Aort cerrahisi sonrası anastomoz psödoanevrizması

Özet

Anastomoz psödoanevrizması, cerrahi anastomoz bölgesindeki aort duvarı bütünlüğünün bozulması sonucu adventisya veya çevre dokularca sınırlanan ekstraluminal kontrastlı kesedir. BTA, anastomozdan dışa uzanan kontrastlı keseyi, iletişim boynunu ve komşu mediastinal hematomu değerlendirir; bulgular klinik bağlamda yorumlanır. Enfeksiyon anastomoz psödoanevrizmasına yol açabilen nedenlerden biridir; anastomoz düzeyindeki kontrast ekstravazasyonu greft dehisansını gösterir. Anastomoz psödoanevrizması rüptür veya fistülle komplike olabilir; koroner buton ve bağlanmış greft yan dalı gibi cerrahi görünümler psödoanevrizmayı taklit edebilir.

Faz ve pencere

Kontrastsız tanısal

Anastomoz çevresindeki hematom, kalsifikasyon, pledget ve hemostatik materyal belirlenir; kontrastlı seride kese gibi görünen yüksek dansiteli cerrahi materyalin ayırt edilmesine yardımcı olur.

BTA tanısal

Arteriyel BTA'da anastomozdan dışarı uzanan kontrastla dolu kese, iletişim boynu, aktif ekstravazasyon ve komşu mediastinal hematom değerlendirilir.

Gecikmiş tanısal

Kontrastlı BTA anastomoz bölgesini ve sızıntıları değerlendirir; operatif görünümler ile komplikasyon ayrımı klinik bağlam ve seri incelemelerle doğrulanmalıdır.

BT bulguları

• Anastomoz kaynaklı kese — greft-doğal aort sütür hattından dışa uzanan, arteriyel fazda kontrastlanan sınırlı çıkıntı.
• Dar boyun — kese ile aort/greft lümeni arasında odaksal iletişim; multiplanar görüntüde anastomoz hattına bağlanır.
• Kontrastlı BTA keseyi, duvar bütünlüğünü ve içerideki trombüs gibi dolum kusurlarını değerlendirir; kesenin morfolojisi ve ölçümü tedavi kararlarını yönlendirir.
• Aktif ekstravazasyon — kontrastın beklenen damar sınırını aşarak çevre hematomuna yayılması.
• Perigraft hematom — kontrastsız BT’de hiperdens, kontrastlı seride heterojen yumuşak doku/koleksiyon olarak izlenebilir; çevre dokularla sınırlı olabilir.
• Greft enfeksiyonunda yeni perigraft koleksiyon ve inflamasyon bulguları izlenir; erken dönemde görülen perigraft hava normal postoperatif görünümün bir parçası olabilir ve klinik bağlamla değerlendirilmelidir.
• Seri büyüme — aynı düzlemde ölçülen kontrastlı kesenin veya çevre hematomunun önceki BTA'ya göre artması.
• Greft enfeksiyonu veya aortoözofageal fistül şüphesinde BT'de perigraft gazı ve inflamasyonu, aort ile özofagus arasındaki yağ planı kaybını ve olası fistül traktını değerlendirin.
• Greft çevresindeki mediastinal gazın seri incelemelerde artması, özellikle özofagus perforasyonu veya aortoözofageal fistül şüphesini destekleyebilir.
• BT anjiyografide psödoanevrizmanın boyutunu ve boyun morfolojisini değerlendirin; seri incelemelerde boyut değişimini izleyin.

Normalde

Ameliyat sonrası beklenen görünüm cerrahi tekniğe göre değişir; bazı greft dalları, pledgetler veya perigraft sıvı psödoanevrizma ya da enfeksiyonu taklit edebilir. Anastomoz hattını koronal ve sagittal planda takip ederek kese boynu olup olmadığını kontrol edin; kontrastsız seriyle pledget ya da kalsifikasyonu ayırın ve aynı noktayı önceki BTA ile karşılaştırın.

Ayırıcı tanı

Gerçek aort anevrizması

genişleme damar duvarının sürekliliği içinde yer alır; cerrahi anastomozdan dar boyunla çıkan ekstravasküler kese görünümü yoktur.

Koroner buton genişlemesi

Bentall sonrası koroner reimplantasyon çevresindeki küçük yuvarlak çıkıntı koroner artere devam eder; kör sonlanan kontrast kesesi psödoanevrizma lehinedir.

Cerrahi amaçlı kör sonlanan greft dalları veya debranching yapıları, kontrastlı çıkıntı şeklinde izlenerek psödoanevrizmayı taklit edebilir; ameliyat raporuyla konumlandırılmalıdır.

Pledget veya hemostatik materyal

kontrastsız seride yüksek dansiteli ya da heterojen görünür; damar lümeniyle kontrastlanan boyun bağlantısı göstermez.

Aort diseksiyonu intimomedial tabakaların hastalıkları arasında yer alır; anastomoz kaynaklı psödoanevrizma ise greft anastomozundan gelişen ayrı bir komplikasyondur.

Tuzaklar

• Koroner butonları anastomoz psödoanevrizması sanmayın; koroner arterin butondan çıkıp çıkmadığını multiplanar kesitlerde takip edin.
• Kontrastlı görüntüde parlak odak olarak görülen pledget veya sütür materyalini yalancı kese saymayın; kontrastsız seri ve ameliyat tekniği yerini açıklayabilir.
• Aortik hareket artefaktı özellikle kök/çıkan aort anastomozunda yalancı duvar düzensizliği yapabilir; ECG-gated BTA ve komşu kesitlerde devamlılık yardımcıdır.
• Anastomoz dışındaki perfüzyon grefti güdüğü beklenen kör sonlanan yapı olabilir; cerrahi harita ve önceki incelemeyle konumunu teyit edin.

Kendini dene

1. Total ark grefti ile sol ortak karotis arter arasındaki anastomozda gelişen komplikasyon nedir?

   • Anastomoz psödoanevrizması
   • Aort diseksiyonu
   • Endoleak
   • Greft trombozu
   Cevabı göster

   Anastomoz psödoanevrizması. Olgu bildiriminde greft ile sol ortak karotis arter arasındaki anastomozda psödoanevrizma gelişmiştir.

2. Bentall ameliyatı sonrası aort kökü çevresindeki sakküler kontrastlı çıkıntının sol ana koroner arterle devamlılığı izleniyor. Çıkıntı hangi cerrahi yapıyla ilişkilidir?

   • Sol koroner arter düğmesi
   • Aort arkı distal anastomozu
   • Sol ana karotis arter greft dalı
   • Safen ven grefti proksimal anastomozu
   Cevabı göster

   Sol koroner arter düğmesi. Sol ana koroner arterle devamlılığı bulunan sakküler çıkıntı, sol koroner arter düğmesi düzeyindeki yapıyla ilişkilidir.

İlgili konular

• Aort grefti enfeksiyonu
• TEVAR sonrası endoleak
• TEVAR sonrası greft yapısal komplikasyonları

Kaynaklar

Bu sayfadaki 38 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla otomatik olarak karşılaştırıldı; 16 cümle bu karşılaştırmada düzeltildi (2026-10-09).

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Eğitim amaçlıdır; hasta başında tanı ve tedavi kararının yerine geçmez, tıbbi tavsiye değildir. Metinler yapay zekâ desteğiyle yazıldı ve otomatik bir adımda kaynak alıntılarıyla karşılaştırıldı; bu bir tıbbi doğrulama değildir ve içerik uzman radyolog incelemesinden geçmedi. Klinik kararlarda güncel kılavuzları, kurum protokollerini ve radyoloji raporunu esas alın.