0159edev\u0161\u00edm u drobn\u00fdch arteri\u00ed se p\u016fsobnost trombolytika sni\u017euje a metoda selh\u00e1v\u00e1. P\u0159\u00ed\u010dinou je mal\u00e1 plocha arterie, kde m\u016f\u017ee trombolytikum p\u016fsobit.<\/li>\n<\/ul>\n<p style=\"text-align: justify;\">Teoretick\u00e9 vysv\u011btlen\u00ed pro trombolytickou a endovaskul\u00e1rn\u00ed l\u00e9\u010dbu je z\u0159ejm\u00e9. P\u0159esto je v\u011bt\u0161ina v\u00fddut\u00ed poplite\u00e1ln\u00ed arterie o\u0161et\u0159ena chirurgicky s n\u00e1slednou antiagrega\u010dn\u00ed l\u00e9\u010dbou. Nemocn\u00e9 je t\u0159eba d\u00e1le sledovatjak klinicky, tak cestou barevn\u00e9 duplexn\u00ed sonografie,proto\u017ee nikdy nelze vylou\u010dit dal\u0161\u00ed r\u016fst v\u00fddut\u011b a jej\u00ed \u00fatlak okol\u00ed nebo stenotick\u00e9 procesy postihuj\u00edc\u00ed bypass.<\/p>\n<p style=\"text-align: justify;\">V\u010dasn\u00e1 detekce komplikace zlep\u0161uje prim\u00e1rn\u00ed asistovanou funkci bypassu.<\/p>\n<p style=\"text-align: justify;\">\n","protected":false},"excerpt":{"rendered":"<p>V\u00fddu\u0165 se m\u016f\u017ee vyskytnout kdekoliv na arteri\u00e1ln\u00edm \u0159e\u010di\u0161ti. Etiologicky m\u016f\u017ee b\u00fdt vrozen\u00e1, aterosklerotick\u00e1, traumatick\u00e1, infek\u010dn\u00ed (z\u00e1n\u011btliv\u00e1, mykotick\u00e1) a poststenotick\u00e1. Nejb\u011b\u017en\u011bj\u0161\u00ed je v\u00fddu\u0165 aterosklerotick\u00e1 p\u0159i dilata\u010dn\u00edm typu ateroskler\u00f3zy. Typickou lokalizac\u00ed je abdomin\u00e1ln\u00ed aorta, p\u00e1nevn\u00ed tepny a poplite\u00e1ln\u00ed arterie. Mykotick\u00e1 v\u00fddu\u0165 vznik\u00e1 nej\u010dast\u011bji zanesen\u00edm infekce krevn\u00edm proudem do st\u011bny arterie, etiologicky je \u010dasto p\u0159\u00ed\u010dinou salmonelov\u00e1 infekce. Z [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":1868,"menu_order":25,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":"","_links_to":"","_links_to_target":""},"class_list":["post-2125","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/eportal.chirurgie.upol.cz\/portal_final\/index.php?rest_route=\/wp\/v2\/pages\/2125","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/eportal.chirurgie.upol.cz\/portal_final\/index.php?rest_route=\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/eportal.chirurgie.upol.cz\/portal_final\/index.php?rest_route=\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/eportal.chirurgie.upol.cz\/portal_final\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/eportal.chirurgie.upol.cz\/portal_final\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=2125"}],"version-history":[{"count":24,"href":"https:\/\/eportal.chirurgie.upol.cz\/portal_final\/index.php?rest_route=\/wp\/v2\/pages\/2125\/revisions"}],"predecessor-version":[{"id":2184,"href":"https:\/\/eportal.chirurgie.upol.cz\/portal_final\/index.php?rest_route=\/wp\/v2\/pages\/2125\/revisions\/2184"}],"up":[{"embeddable":true,"href":"https:\/\/eportal.chirurgie.upol.cz\/portal_final\/index.php?rest_route=\/wp\/v2\/pages\/1868"}],"wp:attachment":[{"href":"https:\/\/eportal.chirurgie.upol.cz\/portal_final\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=2125"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}