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Factors affecting early results after elective open repair of abdominal aortic aneurysms

dc.contributor.advisorDavidović, Lazar
dc.contributor.otherKostić, Dušan
dc.contributor.otherMarković, Dragan
dc.contributor.otherMaksimović, Živan
dc.creatorMaksić, Milanko
dc.date.accessioned2017-06-12T10:09:28Z
dc.date.available2017-06-12T10:09:28Z
dc.date.issued2017-04-19
dc.identifier.urihttp://eteze.bg.ac.rs/application/showtheses?thesesId=5027
dc.identifier.urihttps://fedorabg.bg.ac.rs/fedora/get/o:15701/bdef:Content/download
dc.identifier.urihttp://vbs.rs/scripts/cobiss?command=DISPLAY&base=70036&RID=48965135
dc.identifier.urihttp://nardus.mpn.gov.rs/123456789/8275
dc.description.abstractUvod. Cilj ovog rada je prikaz faktora koji utiču na rane rezltate otvorenog hirurškog lečenja (OHL) aneurizmi abdominalne aorte (AAA). Metod. Istraživanje je sprovedeno u vidu prospektivne studije na 450 pacijenata podvrgnutih elektivnom OHL AAA na Klinici za vaskularnu i endovaskularnu hirurgiju KCS u Beogradu u period januar 2013-septembr 2014 godine. Rezultati. Smrtni ishod zabeležen je kod sedam (1.55%) bolesnika u prvih 30 postoperativnih dana. Uzroci smrtnog ishoda bili su: nekontrolisano krvarenje-1; akutni infarkt miokarda-1; ishemijski kolitis-2, MOFS-2, sepsa-1. Koronarna bolest (OR:3.89; CI:0.85-17.7; p=0.0058), postoperativni akutni infarkt miokarda (OR:29.9; CI:2.56- 334.95; p=0.0053), hronična bubrežna slabost (OR: 7.5; CI 1.35-8.5; p=0.0073), ishemijski kolitis (OR:88.2; CI:4.77-1629.69; p=0.0026), okluzija obe hipogastrične arterije uz nemogućnost da se bar jedna prezervira (OR:17.4; CI:1.99-178.33; p=0.0230), aorto bifemoralna rekonstrukcija (OR:9.06; CI:1.76-46.49; p=0.016), značajno perioperativni krvarenje (>2 litra) (OR:7.32; CI:1.31-10.79; p=0.0001), “hostilni” abdomen (OR:5.25; CI:1.3-21.1; p=0.0055), inflamatorna aneurizma (OR: 13.99; CI:2.88-65.09; p=0.0002), supracelijačno klemovanje aorte (OR:18.7; CI:3.8- 90.6; p=0.0003), prolongirano klemovanje aorte (>60 minuta) (OR:14.25; CI:2.75-64.5; p=0.0003), intraoperativna hipotenzija (OR:6.61; CI:0.71-61.07; p=0.0545), prolongirana operacija (>240 minuta) (OR:8.66; CI:0.91-81.56; p=0.0585) i kompletna dehiscencija laparotomne rane (OR:44.1; CI:3.39-572.78; p=0.0396) povećavaju 30 dnevni mortalitet.Zaključak: Rani moratlitet nakon OHL AAA u centrima sa velikim iskustvom koji imaju dobro obučene multidisciplinarne timove, može biti veoma nizak. Takozvano centralizovano OHL može biti adekvatna solucija za pacijetne sa nepovoljnom anatomijom, odnosno za mladje, nerizične pacijenta sa dugom životnom prognozom.sr
dc.description.abstractTo assess results of open repair (OR) of AAA in a single high volume centre. Methods. We analyzed prospectively collected data of 450 patients who underwent elective OR of AAA at the Clinic for vascular and endovascular surgery of the Serbian Clinical Centre in the period between January 2013 and September 2014. Results. Postoperative death occurred in seven patients (1. 55%) during the first 30 postoperative days. The mortality was caused by: uncontrolled bleeding-1,acute myocardial infarction-1, ischemic colitis-2, MOFS-2, sepsis due to infection and dehiscence of laparotomy wound -1. Coronary artery disease (OR:3.89; CI:0.85-17.7; p=0.0058), postoperative acute myoardial infarction (OR:29.9; CI:2.56-334.95; p=0.0053), chronic renal failure (OR: 7.5; CI 1.35-8.5; p=0.0073), colonic necrosis (OR:88.2; CI:4.77-1629.69; p=0.0026), occlusion of the both hypogastric arteries an the inability to preserve at least one hypogastric artery (OR:17.4; CI:1.99-178.33; p=0.0230), aorto bifemoral reconstruction (OR:9.06; CI:1.76-46.49; p=0.016), significant perioperative blleding (>2 liters) (OR:7.32; CI:1.31-10.79; p=0.0001), hostile abdomen (OR:5.25; CI:1.3-21.1; p=0.0055), inflamatory aneurysm (OR: 13.99; CI:2.88-65.09; p=0.0002), supraceliac aortic cross clamping (OR:18.7; CI:3.8-90.6; p=0.0003), prolonged aortic cross clamping (>60 minutes) (OR:14.25; CI:2.75-64.5; p=0.0003), the intraoperative hypotension (OR:6.61; CI:0.71-61.07; p=0.0545), the prolonged operation (>240 minutes) (OR:8.66; CI:0.91-81.56; p=0.0585) and complete dehiscention of the laparotomy (OR:44.1; CI:3.39-572.78; p=0.0396) increased the 30 day mortality in our study. Conclusions. Early mortality after open repair of AAA in high volume centre might be very low due to experienced multidisciplinary team. Centralized open aortic surgery might be solution for effective treatment of patients with unsuitable anatomy or for young patients with long life expectancy.en
dc.formatapplication/pdf
dc.languagesr
dc.publisherУниверзитет у Београду, Медицински факултетsr
dc.rightsAutorstvo 3.0 Srbija (CC BY 3.0)
dc.sourceУниверзитет у Београдуsr
dc.subjectAAAsr
dc.subjectAAAen
dc.subjectotvoreno hirurško lečenjesr
dc.subjectrani rezultatisr
dc.subjectORen
dc.subjectEarly Resultsen
dc.titleFaktori koji utiču na rane rezultate elektivnog hirurškog lečenja aneurizme abdominalne aortesr
dc.title.alternativeFactors affecting early results after elective open repair of abdominal aortic aneurysmsen
dc.typePhD thesis
dcterms.abstractДавидовић, Лазар; Костић, Душан; Марковић, Драган; Максимовић, Живан; Максић, Миланко; Фактори који утичу на ране резултате елективног хируршког лечења анеуризме абдоминалне аорте; Фактори који утичу на ране резултате елективног хируршког лечења анеуризме абдоминалне аорте;


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