{"id":34432,"date":"2022-10-28T16:56:03","date_gmt":"2022-10-28T09:56:03","guid":{"rendered":"https:\/\/www.vnras.com\/drug\/?p=34432"},"modified":"2022-10-28T16:57:51","modified_gmt":"2022-10-28T09:57:51","slug":"dieu-tri-phinh-dong-mach-chu-bung","status":"publish","type":"post","link":"https:\/\/vnras.com\/drug\/dieu-tri-phinh-dong-mach-chu-bung\/","title":{"rendered":"\u0110i\u1ec1u tr\u1ecb ph\u00ecnh \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 b\u1ee5ng – B\u00e1c s\u0129 Hu\u1ef3nh Ph\u1ea1m Ho\u00e0ng Nam"},"content":{"rendered":"

B\u1ec7nh nh\u00e2n nam 64 tu\u1ed5i \u0111\u1ebfn b\u00e1c s\u0129 gia \u0111\u00ecnh \u0111\u1ec3 kh\u00e1m b\u1ec7nh th\u01b0\u1eddng quy th\u00ec ph\u00e1t hi\u1ec7n m\u1ed9t kh\u1ed1i s\u1edd th\u1ea5y \u0111\u01b0\u1ee3c, n\u1eb1m gi\u1eefa th\u01b0\u1ee3ng v\u1ecb v\u00e0 c\u00f3 m\u1ea1ch \u0111\u1eadp. B\u1ec7nh nh\u00e2n khai kh\u00f4ng \u0111au b\u1ee5ng v\u00e0 kh\u00f4ng \u0111au l\u01b0ng, c\u00f3 th\u1ec3 d\u1ec5 d\u00e0ng leo l\u00ean 2 b\u1eadc c\u1ea7u thang. Ti\u1ec1n s\u1eed b\u1ea3n th\u00e2n ki\u1ec3m so\u00e1t t\u1ed1t t\u0103ng huy\u1ebft \u00e1p v\u00e0 t\u0103ng cholesterol m\u00e1u. Gia \u0111\u00ecnh b\u1ec7nh nh\u00e2n kh\u00f4ng ai m\u1eafc b\u1ec7nh ph\u00ecnh m\u1ea1ch. B\u1ec7nh nh\u00e2n h\u00fat 1 g\u00f3i thu\u1ed1c l\u00e1 (20 \u0111i\u1ebfu) m\u1ed7i ng\u00e0y t\u1eeb 16 tu\u1ed5i \u0111\u1ebfn gi\u1edd. Si\u00eau \u00e2m b\u1ee5ng ph\u00e1t hi\u1ec7n t\u00fai ph\u00ecnh \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 b\u1ee5ng d\u01b0\u1edbi th\u1eadn \u0111\u01b0\u1eddng k\u00ednh l\u1edbn nh\u1ea5t 5.7 cm. N\u00ean \u0111\u00e1nh gi\u00e1 th\u00eam g\u00ec v\u00e0 \u0111i\u1ec1u tr\u1ecb th\u1ebf n\u00e0o ca n\u00e0y?<\/p>\n

V\u1ea5n \u0111\u1ec1 l\u00e2m s\u00e0ng<\/h2>\n
PH\u00ccNH \u0110\u1ed8NG M\u1ea0CH CH\u1ee6 B\u1ee4NG<\/strong> \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a l\u00e0 \u0111\u01b0\u1eddng k\u00ednh \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 \u00edt nh\u1ea5t 3cm. T\u1ea1i Hoa K\u1ef3, t\u1ef7 l\u1ec7 m\u1eafc \u01b0\u1edbc t\u00ednh kho\u1ea3ng 1.4% trong \u0111\u1ed9 tu\u1ed5i 50-84, ho\u1eb7c 1.1 tri\u1ec7u ng\u01b0\u1eddi tr\u01b0\u1edfng th\u00e0nh; t\u1ef7 l\u1ec7 m\u1eafc \u1edf ph\u1ee5 n\u1eef th\u1ea5p h\u01a1n \u0111\u00e0n \u00f4ng v\u00e0 nh\u1eefng ng\u01b0\u1eddi da \u0111en v\u00e0 ch\u00e2u \u00c1 m\u1eafc ph\u00ecnh \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 th\u1ea5p h\u01a1n ng\u01b0\u1eddi da Tr\u1eafng. C\u00e1c y\u1ebfu t\u1ed1 th\u00fac \u0111\u1ea9y b\u1ec7nh g\u1ed3m tu\u1ed5i cao, ti\u1ec1n s\u1eed gia \u0111\u00ecnh c\u00f3 ng\u01b0\u1eddi m\u1eafc, tr\u01b0\u1edbc \u0111\u00e2y ho\u1eb7c hi\u1ec7n t\u1ea1i h\u00fat thu\u1ed1c l\u00e1, t\u0103ng cholesterone m\u00e1u, t\u0103ng huy\u1ebft \u00e1p; \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng th\u00ec gi\u1ea3m nguy c\u01a1 m\u1eafc b\u1ec7nh ph\u00ecnh m\u1ea1ch. Nguy hi\u1ec3m nh\u1ea5t l\u00e0 nguy c\u01a1 v\u1ee1 t\u00fai ph\u00ecnh g\u00e2y t\u1eed vong do xu\u1ea5t huy\u1ebft. Do \u0111\u00f3, m\u1ee5c ti\u00eau \u0111i\u1ec1u tr\u1ecb l\u00e0 can thi\u1ec7p t\u00fai ph\u00ecnh tr\u01b0\u1edbc khi v\u1ee1. M\u1eb7c d\u00f9 c\u00f3 nhi\u1ec1u y\u1ebfu t\u1ed1 \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn th\u1eddi gian v\u00e0 l\u1ef1a ch\u1ecdn ph\u01b0\u01a1ng ph\u00e1p can thi\u1ec7p, ti\u00ean l\u01b0\u1ee3ng \u0111\u1ed9c l\u1eadp quan tr\u1ecdng nh\u1ea5t g\u00e2y v\u1ee1 l\u00e0 \u0111\u01b0\u1eddng k\u00ednh t\u00fai ph\u00ecnh, v\u1edbi nguy c\u01a1 t\u0103ng l\u00ean theo \u0111\u1ed9 l\u1edbn c\u1ee7a t\u00fai ph\u00ecnh. Trong m\u1ed9t nghi\u00ean c\u1ee9u quan s\u00e1t ti\u1ec1n c\u1ee9u \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n ph\u00ecnh \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 b\u1ee5ng m\u00e0 kh\u00f4ng \u0111\u1ee7 \u0111i\u1ec1u ki\u1ec7n \u0111\u1ec3 ti\u1ebfn h\u00e0nh ph\u1eabu thu\u1eadt, nguy c\u01a1 v\u1ee1 l\u00e0 1% m\u1ed7i n\u0103m \u1edf nam khi \u0111\u01b0\u1eddng k\u00ednh t\u00fai ph\u00ecnh l\u00e0 5-5.9 cm v\u00e0 14.1% \u1edf nam m\u1ed7i n\u0103m khi \u0111\u01b0\u1eddng k\u00ednh t\u00fai ph\u00ecnh \u00edt nh\u1ea5t 6cm; t\u1ef7 l\u1ec7 t\u01b0\u01a1ng \u1ee9ng \u1edf n\u1eef l\u00e0 3.9% v\u00e0 22.3% m\u1ed7i n\u0103m. Theo c\u00e1c chuy\u00ean gia \u0111\u1ea7u ng\u00e0nh v\u1ec1 m\u1ea1ch m\u00e1u, th\u1eddi \u0111i\u1ec3m ch\u1ea9n \u0111o\u00e1n l\u00e0 c\u1ef1c k\u1ef3 quan tr\u1ecdng \u0111\u1ec3 c\u00e2n nh\u1eafc c\u00e1c nguy c\u01a1 v\u00e0 thu\u1eadn l\u1ee3i theo d\u00f5i so v\u1edbi can thi\u1ec7p c\u00f3 ch\u1ecdn l\u1ecdc. Th\u1eddi gian v\u00e0 ng\u01b0\u1ee1ng can thi\u1ec7p c\u0169ng nh\u01b0 l\u1ef1a ch\u1ecdn ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb s\u1ebd b\u00e0n ngay sau \u0111\u00e2y.<\/p>\n
C\u00e1c chi\u1ebfn l\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb v\u00e0 b\u1eb1ng ch\u1ee9ng<\/h2>\n
Th\u1eddi gian can thi\u1ec7p<\/h3>\n
\u0110I\u1ec0U TR\u1eca PH\u00ccNH \u0110\u1ed8NG M\u1ea0CH CH\u1ee6 B\u1ee4NG<\/strong><\/p>\n
\n
C\u00e1c nguy c\u01a1 ph\u00ecnh \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 b\u1ee5ng<\/strong> l\u00e0 tu\u1ed5i cao, gi\u1edbi nam, ti\u1ec1n s\u1eed gia \u0111\u00ecnh, tr\u01b0\u1edbc \u0111\u00e2y ho\u1eb7c hi\u1ec7n t\u1ea1i h\u00fat thu\u1ed1c l\u00e1, t\u0103ng cholesterol m\u00e1u v\u00e0 t\u0103ng huy\u1ebft \u00e1p. Nguy c\u01a1 th\u1ea5p \u1edf b\u1ec7nh nh\u00e2n \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng.<\/li>\n
Khuy\u1ebfn c\u00e1o can thi\u1ec7p \u1edf nam c\u00f3 \u0111\u01b0\u1eddng k\u00ednh \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 l\u1edbn nh\u1ea5t l\u00e0 5.5cm ho\u1eb7c cao h\u01a1n v\u00e0 \u1edf n\u1eef c\u00f3 \u0111\u01b0\u1eddng k\u00ednh \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 l\u1edbn nh\u1ea5t l\u00e0 5cm ho\u1eb7c cao h\u01a1n.<\/li>\n
K\u1ebft qu\u1ea3 t\u1eeb c\u00e1c th\u1eed nghi\u1ec7m ng\u1eabu nhi\u00ean, c\u00f3 \u0111\u1ed1i ch\u1ee9ng ch\u1ee9ng minh r\u1eb1ng can thi\u1ec7p n\u1ed9i m\u1ea1ch \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 b\u1ee5ng (EVAR) li\u00ean quan gi\u1ea3m nguy c\u01a1 bi\u1ebfn ch\u1ee9ng chu ph\u1eabu v\u00e0 t\u1eed vong so v\u1edbi can thi\u1ec7p m\u1ed5 m\u1edf \u1ed5 b\u1ee5ng.<\/li>\n
\u01afu \u0111i\u1ec3m s\u1edbm c\u1ee7a EVAR so v\u1edbi ph\u1eabu thu\u1eadt m\u1ed5 m\u1edf l\u00e0 duy tr\u00ec t\u1eeb 2-3 n\u0103m k\u1ec3 t\u1eeb th\u1eddi gian ti\u1ebfn h\u00e0nh can thi\u1ec7p. Kh\u00f4ng c\u00f3 l\u1ee3i \u00edt s\u1ed1ng c\u00f2n l\u00e2u d\u00e0i.<\/li>\n
M\u1eb7c d\u00f9 EVAR li\u00ean quan t\u0103ng nguy c\u01a1 t\u00e1i can thi\u1ec7p, h\u1ea7u h\u1ebft nh\u1eefng can thi\u1ec7p n\u00e0y l\u00e0 x\u00e2m l\u1ea5n n\u1ed9i m\u1ea1ch t\u1ed1i thi\u1ec3u. Trong su\u1ed1t cu\u1ed9c \u0111\u1eddi c\u1ee7a b\u1ec7nh nh\u00e2n, m\u1ed5 m\u1edf li\u00ean quan t\u0103ng nguy c\u01a1 t\u00e1i can thi\u1ec7p m\u1edf \u1ed5 b\u1ee5ng.<\/li>\n
Theo d\u00f5i l\u00e2u d\u00e0i b\u1eb1ng h\u00ecnh \u1ea3nh si\u00eau \u00e2m k\u00e9p (duplex) ho\u1eb7c ch\u1ee5p c\u1eaft l\u1edbp vi t\u00ednh m\u1ea1ch m\u00e1u khuy\u1ebfn c\u00e1o n\u00ean l\u00e0m tr\u00ean b\u1ec7nh nh\u00e2n can thi\u1ec7p b\u1eb1ng EVAR.<\/li>\n<\/ul>\n
C\u00e1c th\u1eed nghi\u1ec7m ng\u1eabu nhi\u00ean cho th\u1ea5y kh\u00f4ng c\u00f3 l\u1ee3i \u00edch s\u1ed1ng c\u00f2n khi ph\u1eabu thu\u1eadt qua theo d\u00f5i ch\u1eb7t ch\u1ebd \u0111\u1ed1i v\u1edbi ph\u00ecnh \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 b\u1ee5ng c\u00f3 \u0111\u01b0\u1eddng k\u00ednh d\u01b0\u1edbi 5.5cm, \u0111\u00e3 \u1ee7ng h\u1ed9 quan \u0111i\u1ec3m cho r\u1eb1ng \u0111\u00e2y l\u00e0 \u0111\u01b0\u1eddng k\u00ednh ng\u01b0\u1ee1ng th\u00edch h\u1ee3p \u0111\u1ec3 can thi\u1ec7p v\u00e0 theo d\u00f5i c\u00e1c t\u00fai ph\u00ecnh c\u00f3 \u0111\u01b0\u1eddng k\u00ednh < 5.5cm s\u1ebd an to\u00e0n v\u00e0 ti\u1ebft ki\u1ec7m chi ph\u00ed. M\u1eb7c d\u00f9 ng\u01b0\u1ee1ng can thi\u1ec7p trong c\u00e1c nh\u00f3m theo d\u00f5i \u1edf nh\u1eefng th\u1eed nghi\u1ec7m n\u00e0y c\u0169ng bao g\u1ed3m s\u1ef1 ti\u1ebfn tri\u1ec3n nhanh ch\u00f3ng c\u1ee7a t\u00fai ph\u00ecnh (\u0111\u1ecbnh ngh\u0129a t\u1ed1c \u0111\u1ed9 ph\u00e1t tri\u1ec3n l\u00e0 >1cm m\u1ed7i n\u0103m), nh\u01b0ng do thi\u1ebfu c\u00e1c d\u1eef li\u1ec7u nghi\u00eam ng\u1eb7t \u0111\u1ec3 \u1ee7ng h\u1ed9 can thi\u1ec7p d\u1ef1a tr\u00ean c\u01a1 s\u1edf di\u1ec5n ti\u1ebfn nhanh c\u1ee7a t\u00fai ph\u00ecnh. M\u1ed9t h\u1ea1n ch\u1ebf quan tr\u1ecdng nh\u1ea5t trong c\u00e1c nghi\u00ean c\u1ee9u n\u00e0y l\u00e0 ng\u01b0\u1ee1ng 5.5 cm d\u1ef1a tr\u00ean ph\u1ea7n l\u1edbn b\u1ec7nh nh\u00e2n tham gia nghi\u00ean c\u1ee9u l\u00e0 \u0111\u00e0n \u00f4ng da Tr\u1eafng, do \u0111\u00f3 t\u00ednh kh\u00e1i qu\u00e1t \u1edf n\u1eef v\u00e0 c\u00e1c ch\u1ee7ng t\u1ed9c hay d\u00e2n t\u1ed9c kh\u00e1c ch\u01b0a r\u00f5 r\u00e0ng. Do k\u00edch th\u01b0\u1edbc b\u1ea9m sinh c\u1ee7a \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 nh\u1ecf h\u01a1n v\u00e0 t\u1ef7 l\u1ec7 v\u1ee1 t\u00fai ph\u00ecnh \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 b\u1ee5ng cao h\u01a1n \u1edf ph\u1ee5 n\u1eef, h\u1ea7u h\u1ebft c\u00e1c chuy\u00ean gia c\u0169ng nh\u01b0 c\u00e1c h\u01b0\u1edbng d\u1eabn khuy\u1ebfn c\u00e1o l\u00e0 \u0111\u01b0\u1eddng k\u00ednh <5cm l\u00e0 ng\u01b0\u1ee1ng th\u00edch h\u1ee3p \u0111\u1ec3 can thi\u1ec7p \u1edf ph\u1ee5 n\u1eef.<\/p>\n
Theo d\u00f5i v\u00e0 \u0111i\u1ec1u tr\u1ecb<\/h3>\n
B\u1ec7nh nh\u00e2n c\u00f3 t\u00fai ph\u00ecnh \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 b\u1ee5ng nh\u1ecf \u0111\u01b0\u1eddng k\u00ednh 3-3.9 cm n\u00ean \u0111\u01b0\u1ee3c theo d\u00f5i b\u1eb1ng si\u00eau \u00e2m k\u00e9p m\u1ed7i 3 n\u0103m, trong khi \u0111\u00f3 nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 \u0111\u01b0\u1eddng k\u00ednh t\u00fai ph\u00ecnh t\u1eeb 4-4.9cm n\u00ean theo d\u00f5i m\u1ed7i n\u0103m 1 l\u1ea7n v\u00e0 nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 k\u00edch th\u01b0\u1edbc t\u00fai ph\u00ecnh 5cm ho\u1eb7c l\u1edbn h\u01a1n n\u00ean theo d\u00f5i m\u1ed7i 6 th\u00e1ng. D\u1eebng h\u00fat thu\u1ed1c l\u00e1 \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o gi\u1ea3m nguy c\u01a1 ti\u1ebfn tri\u1ec3n v\u00e0 v\u1ee1 t\u00fai ph\u00ecnh. C\u00e1c thu\u1ed1c statin, ch\u1eb9n beta v\u00e0 thu\u1ed1c h\u1ea1 \u00e1p c\u00f3 th\u1ec3 ch\u1ec9 \u0111\u1ecbnh \u0111\u1ec3 gi\u1ea3m nguy c\u01a1 tim m\u1ea1ch, nh\u01b0ng ch\u00fang ch\u01b0a \u0111\u01b0\u1ee3c ch\u1ee9ng minh c\u00f3 th\u1ec3 gi\u1ea3m ph\u00e1t tri\u1ec3n t\u00fai ph\u00ecnh v\u00e0 n\u00ean \u0111\u01b0\u1ee3c k\u00ea \u0111\u01a1n v\u1edbi m\u1ee5c \u0111\u00edch \u0111i\u1ec1u tr\u1ecb b\u1ec7nh c\u1ee5 th\u1ec3 v\u00e0 kh\u00f4ng d\u00f9ng th\u01b0\u1eddng quy.<\/p>\n
Trong s\u1ed1 nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 t\u00fai ph\u00ecnh \u0111\u1ee7 l\u1edbn \u0111\u1ec3 can thi\u1ec7p, c\u00e1c h\u01b0\u1edbng \u0111i\u1ec1u tr\u1ecb c\u00f3 th\u1ec3 l\u00e0 can thi\u1ec7p m\u1ed5 h\u1edf ho\u1eb7c can thi\u1ec7p n\u1ed9i m\u1ea1ch \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 (EVAR). Can thi\u1ec7p m\u1ed5 h\u1edf c\u1ea7n r\u1ea1ch 1 \u0111\u01b0\u1eddng gi\u1eefa qua \u1ed5 b\u1ee5ng ho\u1eb7c sau ph\u00fac m\u1ea1c \u0111\u1ec3 b\u1ed9c l\u1ed9 \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 b\u1ee5ng v\u00e0 \u0111\u1ed9ng m\u1ea1ch ch\u1eadu, s\u1ebd \u0111\u01b0\u1ee3c k\u1eb9p l\u1ea1i. Trong qu\u00e1 tr\u00ecnh ph\u1eabu thu\u1eadt, \u0111o\u1ea1n \u0111\u1ed9ng m\u1ea1ch ch\u1ee9a t\u00fai ph\u00ecnh \u0111\u01b0\u1ee3c thay th\u1ebf b\u1eb1ng \u1ed1ng gh\u00e9p nh\u00e2n t\u1ea1o d\u1ea1ng \u1ed1ng ho\u1eb7c hai nh\u00e1nh (h\u00ecnh 1). Trong th\u1ee7 thu\u1eadt EVAR, t\u00fai ph\u00ecnh \u0111\u01b0\u1ee3c gi\u1eef nguy\u00ean v\u00e0 d\u00f2ng m\u00e1u \u0111\u01b0\u1ee3c \u0111\u1ecbnh tuy\u1ebfn l\u1ea1i th\u00f4ng qua \u0111\u1eb7t m\u1ed9t gi\u00e1 \u0111\u1ee1 (stent graft) d\u1ef1a v\u00e0o \u1ed1ng th\u00f4ng catheter, do \u0111\u00f3 tr\u00e1nh \u0111\u01b0\u1ee3c t\u00fai kh\u00ed v\u00e0 kh\u00f4ng c\u1ea7n thi\u1ebft ph\u1ea3i l\u00e0m t\u1eafc \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 t\u1ea1m th\u1eddi (h\u00ecnh 2). Th\u00f4ng th\u01b0\u1eddng, m\u1ed9t modun gi\u00e1 \u0111\u1ee1 2 nh\u00e1nh \u0111\u01b0\u1ee3c neo gi\u1eef b\u00ean d\u01b0\u1edbi \u0111\u1ed9ng m\u1ea1ch th\u1eadn trong m\u1ed9t \u0111o\u1ea1n \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 b\u00ecnh th\u01b0\u1eddng v\u00e0 k\u00e9o d\u00e0i th\u00e0nh \u0111o\u1ea1n b\u00ecnh th\u01b0\u1eddng \u1edf m\u1ed7i \u0111\u1ed9ng m\u1ea1ch ch\u1eadu chung. S\u1ef1 ph\u00f9 h\u1ee3p v\u1ec1 gi\u1ea3i ph\u1eabu v\u1edbi EVAR y\u00eau c\u1ea7u \u0111\u1ee7 c\u00e1c v\u00f9ng b\u1ecbt k\u00edn, \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a l\u00e0 c\u00e1c v\u00f9ng kh\u00f4ng c\u00f3 t\u00fai ph\u00ecnh, \u0111\u1ed9ng m\u1ea1ch c\u00f3 th\u00e0nh song song tr\u00ean v\u00e0 d\u01b0\u1edbi t\u00fai ph\u00ecnh, n\u01a1i m\u00e0 gi\u00e1 \u0111\u1ee1 c\u00f3 th\u1ec3 ch\u1ed1ng l\u1ea1i v\u00e0 b\u1ecbt k\u00edn v\u00e0o th\u00e0nh \u0111\u1ed9ng m\u1ea1ch. C\u00e1c y\u00eau c\u1ea7u c\u1ea7n c\u00f3 n\u1eefa l\u00e0 \u0111\u01b0\u1eddng k\u00ednh ph\u00f9 h\u1ee3p c\u1ee7a \u0111\u1ed9ng m\u1ea1ch \u0111\u00f9i v\u00e0 \u0111\u1ed9ng m\u1ea1ch ch\u1eadu \u0111\u1ec3 th\u00edch h\u1ee3p \u0111\u01b0a c\u00e1c d\u1ee5ng c\u1ee5 v\u00e0o v\u00e0 kh\u00f4ng x\u1ea3y ra co th\u1eaft m\u1ea1ch qu\u00e1 m\u1ee9c ho\u1eb7c c\u00e1c m\u1ea3ng x\u01a1 v\u1eefa n\u1eb7ng, c\u1ea3 2 \u0111\u1ec1u l\u00e0m t\u0103ng nguy c\u01a1 thuy\u00ean t\u1eafc (embolisation). T\u1eeb khi EVAR ra \u0111\u1eddi v\u00e0o n\u0103m 1991, nhi\u1ec1u ph\u00ecnh \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 b\u1ee5ng \u0111\u01b0\u1ee3c can thi\u1ec7p \u1edf Hoa K\u1ef3 gia t\u0103ng \u0111\u00e1ng k\u1ec3, v\u00e0 h\u01a1n 80% nh\u1eefng b\u1ec7nh nh\u00e2n hi\u1ec7n nay \u0111\u01b0\u1ee3c can thi\u1ec7p b\u1eb1ng EVAR. Nhi\u1ec1u t\u1ed5 ch\u1ee9c \u0111\u00e3 cho ph\u00e9p s\u1eed d\u1ee5ng r\u1ed9ng r\u00e3i EVAR nh\u01b0 l\u1ef1a ch\u1ecdn \u0111i\u1ec1u tr\u1ecb h\u00e0ng \u0111\u1ea7u tr\u00ean b\u1ec7nh nh\u00e2n c\u00f3 c\u1ea5u tr\u00fac gi\u1ea3i ph\u1eabu ph\u00f9 h\u1ee3p, kh\u00f4ng ph\u1ee5 thu\u1ed9c tu\u1ed5i t\u00e1c ho\u1eb7c nguy c\u01a1 l\u00e2m s\u00e0ng, lo\u1ea1i b\u1ecf can thi\u1ec7p m\u1ed5 m\u1edf v\u1edbi b\u1ec7nh nh\u00e2n c\u00f3 c\u1ea5u tr\u00fac gi\u1ea3i ph\u1eabu kh\u00f4ng ph\u00f9 h\u1ee3p v\u1edbi EVAR.<\/p>\n
$\"H\u00ecnh$
H\u00ecnh 1. Can thi\u1ec7p m\u1ed5 m\u1edf ph\u00ecnh \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 b\u1ee5ng d\u01b0\u1edbi th\u1eadn<\/figcaption><\/figure>\n
Trong th\u1ee7 thu\u1eadt n\u00e0y, ti\u1ebfn h\u00e0nh m\u1edf \u1ed5 b\u1ee5ng, \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 \u0111\u01b0\u1ee3c k\u1eb9p ph\u00eda tr\u00ean v\u00e0 d\u01b0\u1edbi t\u00fai ph\u00ecnh, v\u00e0 m\u1ed9t
\n\u1ed1ng gh\u00e9p nh\u00e2n t\u1ea1o \u0111\u01b0\u1ee3c kh\u00e2u v\u00e0o v\u1ecb tr\u00ed t\u00fai ph\u00ecnh.<\/p>\n
H\u01b0\u1edbng d\u1eabn ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb d\u1ef1a tr\u00ean b\u1eb1ng ch\u1ee9ng<\/h3>\n
Ba th\u1eed nghi\u1ec7m ng\u1eabu nhi\u00ean c\u00f3 \u0111\u1ed1i ch\u1ee9ng l\u1edbn nh\u1ea5t cho \u0111\u1ebfn nay, trong \u0111\u00f3 k\u1ebft c\u1ee5c c\u1ee7a can thi\u1ec7p m\u1ed5 m\u1edf c\u00f3 ch\u1ecdn l\u1ecdc so v\u1edbi k\u1ebft c\u1ee5c c\u1ee7a EVAR \u0111\u00e3 mang l\u1ea1i k\u1ebft qu\u1ea3 nh\u1ea5t qu\u00e1n. T\u1ea5t c\u1ea3 3 th\u1eed nghi\u1ec7m \u0111\u1ec1u cho th\u1ea5y t\u1ef7 l\u1ec7 m\u1eafc v\u00e0 t\u1ef7 l\u1ec7 t\u1eed vong trong 30 ng\u00e0y th\u1ea5p \u0111\u00e1ng k\u1ec3 \u0111\u1ed1i v\u1edbi EVAR so v\u1edbi can thi\u1ec7p m\u1ed5 h\u1edf (0.5 v\u1edbi 1.7% vs. 3.0 v\u1edbi 4.7%). Kh\u1ea3 n\u0103ng h\u1ed3i ph\u1ee5c nhanh h\u01a1n tr\u00ean b\u1ec7nh nh\u00e2n ti\u1ebfn h\u00e0nh EVAR (th\u1eddi gian n\u1eb1m vi\u1ec7n trung b\u00ecnh t\u1ea1i trung t\u00e2m ch\u0103m s\u00f3c y t\u1ebf l\u00e0 2 ng\u00e0y so v\u1edbi 7 ng\u00e0y khi m\u1ed5 m\u1edf). Tuy nhi\u00ean, l\u1ee3i \u00edch s\u1ed1ng s\u00f3t trong th\u1eddi gian ng\u1eafn gi\u1ea3m khi theo d\u00f5i, do \u0111\u00f3 \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n s\u1ed1ng s\u00f3t sau 2-3 n\u0103m, t\u1ef7 l\u1ec7 s\u1ed1ng c\u00f2n li\u00ean quan 2 th\u1ee7 thu\u1eadt l\u00e0 nh\u01b0 nhau, v\u00e0 v\u1eabn ph\u1ea3i duy tr\u00ec theo d\u00f5i 8-10 n\u0103m. T\u1ef7 l\u1ec7 t\u00e1i can thi\u1ec7p sau EVAR t\u0103ng cao h\u01a1n so v\u1edbi t\u1ef7 l\u1ec7 quan s\u00e1t \u0111\u01b0\u1ee3c khi m\u1ed5 h\u1edf, nh\u01b0ng h\u1ea7u h\u1ebft c\u00e1c th\u1ee7 thu\u1eadt theo d\u00f5i \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n th\u00f4ng qua catheter; nh\u00ecn chung, chi ph\u00ed th\u1ef1c hi\u1ec7n EVAR cao h\u01a1n so v\u1edbi m\u1ed5 h\u1edf.<\/p>\n
D\u1eef li\u1ec7u t\u1eeb kinh nghi\u1ec7m l\u00e2m s\u00e0ng t\u1ea1i Hoa K\u1ef3 \u0111\u00e3 h\u1ed7 tr\u1ee3 c\u00e1c b\u1eb1ng ch\u1ee9ng trong nh\u1eefng th\u1eed nghi\u1ec7m n\u00e0y. Trong m\u1ed9t ph\u00e2n t\u00edch gh\u00e9p \u0111i\u1ec3m d\u1ef1a tr\u00ean xu h\u01b0\u1edbng bao g\u1ed3m h\u01a1n 44.000 ng\u01b0\u1eddi th\u1ee5 h\u01b0\u1edfng d\u1ecbch v\u1ee5 Medicare \u0111\u00e3 ti\u1ebfn h\u00e0nh can thi\u1ec7p \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 b\u1ee5ng t\u1eeb n\u0103m 2001 \u0111\u1ebfn n\u0103m 2004, t\u1ef7 l\u1ec7 t\u1eed vong trong 30 ng\u00e0y l\u00e0 1.2% sau EVAR v\u00e0 4.8% sau m\u1ed5 h\u1edf (P<0.001). Sau 5 n\u0103m theo d\u00f5i, t\u1ef7 l\u1ec7 t\u1eed vong do t\u1ea5t c\u1ea3 nguy\u00ean nh\u00e2n \u0111\u1ec1u nh\u01b0 nhau trong 2 nh\u00f3m, v\u1edbi \u0111\u01b0\u1eddng cong s\u1ed1ng s\u00f3t \u0111\u1ec1u h\u1ed9i t\u1ee5 \u1edf n\u0103m th\u1ee9 3. T\u00e1i can thi\u1ec7p li\u00ean quan h\u1ed3i ph\u1ee5c th\u01b0\u1eddng g\u1eb7p h\u01a1n \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n l\u00e0m EVAR (9.0% vs. 1.7%; P><0.001). Tuy nhi\u00ean, ph\u1eabu thu\u1eadt c\u00f3 c\u00e1c bi\u1ebfn ch\u1ee9ng li\u00ean quan v\u1ebft m\u1ed5 hay m\u1edf \u1ed5 b\u1ee5ng ch\u1eb3ng h\u1ea1n nh\u01b0 tho\u00e1t v\u1ecb v\u1ebft m\u1ed5 ho\u1eb7c t\u1eafc ru\u1ed9t, c\u00f3 t\u1ea7n su\u1ea5t x\u1ea3y ra nhi\u1ec1u h\u01a1n \u1edf b\u1ec7nh nh\u00e2n m\u1ed5 h\u1edf (9.7% vs. 4.1%; P><0.001). L\u1ef1a ch\u1ecdn ph\u01b0\u01a1ng ph\u00e1p can thi\u1ec7p n\u00ean \u0111\u01b0a ra t\u1eeb quy\u1ebft \u0111\u1ecbnh chung v\u00e0 bao g\u1ed3m c\u1ea3 s\u1ef1 ph\u00f9 h\u1ee3p v\u1ec1 gi\u1ea3i ph\u1eabu c\u1ee7a b\u1ec7nh nh\u00e2n, nguy c\u01a1 ph\u1eabu thu\u1eadt v\u00e0 s\u1eb5n s\u00e0ng tu\u00e2n th\u1ee7 y\u00eau c\u1ea7u su\u1ed1t \u0111\u1eddi trong vi\u1ec7c theo d\u00f5i h\u00e0ng n\u0103m b\u1eb1ng h\u00ecnh \u1ea3nh c\u1eadn l\u00e2m s\u00e0ng. S\u1ef1 ph\u00f9 h\u1ee3p gi\u1ea3i ph\u1eabu \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a l\u00e0 m\u1ed7i thi\u1ebft b\u1ecb EVAR l\u00e0 1 ph\u1ea7n c\u1ee7a l\u1ed9 tr\u00ecnh ph\u00ea duy\u1ec7t theo qui \u0111\u1ecbnh; thi\u1ebfu tu\u00e2n th\u1ee7 c\u00e1c h\u01b0\u1edbng d\u1eabn v\u1ec1 gi\u1ea3i ph\u1eabu li\u00ean quan \u0111\u1ebfn m\u1ed7i thi\u1ebft b\u1ecb s\u1ebd mang l\u1ea1i k\u1ebft c\u1ee5c x\u1ea5u. Nhi\u1ec1u h\u01b0\u1edbng d\u1eabn khuy\u1ebfn c\u00e1o n\u00ean theo d\u00f5i b\u1eb1ng h\u00ecnh \u1ea3nh c\u1eadn l\u00e2m s\u00e0ng su\u1ed1t \u0111\u1eddi sau khi l\u00e0m EVAR \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh v\u00e0 \u0111i\u1ec1u tr\u1ecb c\u00e1c bi\u1ebfn ch\u1ee9ng c\u00f3 li\u00ean quan \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 hay c\u00e1c thi\u1ebft b\u1ecb kh\u00e1c, nh\u01b0 ch\u1ea3y m\u00e1u dai d\u1eb3ng trong t\u00fai ph\u00ecnh (nh\u01b0 endoleak – c\u00f2n d\u00f2ng \u0111\u1ed9ng m\u1ea1ch trong t\u00fai ph\u00ecnh) ho\u1eb7c ph\u00ec \u0111\u1ea1i t\u00fai th\u1eeba \u0111\u1ed9ng m\u1ea1ch ch\u1ee7. Theo d\u00f5i h\u00ecnh \u1ea3nh sau can thi\u1ec7p nh\u1eb1m x\u00e1c \u0111\u1ecbnh c\u00e1c bi\u1ebfn ch\u1ee9ng nghi\u00eam tr\u1ecdng v\u00e0 d\u1ef1 ph\u00f2ng t\u1eed vong do v\u1ee1 t\u00fai ph\u00ecnh. C\u00e1c c\u1eadn l\u00e2m s\u00e0ng h\u00ecnh \u1ea3nh h\u1ecdc n\u00e0y bao g\u1ed3m ch\u1ee5p m\u1ea1ch m\u00e1u c\u1eaft l\u1edbp vi t\u00ednh (CT)><0.001). Sau 5 n\u0103m theo d\u00f5i, t\u1ef7 l\u1ec7 t\u1eed vong do t\u1ea5t c\u1ea3 nguy\u00ean nh\u00e2n \u0111\u1ec1u nh\u01b0 nhau trong 2 nh\u00f3m, v\u1edbi \u0111\u01b0\u1eddng cong s\u1ed1ng s\u00f3t \u0111\u1ec1u h\u1ed9i t\u1ee5 \u1edf n\u0103m th\u1ee9 3. T\u00e1i can thi\u1ec7p li\u00ean quan h\u1ed3i ph\u1ee5c th\u01b0\u1eddng g\u1eb7p h\u01a1n \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n l\u00e0m EVAR (9.0% vs. 1.7%; P<0.001). Tuy nhi\u00ean, ph\u1eabu thu\u1eadt c\u00f3 c\u00e1c bi\u1ebfn ch\u1ee9ng li\u00ean quan v\u1ebft m\u1ed5 hay m\u1edf \u1ed5 b\u1ee5ng ch\u1eb3ng h\u1ea1n nh\u01b0 tho\u00e1t v\u1ecb v\u1ebft m\u1ed5 ho\u1eb7c t\u1eafc ru\u1ed9t, c\u00f3 t\u1ea7n su\u1ea5t x\u1ea3y ra nhi\u1ec1u h\u01a1n \u1edf b\u1ec7nh nh\u00e2n m\u1ed5 h\u1edf (9.7% vs. 4.1%; P<0.001).<\/p>\n
L\u1ef1a ch\u1ecdn ph\u01b0\u01a1ng ph\u00e1p can thi\u1ec7p n\u00ean \u0111\u01b0a ra t\u1eeb quy\u1ebft \u0111\u1ecbnh chung v\u00e0 bao g\u1ed3m c\u1ea3 s\u1ef1 ph\u00f9 h\u1ee3p v\u1ec1 gi\u1ea3i ph\u1eabu c\u1ee7a b\u1ec7nh nh\u00e2n, nguy c\u01a1 ph\u1eabu thu\u1eadt v\u00e0 s\u1eb5n s\u00e0ng tu\u00e2n th\u1ee7 y\u00eau c\u1ea7u su\u1ed1t \u0111\u1eddi trong vi\u1ec7c theo d\u00f5i h\u00e0ng n\u0103m b\u1eb1ng h\u00ecnh \u1ea3nh c\u1eadn l\u00e2m s\u00e0ng. S\u1ef1 ph\u00f9 h\u1ee3p gi\u1ea3i ph\u1eabu \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a l\u00e0 m\u1ed7i thi\u1ebft b\u1ecb EVAR l\u00e0 1 ph\u1ea7n c\u1ee7a l\u1ed9 tr\u00ecnh ph\u00ea duy\u1ec7t theo qui \u0111\u1ecbnh; thi\u1ebfu tu\u00e2n th\u1ee7 c\u00e1c h\u01b0\u1edbng d\u1eabn v\u1ec1 gi\u1ea3i ph\u1eabu li\u00ean quan \u0111\u1ebfn m\u1ed7i thi\u1ebft b\u1ecb s\u1ebd mang l\u1ea1i k\u1ebft c\u1ee5c x\u1ea5u. Nhi\u1ec1u h\u01b0\u1edbng d\u1eabn khuy\u1ebfn c\u00e1o n\u00ean theo d\u00f5i b\u1eb1ng h\u00ecnh \u1ea3nh c\u1eadn l\u00e2m s\u00e0ng su\u1ed1t \u0111\u1eddi sau khi l\u00e0m EVAR \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh v\u00e0 \u0111i\u1ec1u tr\u1ecb c\u00e1c bi\u1ebfn ch\u1ee9ng c\u00f3 li\u00ean quan \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 hay c\u00e1c thi\u1ebft b\u1ecb kh\u00e1c, nh\u01b0 ch\u1ea3y m\u00e1u dai d\u1eb3ng trong t\u00fai ph\u00ecnh (nh\u01b0 endoleak – c\u00f2n d\u00f2ng \u0111\u1ed9ng m\u1ea1ch trong t\u00fai ph\u00ecnh) ho\u1eb7c ph\u00ec \u0111\u1ea1i t\u00fai th\u1eeba \u0111\u1ed9ng m\u1ea1ch ch\u1ee7. Theo d\u00f5i h\u00ecnh \u1ea3nh sau can thi\u1ec7p nh\u1eb1m x\u00e1c \u0111\u1ecbnh c\u00e1c bi\u1ebfn ch\u1ee9ng nghi\u00eam tr\u1ecdng v\u00e0 d\u1ef1 ph\u00f2ng t\u1eed vong do v\u1ee1 t\u00fai ph\u00ecnh. C\u00e1c c\u1eadn l\u00e2m s\u00e0ng h\u00ecnh \u1ea3nh h\u1ecdc n\u00e0y bao g\u1ed3m ch\u1ee5p m\u1ea1ch m\u00e1u c\u1eaft l\u1edbp vi t\u00ednh (CT) trong th\u00e1ng \u0111\u1ea7u sau khi l\u00e0m EVAR, theo d\u00f5i d\u01b0\u1edbi s\u1ef1 h\u01b0\u1edbng d\u1eabn c\u1ee7a si\u00eau \u00e2m k\u00e9p h\u00e0ng n\u0103m. Tr\u00ean m\u1ed9t s\u1ed1 b\u1ec7nh nh\u00e2n, si\u00eau \u00e2m c\u00f3 th\u1ec3 kh\u00f4ng kh\u1ea3 thi (nh\u01b0 b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 tr\u1ea1ng l\u1edbn), v\u00ec th\u1ebf c\u00f3 th\u1ec3 ch\u1ee5p m\u1ea1ch m\u00e1u CT ho\u1eb7c MRI. Nh\u1eefng nguy c\u01a1 ti\u1ebfp x\u00fac v\u1edbi b\u1ee9c x\u1ea1 v\u00e0 s\u1eed d\u1ee5ng ch\u1ea5t c\u1ea3n quang ch\u1ee9a iode n\u00ean trao \u0111\u1ed5i v\u1edbi b\u1ec7nh nh\u00e2n.<\/p>\n
$\"H\u00ecnh$
H\u00ecnh 2. Can thi\u1ec7p n\u1ed9i m\u1ea1ch trong ph\u00ecnh \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 b\u1ee5ng d\u01b0\u1edbi th\u1eadn.<\/figcaption><\/figure>\n
Ti\u1ebfp c\u1eadn \u0111\u1ed9ng m\u1ea1ch \u0111\u00f9i d\u01b0\u1edbi da ho\u1eb7c v\u1ebft r\u1ea1ch nh\u1ecf \u1edf b\u1eb9n \u0111\u1ec3 b\u1ed9c l\u1ed9 \u0111\u1ed9ng m\u1ea1ch \u0111\u00f9i nh\u1eb1m m\u1ee5c \u0111\u00edch \u0111\u01b0a
\ngi\u00e1 \u0111\u1ee1 (stent graft) v\u00e0o, d\u01b0\u1edbi h\u01b0\u1edbng d\u1eabn c\u1ee7a Xquang \u0111\u1ec3 lo\u1ea1i tr\u1eeb d\u00f2ng m\u00e1u \u0111\u1ebfn t\u00fai ph\u00ecnh.<\/p>\n
M\u1eb7c d\u00f9 nguy c\u01a1 ung th\u01b0 su\u1ed1t \u0111\u1eddi do ti\u1ebfp x\u00fac b\u1ee9c x\u1ea1 li\u1ec1u th\u1ea5p th\u00ec th\u1ea5p h\u01a1n nhi\u1ec1u \u1edf b\u1ec7nh nh\u00e2n > 65 tu\u1ed5i so v\u1edbi nh\u1eefng b\u1ec7nh nh\u00e2n tr\u1ebb tu\u1ed5i, \u1ea3nh h\u01b0\u1edfng khi ti\u1ebfp x\u00fac v\u1edbi ph\u00f3ng x\u1ea1 v\u1edbi nhi\u1ec1u nghi\u00ean c\u1ee9u CT ch\u01b0a \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 trong d\u1ecbch t\u1ec5 h\u1ecdc quy m\u00f4 l\u1edbn. Nh\u1eefng nguy c\u01a1 g\u00e2y \u0111\u1ed9c th\u1eadn do ch\u1ea5t c\u1ea3n quang th\u1ea5p h\u01a1n \u1edf b\u1ec7nh nh\u00e2n c\u00f3 \u0111\u1ed9 l\u1ecdc c\u1ea7u th\u1eadn \u01b0\u1edbc t\u00ednh tr\u00ean 30 ml\/ph\/1.73 m2 di\u1ec7n t\u00edch b\u1ec1 m\u1eb7t c\u01a1 th\u1ec3.<\/p>\n
V\u1ee1 t\u00fai ph\u00ecnh \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 sau EVAR \u0111\u01b0\u1ee3c ghi nh\u1eadn chi\u1ebfm 5.4% b\u1ec7nh nh\u00e2n. Nhu c\u1ea7u t\u00e1i can thi\u1ec7p nh\u1eb1m duy tr\u00ec lo\u1ea1i tr\u1eeb t\u00fai ph\u00ecnh kh\u1ecfi v\u00f2ng tu\u1ea7n ho\u00e0n v\u00e0 \u0111\u1ec1 ph\u00f2ng v\u1ee1 mu\u1ed9n \u0111\u00e3 \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o trong giai \u0111o\u1ea1n theo d\u00f5i s\u1edbm, gi\u1eefa k\u1ef3 v\u00e0 l\u00e2u d\u00e0i v\u00e0 kh\u00f4ng c\u1ed1 \u0111\u1ecbnh theo th\u1eddi gian, v\u00ec th\u1ebf n\u00ean theo d\u00f5i su\u1ed1t \u0111\u1eddi. Ng\u01b0\u1ee3c l\u1ea1i, v\u1edbi m\u1ed5 h\u1edf, theo d\u00f5i su\u1ed1t \u0111\u1eddi l\u1ea1i kh\u00f4ng quan tr\u1ecdng do \u0111\u1ed9 b\u1ec1n c\u1ee7a can thi\u1ec7p l\u00e2u h\u01a1n v\u00e0 \u00edt nhu c\u1ea7u t\u00e1i can thi\u1ec7p. Sau m\u1ed5 h\u1edf, h\u1ea7u h\u1ebft c\u00e1c b\u00e1c s\u0129 ngo\u1ea1i khoa v\u1ec1 m\u1ea1ch m\u00e1u s\u1ebd theo d\u00f5i b\u1ec7nh nh\u00e2n cho \u0111\u1ebfn khi h\u1ecd ho\u00e0n to\u00e0n tr\u1edf v\u1ec1 tr\u1ea1ng th\u00e1i b\u00ecnh th\u01b0\u1eddng sau ph\u1eabu thu\u1eadt. Sau \u0111\u00f3, b\u1ec7nh nh\u00e2n th\u01b0\u1eddng ch\u1ec9 nh\u1eadn ra khi m\u1ed9t v\u1ea5n \u0111\u1ec1 m\u1edbi ph\u00e1t sinh, b\u1edfi v\u00ec v\u1ee1 t\u00fai ph\u00ecnh sau can thi\u1ec7p m\u1ed5 h\u1edf l\u00e0 c\u1ef1c k\u1ef3 hi\u1ebfm g\u1eb7p.<\/p>\n
$\"H\u00ecnh$
H\u00ecnh 3. Can thi\u1ec7p n\u1ed9i m\u1ea1ch ph\u1ee9c h\u1ee3p ph\u00ecnh \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 ng\u1ef1c-b\u1ee5ng.<\/figcaption><\/figure>\n
Can thi\u1ec7p n\u1ed9i m\u1ea1ch c\u00f3 l\u1ed7 th\u1ee7ng (h\u00ecnh A) v\u00e0 c\u00f3 nh\u00e1nh (h\u00ecnh B) c\u1ee7a m\u1ed9t ph\u1ee9c h\u1ee3p ph\u00ecnh \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 ng\u1ef1c-b\u1ee5ng.<\/p>\n
C\u00e1c l\u0129nh v\u1ef1c ch\u01b0a r\u00f5 r\u00e0ng<\/h2>\n
Kh\u00f4ng r\u00f5 t\u1ea1i sao nh\u1eefng th\u1eed nghi\u1ec7m li\u00ean t\u1ee5c ch\u1ee9ng minh l\u1ee3i \u00edch s\u1ed1ng s\u00f3t s\u1edbm \u0111\u00e1ng k\u1ec3 m\u00e0 EVAR mang l\u1ea1i, so v\u1edb m\u1ed5 m\u1edf, l\u1ea1i kh\u00f4ng duy tr\u00ec qu\u00e1 2-3 n\u0103m. Nh\u1eefng l\u00fd do h\u1ee3p l\u00fd l\u00e0 nguy c\u01a1 tim m\u1ea1ch ti\u1ec1m \u1ea9n, tu\u00e2n th\u1ee7 k\u00e9m v\u1edbi c\u00e1c khuy\u1ebfn c\u00e1o theo d\u00f5i \u0111i\u1ec1u tr\u1ecb (c\u00f3 th\u1ec3 do t\u01b0 v\u1ea5n kh\u00f4ng \u0111\u1ea7y \u0111\u1ee7 ho\u1eb7c hi\u1ec3u kh\u00f4ng \u0111\u00fang c\u00e1c khuy\u1ebfn c\u00e1o), t\u0103ng t\u00ecnh tr\u1ea1ng vi\u00eam k\u00e9o d\u00e0i do xu\u1ea5t hi\u1ec7n m\u1ed9t t\u00fai ph\u00ecnh nguy\u00ean v\u1eb9n, d\u1eabn \u0111\u1ebfn c\u00e1c bi\u1ebfn c\u1ed1 tim m\u1ea1ch (m\u1ed9t k\u1ebft c\u1ee5c c\u1ea7n ph\u1ea3i nghi\u00ean c\u1ee9u), \u00e1p su\u1ea5t t\u00fai kh\u00ed dai d\u1eb5ng m\u00e0 kh\u00f4ng c\u00f3 endoleak (c\u00f2n d\u00f2ng \u0111\u1ed9ng m\u1ea1ch trong t\u00fai ph\u00ecnh) c\u00f3 th\u1ec3 x\u00e1c \u0111\u1ecbnh nh\u1edd h\u00ecnh \u1ea3nh h\u1ecdc, v\u00e0 c\u00e1c l\u1ed7i thi\u1ebft b\u1ecb.<\/p>\n
H\u00ecnh 3. Can thi\u1ec7p n\u1ed9i m\u1ea1ch ph\u1ee9c h\u1ee3p ph\u00ecnh \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 ng\u1ef1c-b\u1ee5ng. Can thi\u1ec7p n\u1ed9i m\u1ea1ch c\u00f3 l\u1ed7 th\u1ee7ng (h\u00ecnh A) v\u00e0 c\u00f3 nh\u00e1nh (h\u00ecnh B) c\u1ee7a m\u1ed9t ph\u1ee9c h\u1ee3p ph\u00ecnh \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 ng\u1ef1c-b\u1ee5ng.<\/p>\n
M\u1eb7c d\u00f9 s\u1ef1 m\u00f2n c\u1ee7a gi\u00e1 \u0111\u1ee1 (stent graft) gi\u1ea3i th\u00edch m\u1ed9t v\u00e0i h\u01b0 h\u1ecfng c\u1ee7a d\u1ee5ng c\u1ee5, nh\u01b0ng nhi\u1ec1u tr\u01b0\u1eddng h\u1ee3p h\u01b0 h\u1ecfng c\u00f3 th\u1ec3 gi\u1ea3i th\u00edch l\u00e0 do \u0111\u1eb7t kh\u00f4ng ph\u00f9 h\u1ee3p – \u0111\u00f3 l\u00e0, stent \u0111\u1eb7t \u1edf b\u1ec7nh nh\u00e2n c\u00f3 c\u1ea5u tr\u00fac gi\u1ea3i ph\u1eabu kh\u00f4ng ph\u00f9 h\u1ee3p v\u1edbi h\u01b0\u1edbng d\u1eabn s\u1eed d\u1ee5ng. Gi\u1ea3i ph\u1eabu kh\u00f4ng ph\u00f9 h\u1ee3p \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o \u1edf 18-63% b\u1ec7nh nh\u00e2n ti\u1ebfn h\u00e0nh EVAR v\u00e0 r\u00f5 r\u00e0ng c\u00f3 li\u00ean quan k\u1ebft c\u1ee5c ngh\u00e8o n\u00e0n. N\u1ebfu v\u1eabn \u00e1p d\u1ee5ng r\u1ed9ng r\u00e3i k\u1ef9 thu\u1eadt n\u00e0y tr\u00ean b\u1ec7nh nh\u00e2n c\u00f3 c\u1ea5u tr\u00fac gi\u1ea3i ph\u1eabu kh\u00f4ng ph\u00f9 h\u1ee3p, nh\u1eefng l\u1ee3i \u00edch ng\u1eafn h\u1ea1n s\u1ebd b\u1ecb thay th\u1ebf b\u1eb1ng t\u0103ng t\u1ef7 l\u1ec7 \u0111i\u1ec1u tr\u1ecb th\u1ea5t b\u1ea1i, t\u0103ng chi ph\u00ed t\u00e1i can thi\u1ec7p v\u00e0 v\u1ee1 t\u00fai ph\u00ecnh ti\u1ec1m n\u0103ng b\u1ea5t k\u1ef3 th\u1eddi gian n\u00e0o trong qu\u00e1 tr\u00ecnh theo d\u00f5i.<\/p>\n
C\u00e1c c\u00f4ng ngh\u1ec7 n\u1ed9i m\u1ea1ch m\u1edbi \u0111ang m\u1edf r\u1ed9ng ph\u00e1t tri\u1ec3n \u0111\u1ec3 s\u1eed d\u1ee5ng th\u00edch h\u1ee3p EVAR tr\u00ean nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 khi\u1ebfm khuy\u1ebft c\u1ea5u tr\u00fac gi\u1ea3i ph\u1eabu v\u1edbi c\u00e1c thi\u1ebft b\u1ecb th\u01b0\u01a1ng m\u1ea1i hi\u1ec7n c\u00f3 (m\u00e0 \u0111\u01b0\u1ee3c thi\u1ebft k\u1ebf \u0111\u1ec3 \u0111\u1eb7t b\u00ean d\u01b0\u1edbi \u0111\u1ed9ng m\u1ea1ch th\u1eadn). C\u00e1c c\u00f4ng ngh\u1ec7 n\u00e0y y\u00eau c\u1ea7u s\u1ef1 k\u1ebft h\u1ee3p n\u1ed9i m\u1ea1ch c\u1ee7a c\u00e1c nh\u00e1nh b\u00ean \u0111\u1ed9ng m\u1ea1ch ch\u1ee7, nh\u01b0 \u0111\u1ed9ng m\u1ea1ch th\u1eadn v\u00e0 \u0111\u1ed9ng m\u1ea1ch m\u1ea1c treo, v\u1edbi s\u1eed d\u1ee5ng c\u00e1c gi\u00e1 \u0111\u1ee1 \u0111\u01b0\u1ee3c thi\u1ebft k\u1ebf \u0111\u1eb7t bi\u1ec7t c\u00f3 c\u00e1c l\u1ed7 m\u1edf b\u1eb1ng v\u1ea3i (\u0111\u1ec7m t\u0103ng c\u01b0\u1eddng) ho\u1eb7c c\u00e1c nh\u00e1nh b\u00ean (nh\u00e1nh c\u00f3 h\u01b0\u1edbng).<\/p>\n
$\"H\u00ecnh$
H\u00ecnh 4. Can thi\u1ec7p m\u1ed5 m\u1edf ph\u1ee9c h\u1ee3p ph\u00ecnh \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 ng\u1ef1c-b\u1ee5ng<\/figcaption><\/figure>\n
B\u1ed9c l\u1ed9 khoang ng\u1ef1c v\u00e0 b\u1ee5ng, ph\u00e2n chia c\u01a1 ho\u00e0nh, k\u1eb9p qua \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 ph\u00eda tr\u00ean v\u00e0 d\u01b0\u1edbi t\u00fai ph\u00ecnh, kh\u00e2u m\u1ed9t \u1ed1ng gh\u00e9p nh\u00e2n t\u1ea1o \u0111\u1eb7t v\u00e0o t\u00fai ph\u00ecnh, v\u1edbi s\u1ef1 k\u1ebft h\u1ee3p c\u1ee7a \u0111\u1ed9ng m\u1ea1ch th\u00e2n t\u1ea1ng, \u0111\u1ed9ng m\u1ea1ch m\u1ea1c treo tr\u00e0ng tr\u00ean, \u0111\u1ed9ng m\u1ea1ch th\u1eadn tr\u00e1i v\u00e0 \u0111\u1ed9ng m\u1ea1ch th\u1eadn ph\u1ea3i.<\/p>\n
Sau khi gh\u00e9p gi\u00e1 \u0111\u1ee1 \u0111\u1ed9ng m\u1ea1ch ch\u1ee7, c\u00e1c stent b\u1eafc c\u1ea7u \u0111\u01b0\u1ee3c \u0111\u1eb7t v\u00e0o gi\u1eefa c\u00e1c l\u1ed7 th\u1ee7ng ho\u1eb7c c\u00e1c nh\u00e1nh v\u00e0 m\u1ed7i m\u1ea1ch m\u00e1u m\u1ee5c ti\u00eau. C\u1ea3 2 d\u1ea1ng can thi\u1ec7p n\u1ed9i m\u1ea1ch \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 \u1edf c\u00e1c l\u1ed7 th\u1ee7ng v\u00e0 c\u00e1c nh\u00e1nh – t\u1eeb v\u00f2m \u0111\u1ed9ng m\u1ea1ch ch\u1ee7, xuy\u00ean qua \u0111o\u1ea1n n\u1ed9i t\u1ea1ng v\u00e0 \u0111\u1ebfn \u0111\u1ed9ng m\u1ea1ch ch\u1eadu – \u0111\u00e3 \u0111\u01b0\u1ee3c \u00e1p d\u1ee5ng t\u1ea1i c\u00e1c trung t\u00e2m l\u1edbn kh\u1eafp th\u1ebf gi\u1edbi chuy\u00ean \u0111i\u1ec1u tr\u1ecb ph\u00ecnh \u0111\u1ed9ng m\u1ea1ch ph\u1ee9c t\u1ea1p. Nh\u00ecn chung, c\u00e1c l\u1ed7 th\u1ee7ng t\u0103ng c\u01b0\u1eddng \u0111\u01b0\u1ee3c \u01b0u ti\u00ean tr\u00ean b\u1ec7nh nh\u00e2n ph\u00ecnh \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 c\u00f3 v\u1ecb tr\u00ed ch\u1ee7 y\u1ebfu trong \u1ed5 b\u1ee5ng (nh\u01b0 ph\u00ecnh \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 b\u00ean th\u1eadn) (h\u00ecnh 3A), trong khi \u0111\u00f3 can thi\u1ec7p n\u1ed9i m\u1ea1ch qua c\u00e1c nh\u00e1nh \u01b0u ti\u00ean d\u00f9ng tr\u00ean b\u1ec7nh nh\u00e2n ph\u00ecnh \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 m\u1edf r\u1ed9ng v\u00e0o l\u1ed3ng ng\u1ef1c (h\u00ecnh 3B), n\u01a1i c\u00f3 kho\u1ea3ng tr\u1ed1ng r\u1ed9ng h\u01a1n gi\u1eefa gi\u00e1 \u0111\u1ee1 \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 v\u00e0 nh\u00e1nh b\u00ean. Kh\u00f4ng gi\u1ed1ng EVAR d\u01b0\u1edbi th\u1eadn, m\u00e0 c\u00f3 th\u1ec3 theo d\u00f5i th\u01b0\u1eddng quy b\u1eb1ng c\u00e1ch si\u00eau \u00e2m k\u00e9p \u1ed5 b\u1ee5ng, EVAR c\u00e1c l\u1ed7 th\u1ee7ng v\u00e0 nh\u00e1nh (FB-EVAR) th\u01b0\u1eddng ph\u1ea3i ch\u1ee5p CT m\u1ea1ch m\u00e1u nh\u1eb1m m\u1ee5c \u0111\u00edch x\u00e1c \u0111\u1ecbnh h\u00ecnh \u1ea3nh gi\u00e1 \u0111\u1ee1 m\u1edf r\u1ed9ng v\u00e0o ng\u1ef1c, m\u00e0 si\u00eau \u00e2m kh\u00f4ng th\u1ec3 l\u00e0m \u0111\u01b0\u1ee3c.<\/p>\n
Can thi\u1ec7p m\u1ed5 h\u1edf ph\u1ee9c h\u1ee3p ph\u00ecnh \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 l\u00e0 th\u1ee7 thu\u1eadt kh\u00e1 th\u00e1ch th\u1ee9c, \u0111\u00f2i h\u1ecfi b\u1ed9c l\u1ed9 r\u1ed9ng v\u1ebft m\u1ed5 v\u00e0 th\u1eddi gian k\u00e9o d\u00e0i h\u01a1n thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9 c\u01a1 quan \u0111\u00edch trong qu\u00e1 tr\u00ecnh k\u1eb9p \u0111\u1ed9ng \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 (h\u00ecnh 4). V\u00ec l\u00fd do n\u00e0y, nguy c\u01a1 m\u1eafc b\u1ec7nh v\u00e0 t\u1ef7 l\u1ec7 t\u1eed vong t\u0103ng l\u00ean \u0111\u00e1ng k\u1ec3 so v\u1edbi can thi\u1ec7p \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 b\u1ee5ng d\u01b0\u1edbi th\u1eadn. Hi\u1ec7n nay kh\u00f4ng c\u00f3 c\u00e1c th\u1eed nghi\u1ec7m ng\u1eabu nhi\u00ean so s\u00e1nh gi\u1eefa m\u1ed5 h\u1edf v\u00e0 FB-EVAR tr\u00ean b\u1ec7nh nh\u00e2n ph\u00ecnh \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 ph\u1ee9c h\u1ee3p. C\u00e1c nghi\u00ean c\u1ee9u quan s\u00e1t ti\u1ec1n c\u1ee9u \u0111\u01a1n trung t\u00e2m v\u00e0 \u0111a trung t\u00e2m \u0111\u00e3 ch\u1ee9ng minh t\u1ef7 l\u1ec7 th\u1ea5p c\u00e1c bi\u1ebfn ch\u1ee9ng v\u00e0 t\u1eed vong v\u1edbi FB-EVAR so v\u1edbi c\u00e1c nghi\u00ean c\u1ee9u \u0111o\u00e0n h\u1ec7 c\u00f3 t\u00ednh l\u1ecbch s\u1eed \u0111\u00e3 \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o m\u1ed5 h\u1edf. V\u00ed d\u1ee5, theo m\u1ed9t nghi\u00ean c\u1ee9u c\u1ee7a Hi\u1ec7p h\u1ed9i \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 Hoa K\u1ef3, t\u1ef7 l\u1ec7 t\u1eed vong trong 30 ng\u00e0y l\u00e0 1.1% tr\u00ean t\u1ed5ng s\u1ed1 893 b\u1ec7nh nh\u00e2n l\u00e0m FB[1]EVAR \u0111i\u1ec1u tr\u1ecb ph\u00ecnh \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 b\u00ean th\u1eadn ho\u1eb7c ng\u1ef1c-b\u1ee5ng, trong khi \u0111\u00f3 nhi\u1ec1u nghi\u00ean c\u1ee9u l\u1edbn, \u0111\u01a1n trung t\u00e2m \u0111\u00e1nh gi\u00e1 can thi\u1ec7p m\u1ed5 h\u1edf ph\u00ecnh \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 ng\u1ef1c-b\u1ee5ng, t\u1ef7 l\u1ec7 t\u1eed vong trong 30 ng\u00e0y dao \u0111\u1ed9ng t\u1eeb 7-16%. Trong khi ch\u1edd th\u00eam d\u1eef li\u1ec7u \u0111\u1ec3 bi\u1ebft t\u00ednh hi\u1ec7u qu\u1ea3 c\u1ee7a c\u00e1c thi\u1ebft b\u1ecb FB-EVAR, quy\u1ec1n truy c\u1eadp v\u00e0o c\u00e1c thi\u1ebft b\u1ecb n\u00e0y v\u1eabn b\u1ecb gi\u1edbi h\u1ea1n \u1edf v\u00e0i trung t\u00e2m t\u1ea1i Hoa K\u1ef3, n\u01a1i m\u00e0 c\u00e1c nghi\u00ean c\u1ee9u mi\u1ec5n tr\u1eeb thi\u1ebft b\u1ecb \u0111\u01b0\u1ee3c ch\u1ea5p thu\u1eadn do C\u1ee5c qu\u1ea3n l\u00fd th\u1ef1c ph\u1ea9m v\u00e0 thu\u1ed1c \u0111ang \u0111\u01b0\u1ee3c ti\u1ebfn h\u00e0nh (xem ClinicalTrial.gov numbers, NCT02050113 and NCT02089607).<\/p>\n
C\u00e1c h\u01b0\u1edbng d\u1eabn<\/h2>\n
C\u00e1c h\u01b0\u1edbng d\u1eabn \u0111i\u1ec1u tr\u1ecb ph\u00ec \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 b\u1ee5ng \u0111\u1ec1u \u0111\u01b0\u1ee3c c\u00f4ng b\u1ed1 b\u1edfi Hi\u1ec7p h\u1ed9i ph\u1eabu thu\u1eadt m\u1ea1ch m\u00e1u (SVS) v\u00e0 Hi\u1ec7p h\u1ed9i ph\u1eabu thu\u1eadt m\u1ea1ch m\u00e1u ch\u00e2u \u00c2u (ESVS). C\u1ea3 2 t\u00e0i li\u1ec7u \u0111\u1ec1u c\u00f3 m\u1ee9c ch\u1ee9ng c\u1ee9 B (trung b\u00ecnh, SVS) ho\u1eb7c m\u1ee9c C (th\u1ea5p, ESVS), \u0111\u1ed9 2 (y\u1ebfu) khuy\u1ebfn c\u00e1o can thi\u1ec7p c\u00f3 l\u1ef1a ch\u1ecdn t\u00fai ph\u00ecnh c\u00f3 \u0111\u01b0\u1eddng k\u00ednh 5.5cm ho\u1eb7c l\u1edbn h\u01a1n. V\u1edbi k\u00edch th\u01b0\u1edbc b\u1ea9m sinh c\u1ee7a \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 \u1edf ph\u1ee5 n\u1eef, c\u00e1c hi\u1ec7p h\u1ed9i \u0111\u01b0a ra m\u1ee9c ch\u1ee9ng c\u1ee9 B (trung b\u00ecnh, SVS), m\u1ee9c C (th\u1ea5p, ESVS), m\u1ee9c 2 (y\u1ebfu) khuy\u1ebfn c\u00e1o \u0111i\u1ec1u tr\u1ecb c\u00f3 ch\u1ecdn l\u1ecdc c\u00e1c t\u00fai ph\u00ecnh c\u00f3 \u0111\u01b0\u1eddng k\u00ednh 5cm ho\u1eb7c l\u1edbn h\u01a1n \u1edf ph\u1ee5 n\u1eef. M\u1eb7c d\u00f9 c\u00e1c h\u01b0\u1edbng d\u1eabn kh\u00f4ng bao g\u1ed3m m\u1ed9t khuy\u1ebfn c\u00e1o v\u1ec1 nh\u1eefng l\u1ee3i \u00edch c\u1ee7a m\u1ed5 h\u1edf so v\u1edbi EVAR, c\u00e1c h\u01b0\u1edbng d\u1eabn c\u1ee7a ESVS khuy\u1ebfn c\u00e1o can thi\u1ec7p b\u1eb1ng EVAR trong h\u1ea7u h\u1ebft b\u1ec7nh nh\u00e2n c\u00f3 gi\u1ea3i ph\u1eabu ph\u00f9 h\u1ee3p v\u00e0 kh\u1ea3 thi k\u00e9o d\u00e0i s\u1ef1 s\u1ed1ng (> 2 n\u0103m). C\u1ea3 2 h\u01b0\u1edbng d\u1eabn \u0111\u1ec1u kh\u00f4ng c\u00f3 \u0111i\u1ec1u tr\u1ecb \u0111\u1eb7c hi\u1ec7u \u0111\u01b0\u1ee3c ch\u1ea5p thu\u1eadn c\u00f3 th\u1ec3 l\u00e0m ch\u1eadm l\u1ea1i t\u1ed1c \u0111\u1ed9 gi\u00e3n t\u00fai ph\u00ecnh.<\/p>\n
Ng\u01b0\u1eddi ta th\u1eeba nh\u1eadn thi\u1ebfu d\u1eef li\u1ec7u trong c\u00e1c nghi\u00ean c\u1ee9u ng\u1eabu nhi\u00ean \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 k\u1ebft c\u1ee5c v\u00e0 ti\u1ebft ki\u1ec7m chi ph\u00ed s\u00e0ng l\u1ecdc nh\u1eefng ng\u01b0\u1eddi th\u00e2n b\u1eadc 1 (ba, m\u1eb9, anh\/ch\u1ecb\/em ru\u1ed9t) m\u1eafc ph\u00ecnh \u0111\u1ed9ng m\u1ea1ch ch\u1ee7, c\u1ea3 2 h\u01b0\u1edbng d\u1eabn SVS v\u00e0 ESVS khuy\u1ebfn c\u00e1o s\u00e0ng l\u1ecdc si\u00eau \u00e2m 1 l\u1ea7n nh\u1eefng ng\u01b0\u1eddi th\u00e2n b\u1eadc 1 nam v\u00e0 n\u1eef (m\u1ee9c ch\u1ee9ng c\u1ee9 C, th\u1ea5p), khuy\u1ebfn c\u00e1o m\u1ee9c 2, y\u1ebfu), m\u1eb7c d\u00f9 c\u00e1c hi\u1ec7p h\u1ed9i ph\u00e2n bi\u1ec7t tu\u1ed5i t\u00e1c \u0111\u1ec3 s\u00e0ng l\u1ecdc (nam 65 tu\u1ed5i v\u00e0 n\u1eef 50 tu\u1ed5i). Nh\u1eadn th\u1ea5y ph\u00f9 h\u1ee3p v\u1edbi h\u01b0\u1edbng d\u1eabn c\u1ee7a SVS, c\u00e1c trung t\u00e2m cung c\u1ea5p d\u1ecbch v\u1ee5 ch\u0103m s\u00f3c v\u00e0 h\u1ed7 tr\u1ee3 y t\u1ebf \u0111\u00e3 \u0111\u01b0a ra g\u00f3i b\u1ea3o hi\u1ec3m s\u00e0ng l\u1ecdc si\u00eau \u00e2m 1 l\u1ea7n \u1edf nam v\u00e0 n\u1eef c\u00f3 ti\u1ec1n s\u1eed gia \u0111\u00ecnh m\u1eafc b\u1ec7nh ph\u00ecnh \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 nh\u01b0 1 ph\u1ea7n trong d\u1ecbch v\u1ee5 kh\u00e1m s\u1ee9c kh\u1ecfe c\u1ee7a h\u1ecd \u201cch\u00e0o m\u1eebng \u0111\u1ebfn v\u1edbi trung t\u00e2m y khoa\u201d (\u0111\u00e0n \u00f4ng t\u1eeb 65-75 tu\u1ed5i c\u0169ng \u0111\u01b0\u1ee3c b\u1ea3o hi\u1ec3m n\u1ebfu h\u1ecd h\u00fat >100 \u0111i\u1ebfu thu\u1ed1c trong su\u1ed1t cu\u1ed9c \u0111\u1eddi); ch\u00fang t\u00f4i \u0111\u1ed3ng \u00fd v\u1edbi c\u00e1c khuy\u1ebfn c\u00e1o trong h\u01b0\u1edbng d\u1eabn SVS. Hi\u1ec7n nay h\u1ea7u h\u1ebft c\u00e1c khuy\u1ebfn c\u00e1o s\u00e0ng l\u1ecdc t\u1eeb nh\u00f3m chuy\u00ean tr\u00e1ch d\u1ecbch v\u1ee5 d\u1ef1 ph\u00f2ng Hoa K\u1ef3 \u0111\u1ec1u nh\u1ea5t qu\u00e1n v\u1edbi nh\u1eefng h\u01b0\u1edbng d\u1eabn n\u00e0y \u1edf nam, nh\u01b0ng trong tr\u01b0\u1eddng h\u1ee3p kh\u00f4ng c\u00f3 \u0111\u1ee7 d\u1eef li\u1ec7u, d\u1ecbch v\u1ee5 d\u1ef1 ph\u00f2ng khuy\u1ebfn c\u00e1o n\u00ean s\u00e0ng l\u1ecdc \u1edf ph\u1ee5 n\u1eef c\u00f3 ng\u01b0\u1eddi th\u00e2n b\u1eadc 1 b\u1ecb ph\u00ecnh \u0111\u1ed9ng m\u1ea1ch ch\u1ee7.<\/p>\n
K\u1ebft lu\u1eadn v\u00e0 khuy\u1ebfn c\u00e1o<\/h2>\n
B\u1ec7nh nh\u00e2n ph\u00ecnh \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 b\u1ee5ng d\u01b0\u1edbi th\u1eadn c\u00f3 \u0111\u01b0\u1eddng k\u00ednh l\u1edbn h\u01a1n 5.5cm l\u00e0 ng\u01b0\u1ee1ng can thi\u1ec7p. Ch\u1ee5p m\u1ea1ch m\u00e1u CT v\u1edbi l\u00e1t c\u1eaft m\u1ecfng (1-2mm) v\u00f9ng b\u1ee5ng v\u00e0 ch\u1eadu \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh c\u1ea5u tr\u00fac gi\u1ea3i ph\u1eabu c\u1ee7a b\u1ec7nh nh\u00e2n c\u00f3 ph\u00f9 h\u1ee3p v\u1edbi th\u1ee7 thu\u1eadt EVAR kh\u00f4ng v\u00e0 \u0111\u00e1nh gi\u00e1 th\u00eam sau m\u1ed5 nguy c\u01a1 ph\u1eabu thu\u1eadt. N\u1ebfu gi\u1ea3i ph\u1eabu c\u00f3 th\u1ec3 can thi\u1ec7p b\u1eb1ng thi\u1ebft b\u1ecb EVAR th\u01b0\u1eddng quy, h\u1ea7u h\u1ebft c\u00e1ch ti\u1ebfp c\u1eadn \u0111i\u1ec1u tr\u1ecb ph\u00f9 h\u1ee3p d\u1ef1a v\u00e0o \u0111\u00e1nh gi\u00e1 nguy c\u01a1 ph\u1eabu thu\u1eadt v\u00e0 mong mu\u1ed1n c\u1ee7a b\u1ec7nh nh\u00e2n, n\u00ean gi\u1ea3i th\u00edch cho b\u1ec7nh nh\u00e2 nh\u1eb1m \u0111\u01b0a ra quy\u1ebft \u0111\u1ecbnh chung. Tr\u00ean b\u1ec7nh nh\u00e2n c\u00f3 nguy c\u01a1 ph\u1eabu thu\u1eadt cao, EVAR l\u00e0 l\u1ef1a ch\u1ecdn h\u00e0ng \u0111\u1ea7u v\u00ec gi\u1ea3m t\u1ef7 l\u1ec7 m\u1eafc b\u1ec7nh v\u00e0 t\u1eed vong so v\u1edbi m\u1ed5 m\u1edf. N\u1ebfu x\u00e1c \u0111\u1ecbnh \u0111\u01b0\u1ee3c nguy c\u01a1 ph\u1eabu thu\u1eadt tr\u00ean b\u1ec7nh nh\u00e2n th\u1ea5p ho\u1eb7c trung b\u00ecnh, l\u1ef1a ch\u1ecdn EVAR ho\u1eb7c m\u1ed5 m\u1edf \u0111\u1ec1u h\u1ee3p l\u00fd. Ch\u00fang t\u00f4i \u01b0a chu\u1ed9ng d\u00f9ng EVAR n\u1ebfu b\u1ec7nh nh\u00e2n cam k\u1ebft theo d\u00f5i su\u1ed1t \u0111\u1eddi b\u1eb1ng h\u00ecnh \u1ea3nh c\u1eadn l\u00e2m s\u00e0ng n\u1ebfu kh\u00f4ng s\u1ebd ti\u1ebfn h\u00e0nh m\u1ed5 m\u1edf, gi\u00e1o d\u1ee5c b\u1ec7nh nh\u00e2n v\u1ec1 m\u1ed1i quan h\u1ec7 gi\u1eefa kh\u00f4ng tu\u00e2n th\u1ee7 theo d\u00f5i v\u00e0 t\u0103ng nguy c\u01a1 b\u1ec7nh t\u1eadt v\u00e0 t\u1eed vong trong th\u1eddi gian ng\u1eafn v\u00e0 nguy c\u01a1 t\u1ed1n nhi\u1ec1u t\u1eddi gian h\u1ed3i ph\u1ee5c. Ch\u00fang t\u00f4i c\u0169ng khuy\u1ebfn c\u00e1o b\u1ea5t k\u1ef3 ng\u01b0\u1eddi th\u00e2n b\u1eadc 1 n\u00e0o c\u1ee7a b\u1ec7nh nh\u00e2n 65 tu\u1ed5i tr\u1edf l\u00ean n\u00ean \u0111i t\u1ea7m so\u00e1t b\u1eb1ng si\u00eau \u00e2m ki\u1ec3m tra \u0111\u1ed9ng m\u1ea1ch ch\u1ee7.<\/p>\n
T\u00e0i li\u1ec7u tham kh\u1ea3o<\/h2>\n
\n
Chaikof EL, Dalman RL, Eskandari MK, et al. The Society for Vascular Surgery practice guidelines on the care of patients with an abdominal aortic aneurysm. J Vasc Surg 2018; 67(1): 2.e2-77.e2.<\/li>\n
Kent KC, Zwolak RM, Egorova NN, et al. Analysis of risk factors for abdominal aortic aneurysm in a cohort of more than 3 million individuals. J Vasc Surg 2010; 52: 539-48.<\/li>\n
Summers KL, Kerut EK, Sheahan CM, Sheahan MG III. Evaluating the preva[1]lence of abdominal aortic aneurysms in the United States through a national screening database. J Vasc Surg 2021; 73: 61-8.<\/li>\n
Chan WK, Yong E, Hong Q, et al. Sys[1]tematic review and meta-analysis of the prevalence of abdominal aortic aneurysm in Asian populations. J Vasc Surg 2021; 73(3): 1069.e1-1074.e1.<\/li>\n
Lederle FA, Johnson GR, Wilson SE, et al. Prevalence and associations of ab[1]dominal aortic aneurysm detected through screening. Ann Intern Med 1997; 126: 441-9.<\/li>\n
Brown PM, Zelt DT, Sobolev B. The risk of rupture in untreated aneurysms: the impact of size, gender, and expansion rate. J Vasc Surg 2003; 37: 280-4.<\/li>\n
Lederle FA, Wilson SE, Johnson GR, et al. Immediate repair compared with surveillance of small abdominal aortic aneurysms. N Engl J Med 2002; 346: 1437- 44.<\/li>\n
The UK Small Aneurysm Trial Partici[1]pants. Mortality results for randomised controlled trial of early elective surgery or ultrasonographic surveillance for small abdominal aortic aneurysms. Lancet 1998; 352: 1649-55.<\/li>\n
Filardo G, Powell JT, Martinez MA-M, Ballard DJ. Surgery for small asymptomatic abdominal aortic aneurysms. Cochrane Database Syst Rev 2015; 2: CD001835.<\/li>\n
Sharp MA, Collin J. A myth exposed: fast growth in diameter does not justify precocious abdominal aortic aneurysm repair. Eur J Vasc Endovasc Surg 2003; 25: 408-11.<\/li>\n
Sweeting MJ, Thompson SG, Brown LC, Powell JT; RESCAN collaborators. Meta-analysis of individual patient data to examine factors affecting growth and rupture of small abdominal aortic aneu[1]rysms. Br J Surg 2012; 99: 655-65.<\/li>\n
Brown LC, Powell JT. Risk factors for aneurysm rupture in patients kept under ultrasound surveillance. Ann Surg 1999; 230: 289-97.<\/li>\n
Wanhainen A, Verzini F, Van Herzeele I, et al. Editor\u2019s choice \u2014 European Soci[1]ety for Vascular Surgery (ESVS) 2019 clin[1]ical practice guidelines on the manage[1]ment of abdominal aorto-iliac artery aneurysms. Eur J Vasc Endovasc Surg 2019; 57: 8-93.<\/li>\n
Chaikof EL, Brewster DC, Dalman RL, et al. SVS practice guidelines for the care of patients with an abdominal aortic an[1]eurysm: executive summary. J Vasc Surg 2009; 50: 880-96.<\/li>\n
Volodos NL, Karpovich IP, Troyan VI, et al. Clinical experience of the use of self[1]fixing synthetic prostheses for remote en[1]doprosthetics of the thoracic and the ab[1]dominal aorta and iliac arteries through the femoral artery and as intraoperative endoprosthesis for aorta reconstruction. Vasa Suppl 1991; 33: 93-5.<\/li>\n
Parodi JC, Palmaz JC, Barone HD. Transfemoral intraluminal graft implan[1]tation for abdominal aortic aneurysms. Ann Vasc Surg 1991; 5: 491-9.<\/li>\n
Lederle FA, Freischlag JA, Kyriakides TC, et al. Outcomes following endovascu[1]lar vs open repair of abdominal aortic an[1]eurysm: a randomized trial. JAMA 2009; 302: 1535-42.<\/li>\n
Buck DB, van Herwaarden JA, Schermerhorn ML, Moll FL. Endovascular treatment of abdominal aortic aneurysms. Nat Rev Cardiol 2014; 11: 112-23.<\/li>\n
Dua A, Kuy S, Lee CJ, Upchurch GR Jr, Desai SS. Epidemiology of aortic aneu[1]rysm repair in the United States from 2000 to 2010. J Vasc Surg 2014; 59: 1512-7.<\/li>\n
Greenhalgh RM, Brown LC, Powell JT, Thompson SG, Epstein D, Sculpher MJ. Endovascular versus open repair of abdominal aortic aneurysm. N Engl J Med 2010; 362: 1863-71.<\/li>\n
De Bruin JL, Baas AF, Buth J, et al. Long-term outcome of open or endovas[1]cular repair of abdominal aortic aneu[1]rysm. N Engl J Med 2010; 362: 1881-9.<\/li>\n
Schermerhorn ML, O\u2019Malley AJ, Jhaveri A, Cotterill P, Pomposelli F, Landon BE. Endovascular vs. open repair of abdomi[1]nal aortic aneurysms in the Medicare population. N Engl J Med 2008; 358: 464- 74.<\/li>\n
Schanzer A, Greenberg RK, Hevelone N, et al. Predictors of abdominal aortic aneurysm sac enlargement after endovas[1]cular repair. Circulation 2011; 123: 2848- 55.<\/li>\n
Moll FL, Powell JT, Fraedrich G, et al. Management of abdominal aortic aneu[1]rysms clinical practice guidelines of the European Society for Vascular Surgery. Eur J Vasc Endovasc Surg 2011; 41: Suppl 1: S1-S58.<\/li>\n
Brenner DJ, Hall EJ. Computed tomography \u2014 an increasing source of radiation exposure. N Engl J Med 2007; 357: 2277-84.<\/li>\n
Einstein AJ, Moser KW, Thompson RC, Cerqueira MD, Henzlova MJ. Radia[1]tion dose to patients from cardiac diagnostic imaging. Circulation 2007; 116: 1290-305.<\/li>\n
Davenport MS, Perazella MA, Yee J, et al. Use of intravenous iodinated con[1]trast media in patients with kidney disease: consensus statements from the American College of Radiology and the National Kidney Foundation. Kidney Med 2020; 2: 85-93.<\/li>\n
Schermerhorn ML, Buck DB, O\u2019Malley AJ, et al. Long-term outcomes of abdom[1]inal aortic aneurysm in the Medicare population. N Engl J Med 2015; 373: 328- 38.<\/li>\n
Schanzer A, Messina LM, Ghosh K, et al. Follow-up compliance after endo[1]vascular abdominal aortic aneurysm re[1]pair in Medicare beneficiaries. J Vasc Surg 2015; 61(1): 16.e1-22.e1.<\/li>\n
O\u2019Donnell TFX, Deery SE, Boitano LT, et al. Aneurysm sac failure to regress after endovascular aneurysm repair is associ[1]ated with lower long-term survival. J Vasc Surg 2019; 69: 414-22.<\/li>\n
Deery SE, Ergul EA, Schermerhorn ML, et al. Aneurysm sac expansion is in[1]dependently associated with late mortal[1]ity in patients treated with endovascular aneurysm repair. J Vasc Surg 2018;67:157- 64.<\/li>\n
Holt PJE, Karthikesalingam A, Patter[1]son BO, et al. Aortic rupture and sac ex[1]pansion after endovascular repair of ab[1]dominal aortic aneurysm. Br J Surg 2012; 99:1657-64.<\/li>\n
AbuRahma AF, Campbell J, Stone PA, et al. The correlation of aortic neck length to early and late outcomes in endovascu[1]lar aneurysm repair patients. J Vasc Surg 2009;50:738-48.<\/li>\n
Abbruzzese TA, Kwolek CJ, Brewster DC, et al. Outcomes following endovascu[1]lar abdominal aortic aneurysm repair (EVAR): an anatomic and device-specific analysis. J Vasc Surg 2008;48:19-28.<\/li>\n
Aburahma AF, Campbell JE, Mousa AY, et al. Clinical outcomes for hostile versus favorable aortic neck anatomy in endovascular aortic aneurysm repair us[1]ing modular devices. J Vasc Surg 2011;54: 13-21.<\/li>\n
Pitoulias GA, Valdivia AR, Hahtaporn[1]sawan S, et al. Conical neck is strongly associated with proximal failure in stan[1]dard endovascular aneurysm repair. J Vasc Surg 2017;66:1686-95.<\/li>\n
Simons JP, Crawford AS, Flanagan CP, et al. Evolution of fenestrated\/branched endovascular aortic aneurysm repair com[1]plexity and outcomes at an organized cen[1]ter for the treatment of complex aortic disease. J Vasc Surg 2021;73(4):1148.e2- 1155.e2.<\/li>\n
Tenorio ER, Oderich GS, K\u00f6lbel T, et al. Multicenter global early feasibility study to evaluate total endovascular arch repair using three-vessel inner branch stent[1]grafts for aneurysms and dissections. J Vasc Surg 2021 April 16 (Epub ahead of print).<\/li>\n
Verscheure D, Haulon S, Tsilimparis N, et al. Endovascular treatment of post type A chronic aortic arch dissection with a branched endograft: early results from a retrospective international multicenter study. Ann Surg 2021;273:997-1003.<\/li>\n
Dake MD, Fischbein MP, Bavaria JE, et al. Evaluation of the Gore TAG thoracic branch endoprosthesis in the treatment of proximal descending thoracic aortic an[1]eurysms. J Vasc Surg 2021 April 30 (Epub ahead of print).<\/li>\n
Nordon IM, Hinchliffe RJ, Holt PJ, Loftus IM, Thompson MM. Modern treat[1]ment of juxtarenal abdominal aortic an[1]eurysms with fenestrated endografting and open repair \u2014 a systematic review. Eur J Vasc Endovasc Surg 2009;38:35-41.<\/li>\n
Oderich GS, Farber MA, Schneider D, et al. Final 5-year results of the United States Zenith Fenestrated prospective mul[1]ticenter study for juxtarenal abdominal aortic aneurysms. J Vasc Surg 2021;73(4): 1128.e2-1138.e2.<\/li>\n
Farber MA, Oderich GS, Timaran C, Sanchez LA, Dawson Z. Results from a prospective multicenter feasibility study of Zenith p-Branch stent graft. J Vasc Surg 2019;70(5):1409.e3-1418.e3.<\/li>\n
Schneider DB, Matsumura JS, Lee JT, Peterson BG, Chaer RA, Oderich GS. Pro[1]spective, multicenter study of endovascu[1]lar repair of aortoiliac and iliac aneurysms using the Gore Iliac Branch Endoprosthe[1]sis. J Vasc Surg 2017;66:775-85.<\/li>\n
Coselli JS, LeMaire SA, Preventza O, et al. Outcomes of 3309 thoracoabdomi[1]nal aortic aneurysm repairs. J Thorac Car[1]diovasc Surg 2016;151:1323-37.<\/li>\n
Wong DR, Parenti JL, Green SY, et al. Open repair of thoracoabdominal aortic aneurysm in the modern surgical era: con[1]temporary outcomes in 509 patients. J Am Coll Surg 2011;212:569-81.<\/li>\n
Rigberg DA, McGory ML, Zingmond DS, et al. Thirty-day mortality statistics underestimate the risk of repair of thora[1]coabdominal aortic aneurysms: a state[1]wide experience. J Vasc Surg 2006;43:217- 23.<\/li>\n
K\u00e4rkk\u00e4inen JM, Sandri GA, Tenorio ER, et al. Prospective assessment of health[1]related quality of life after endovascular repair of pararenal and thoracoabdomi[1]nal aortic aneurysms using fenestrated[1]branched endografts. J Vasc Surg 2019; 69(5):1356.e6-1366.e6.<\/li>\n
Schanzer A, Beck AW, Eagleton M, et al. Results of fenestrated and branched endovascular aortic aneurysm repair after failed infrarenal endovascular aortic an[1]eurysm repair. J Vasc Surg 2020;72:849- 58.<\/li>\n
Motta F, Oderich GS, Tenorio ER, et al. Fenestrated-branched endovascular aortic repair is a safe and effective option for octogenarians in treating complex aortic aneurysm compared with nonoctogenari[1]ans. J Vasc Surg 2021;74(2):353.e1-362.e1.<\/li>\n
Estrera AL, Sandhu HK, Charlton-Ouw KM, et al. A quarter century of organ pro[1]tection in open thoracoabdominal repair. Ann Surg 2015;262:660-8.<\/li>\n
Latz CA, Cambria RP, Patel VI, et al. Durability of open surgical repair of type I-III thoracoabdominal aortic aneurysm. J Vasc Surg 2019;70:413-23.<\/li>\n
Bj\u00f6rck M, Earnshaw JJ, Acosta S, et al. Editor\u2019s choice \u2014 European Society for Vascular Surgery (ESVS) 2020 clinical practice guidelines on the management of acute limb ischaemia. Eur J Vasc Endovasc Surg 2020;59:173-218.<\/li>\n
Shreibati JB, Baker LC, Hlatky MA, Mell MW. Impact of the Screening Ab[1]dominal Aortic Aneurysms Very Efficient[1]ly (SAAAVE) Act on abdominal ultrasonog[1]raphy use among Medicare beneficiaries. Arch Intern Med 2012;172:1456-62.<\/li>\n
Owens DK, Davidson KW, Krist AH, et al. Screening for abdominal aortic an[1]eurysm: US Preventive Services Task Force recommendation statement. JAMA 2019; 322:2211-8.<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"
nhathuocluuanh. \u0110i\u1ec1u tr\u1ecb ph\u00ecnh \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 b\u1ee5ng \u0110\u1ec3 t\u1ea3i file PDF, h\u00e3y click T\u1ea0I \u0110\u00c2Y. Andres Schanzer, M.D., and Gustavo S. Oderich, M.D. D\u1ecbch: B\u00e1c s\u0129. Hu\u1ef3nh Ph\u1ea1m Ho\u00e0ng Nam B\u1ec7nh nh\u00e2n nam 64 tu\u1ed5i \u0111\u1ebfn b\u00e1c s\u0129 gia \u0111\u00ecnh \u0111\u1ec3 kh\u00e1m b\u1ec7nh th\u01b0\u1eddng quy th\u00ec ph\u00e1t hi\u1ec7n m\u1ed9t kh\u1ed1i s\u1edd th\u1ea5y \u0111\u01b0\u1ee3c, n\u1eb1m […]\n","protected":false},"author":1,"featured_media":34439,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[1],"tags":[],"class_list":["post-34432","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-y-te-suc-khoe"],"acf":[],"_links":{"self":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/34432","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/comments?post=34432"}],"version-history":[{"count":0,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/34432\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media\/34439"}],"wp:attachment":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media?parent=34432"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/categories?post=34432"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/tags?post=34432"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}