Značaj promene hemostaznog sistema kod hiruškog lečenja aneurizme abdominalne aorte klasičnom i endovaskularnom tehnikom

Abstract

Aneurism of the abdominal aorta (AAA) is pathological enlargement of infrarenal aorta for more than 50% of its lumen. The only successful way to treat the AAA is surgical reconstruction of affected segment of the aorta. Surgical reconstruction means open, classical reconstruction (AAA) where the affected part reconstructs by graft and endovascular reconstruction (EVAR) where endovascular grafts placed inside AAA and in this way to surgically reconstructed AAA. Prospective clinical study included 70 patients with AAA which were divided into two groups and operated. First group of patients was operated by classical (open) technique and second group was operated by endovascular technique. All patients had indications for reconstruction according to current and internationally accepted criteria for treatment AAA. Clinical and laboratory parameters were analyzed (general blood test, biochemical, immunological, hemostatic parameters) in preoperative, intraoperative and postoperative period with a focus on of the coagulation system with its clinical manifestations. The parameters were monitored before, during and after surgery, that meant zero, first, third, seventh and fourteenth days. The research topic is very current as with scientific aspect and the aspect of everyday clinical practice. Studies dealing with the problems of treating AAA by conventional and endovascular techniques were mostly focused to comparative analysis of these two techniques and the incidence of early postoperative mortality and expected survival time of patients with AAA after reconstruction. There is a small number of studies that analyzes the causes of intra-operative and early postoperative mortality in the treatment of AAA by classical and endovascular technique (there is no similar study in our country). Our study analyzed the significance of changes in the hemostatic system before and during surgery and in the early postoperative period. The results should provide additional explanation for the occurrence of complications (bleeding, thrombosis) with all its clinical manifestations. Changes hemostatic status were monitored by standard tests of hemostasis and "Point of Care" tests. After this study and analysis we expect to be able to detect patients at risk to develop complications such as bleeding and thrombosis before surgery, during surgery and immediate after surgery. According with these findings, we correct the hemostatic system and just substitute the missing factors and significantly reduced the use of whole blood and blood products. On that way we are able to effectively treat complications. Therefore we can affect to reduction mortality during surgery and in the early postoperative period.