Vasküler Cerrahi Sonrası Medikal Tedavi ve Yara Bakımı
Özet
Vasküler travma cerrahisi sonrası medikal tedavi; antitrombotik tedavi, kanama kontrolü, enfeksiyon profilaksisi, diyabet yönetimi ve yara bakımını içeren multidisipliner bir yaklaşımla planlanmalıdır. Antitrombotik ilaçlar tromboz riskini azaltırken, kanama yönetimi ve transfüzyon protokolleri hemodinamik stabiliteyi sağlar. Enfeksiyon riskini önlemek için aseptik yara bakımı ve uygun antibiyotik tedavisi uygulanır. Diyabetik hastalarda kan şekeri kontrolü yara iyileşmesini desteklerken, modern yara kapama yöntemleri enfeksiyon riskini azaltır ve iyileşmeyi hızlandırır. Bu stratejiler, komplikasyonları önleyerek hasta sağkalımını ve yaşam kalitesini artırmayı hedefler.
Referanslar
Rasmussen TE, Tai NRM. Rich’s Vascular Trauma E-Book. Elsevier Health Sciences; 2021. 435 p.
Zierler RE, Jordan WD, Lal BK, et al. The Society for Vascular Surgery practice guidelines on follow-up after vascular surgery arterial procedures. Journal of Vascular Surgery. 2018;68(1): 256–284. doi:10.1016/j.jvs.2018.04.018
Suckow BD, Kraiss LW, Stone DH, et al. Comparison of graft patency, limb salvage, and antithrombotic therapy between prosthetic and autogenous below-knee bypass for critical limb ischemia. Annals of Vascular Surgery. 2013;27(8): 1134–1145. doi:10.1016/j.avsg.2013.01.019
Suckow BD, Kraiss LW, Schanzer A, et al. Statin therapy after infrainguinal bypass surgery for critical limb ischemia is associated with improved 5-year survival. Journal of Vascular Surgery. 2015;61(1): 126–133. doi:10.1016/j.jvs.2014.05.093
Spudil V, Hána L, Pohnán R. Peripheral vascular trauma - basic management, diagnosis and treatment. Rozhledy V Chirurgii: Mesicnik Ceskoslovenske Chirurgicke Spolecnosti. 2023;102(8): 315–320. doi:10.33699/PIS.2023.102.8.315-320
Góes AM de O, Parreira JG, Kleinsorge GHD, et al. Brazilian guidelines on diagnosis and management of traumatic vascular injuries. Jornal Vascular Brasileiro. 2023;22: e20230042. doi:10.1590/1677-5449.202300422
Dobson GP. Addressing the Global Burden of Trauma in Major Surgery. Frontiers in Surgery. 2015;2: 43. doi:10.3389/fsurg.2015.00043
Geraghty AJ, Welch K. Antithrombotic agents for preventing thrombosis after infrainguinal arterial bypass surgery. The Cochrane Database of Systematic Reviews. 2011;2011(6): CD000536. doi:10.1002/14651858.CD000536.pub2
Gassman AA, Degner BC, Al-Nouri O, et al. Aspirin usage is associated with improved prosthetic infrainguinal bypass graft patency. Vascular. 2014;22(2): 105–111. doi:10.1177/1708538112473977
Bedenis R, Lethaby A, Maxwell H, et al. Antiplatelet agents for preventing thrombosis after peripheral arterial bypass surgery. The Cochrane Database of Systematic Reviews. 2015;2015(2): CD000535. doi:10.1002/14651858.CD000535.pub3
Dagher NN, Modrall JG. Pharmacotherapy before and after revascularization: anticoagulation, antiplatelet agents, and statins. Seminars in Vascular Surgery. 2007;20(1): 10–14. doi:10.1053/j.semvascsurg.2007.02.006
Comerota AJ, Thakur S. Management of anticoagulation and platelet inhibition in reconstructive vascular surgery. Vascular. 2008;16 Suppl 1: S48-54.
De Martino RR, Eldrup-Jorgensen J, Nolan BW, et al. Perioperative management with antiplatelet and statin medication is associated with reduced mortality following vascular surgery. Journal of Vascular Surgery. 2014;59(6): 1615-1621.e1. doi:10.1016/j.jvs.2013.12.013
Govsyeyev N, Nehler M, Conte MS, et al. Rivaroxaban in patients with symptomatic peripheral artery disease after lower extremity bypass surgery with venous and prosthetic conduits. Journal of Vascular Surgery. 2023;77(4): 1107-1118.e2. doi:10.1016/j.jvs.2022.11.062
Bauersachs R, Zannad F. Rivaroxaban: A New Treatment Paradigm in the Setting of Vascular Protection? Thrombosis and Haemostasis. Schattauer; 2018;118: S12–S22. doi:10.1055/s-0038-1636530
Dörffler-Melly J, Büller HR, Koopman MM, et al. Antithrombotic agents for preventing thrombosis after infrainguinal arterial bypass surgery. The Cochrane Database of Systematic Reviews. 2003;(4): CD000536. doi:10.1002/14651858.CD000536
Liu J-L, Li J-Y, Jiang P, et al. Literature review of peripheral vascular trauma: Is the era of intervention coming? Chinese Journal of Traumatology = Zhonghua Chuang Shang Za Zhi. 2020;23(1): 5–9. doi:10.1016/j.cjtee.2019.11.003
Roberts I, Shakur H, Coats T, et al. The CRASH-2 trial: a randomised controlled trial and economic evaluation of the effects of tranexamic acid on death, vascular occlusive events and transfusion requirement in bleeding trauma patients. Health Technology Assessment (Winchester, England). 2013;17(10): 1–79. doi:10.3310/hta17100
Inui T, Bandyk DF. Vascular surgical site infection: risk factors and preventive measures. Seminars in Vascular Surgery. 2015;28(3): 201–207. doi:10.1053/j.semvascsurg.2016.02.002
Brown KV, Ramasamy A, Tai N, et al. Complications of Extremity Vascular Injuries in Conflict. Journal of Trauma and Acute Care Surgery. 2009;66(4): S145. doi:10.1097/TA.0b013e31819cdd82
Vogel TR, Dombrovskiy VY, Carson JL, et al. Infectious complications after elective vascular surgical procedures. Journal of Vascular Surgery. 2010;51(1): 122–130. doi:10.1016/j.jvs.2009.08.006
Gharamti A, Kanafani ZA. Vascular Graft Infections: An update. Infectious Disease Clinics of North America. 2018;32(4): 789–809. doi:10.1016/j.idc.2018.06.003
Rodríguez-Caravaca G, Gutiérrez-Baz M, Benito-Fernández L de, et al. Antibiotic prophylaxis adequacy assessment and its influence on surgical site infection in peripheral vascular bypass surgery. Cirugía y cirujanos. Academia Mexicana de Cirugía A.C.; 2021;89(5): 618–623. doi:10.24875/ciru.20000838
Amato B, Compagna R, De Vivo S, et al. Groin Surgical Site Infection in Vascular Surgery: Systemic Review on Peri-Operative Antibiotic Prophylaxis. Antibiotics. Multidisciplinary Digital Publishing Institute; 2022;11(2): 134. doi:10.3390/antibiotics11020134
Wouthuyzen-Bakker M, van Oosten M, Bierman W, et al. Diagnosis and treatment of vascular graft and endograft infections: a structured clinical approach. International Journal of Infectious Diseases. 2023;126: 22–27. doi:10.1016/j.ijid.2022.11.011
Seretny M, Colvin LA. Pain management in patients with vascular disease. British Journal of Anaesthesia. 2016;117 Suppl 2: ii95–ii106. doi:10.1093/bja/aew212
Busser MJ, Kunju SM, Gurunathan U. Perioperative pain management in thoracic surgery: A survey of practices in Australia and New Zealand. Anaesthesia and Intensive Care. 2023;51(5): 348–358. doi:10.1177/0310057X231172787
Haney LJ, Pugh MJV, Copeland LA, et al. Persistent Pain, Physical Dysfunction, and Decreased Quality of Life After Combat Extremity Vascular Trauma. Annals of Vascular Surgery. 2021;71: 167–180. doi:10.1016/j.avsg.2020.08.104
Boric K, Boric M, Boric T, et al. Analysis of perioperative pain management in vascular surgery indicates that practice does not adhere with guidelines: a retrospective cross-sectional study. Journal of Pain Research. 2017;10: 203–209. doi:10.2147/JPR.S123894
Schjerning A-M, McGettigan P, Gislason G. Cardiovascular effects and safety of (non-aspirin) NSAIDs. Nature Reviews. Cardiology. 2020;17(9): 574–584. doi:10.1038/s41569-020-0366-z
Corder G, Castro DC, Bruchas MR, et al. Endogenous and Exogenous Opioids in Pain. Annual Review of Neuroscience. 2018;41: 453–473. doi:10.1146/annurev-neuro-080317-061522
Senderovich H, Jeyapragasan G. Is there a role for combined use of gabapentin and pregabalin in pain control? Too good to be true? Current Medical Research and Opinion. 2018;34(4): 677–682. doi:10.1080/03007995.2017.1391756
Aygin D, Kalkan ÖK, Akbayır N. Ameliyat Sonrası Erken Dönem Mobilizasyonun Hızlı İyileşmeye Katkısı. Sakarya Üniversitesi Holistik Sağlık Dergisi. Sakarya University; 2022;5(3): 392–403. doi:10.54803/sauhsd.1168814
Uğurlu AK, Kula Şahi̇n S, Seçgi̇nli̇ S, et al. Ameliyat Sonrası İlk 24 Saatte Erken Ayağa Kaldırmanın Hızlı İyileşmeye Etkisi: Sistematik Derleme. | EBSCOhost. [Online] p. 280. doi:10.5336/nurses.2016-53678
Bayir A. Erişkin Hastalarda Ağrı Yönetimi. Turkiye Klinikleri Emergency Medicine - Special Topics. Turkiye Klinikleri; 2022;8(1): 80–85.
Aydin A, Çi̇li̇ngi̇r D. Kardiyak Cerrahide Farmakolojik Ve Nonfarmakolojik Yöntemlerle Ağrı Yönetimi. https://avesis.ktu.edu.tr/yayin/63928041-8fdb-47cf-8b02-0f47211d7de5/kardiyak-cerrahide-farmakolojik-ve-nonfarmakolojik-yontemlerle-agri-yonetimi
Jansen-Chaparro S, López-Carmona MD, Cobos-Palacios L, et al. Statins and Peripheral Arterial Disease: A Narrative Review. Frontiers in Cardiovascular Medicine. 2021;8: 777016. doi:10.3389/fcvm.2021.777016
Sanders RD, Nicholson A, Lewis SR, et al. Perioperative statin therapy for improving outcomes during and after noncardiac vascular surgery - Sanders, RD - 2013 | Cochrane Library. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD009971.pub2/full
Stalenhoef AFH. The benefit of statins in non-cardiac vascular surgery patients. Journal of Vascular Surgery. 2009;49(1): 260–265. doi:10.1016/j.jvs.2008.11.070
Schanzer A, Hevelone N, Owens CD, et al. Statins are independently associated with reduced mortality in patients undergoing infrainguinal bypass graft surgery for critical limb ischemia. Journal of Vascular Surgery. 2008;47(4): 774–781. doi:10.1016/j.jvs.2007.11.056
Duwayri Y, Jordan WD. Diabetes, dysglycemia, and vascular surgery. Journal of Vascular Surgery. 2020;71(2): 701–711. doi:10.1016/j.jvs.2019.05.027
Fahy BG, Sheehy AM, Coursin DB. Glucose control in the intensive care unit. Critical Care Medicine. 2009;37(5): 1769–1776. doi:10.1097/CCM.0b013e3181a19ceb
May AK, Kauffmann RM, Collier BR. The place for glycemic control in the surgical patient. Surgical Infections. 2011;12(5): 405–418. doi:10.1089/sur.2011.019
King JT, Goulet JL, Perkal MF, et al. Glycemic control and infections in patients with diabetes undergoing noncardiac surgery. Annals of Surgery. 2011;253(1): 158–165. doi:10.1097/SLA.0b013e3181f9bb3a
Krinsley JS, Meyfroidt G, van den Berghe G, et al. The impact of premorbid diabetic status on the relationship between the three domains of glycemic control and mortality in critically ill patients. Current Opinion in Clinical Nutrition and Metabolic Care. 2012;15(2): 151–160. doi:10.1097/MCO.0b013e32834f0009
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Referanslar
Rasmussen TE, Tai NRM. Rich’s Vascular Trauma E-Book. Elsevier Health Sciences; 2021. 435 p.
Zierler RE, Jordan WD, Lal BK, et al. The Society for Vascular Surgery practice guidelines on follow-up after vascular surgery arterial procedures. Journal of Vascular Surgery. 2018;68(1): 256–284. doi:10.1016/j.jvs.2018.04.018
Suckow BD, Kraiss LW, Stone DH, et al. Comparison of graft patency, limb salvage, and antithrombotic therapy between prosthetic and autogenous below-knee bypass for critical limb ischemia. Annals of Vascular Surgery. 2013;27(8): 1134–1145. doi:10.1016/j.avsg.2013.01.019
Suckow BD, Kraiss LW, Schanzer A, et al. Statin therapy after infrainguinal bypass surgery for critical limb ischemia is associated with improved 5-year survival. Journal of Vascular Surgery. 2015;61(1): 126–133. doi:10.1016/j.jvs.2014.05.093
Spudil V, Hána L, Pohnán R. Peripheral vascular trauma - basic management, diagnosis and treatment. Rozhledy V Chirurgii: Mesicnik Ceskoslovenske Chirurgicke Spolecnosti. 2023;102(8): 315–320. doi:10.33699/PIS.2023.102.8.315-320
Góes AM de O, Parreira JG, Kleinsorge GHD, et al. Brazilian guidelines on diagnosis and management of traumatic vascular injuries. Jornal Vascular Brasileiro. 2023;22: e20230042. doi:10.1590/1677-5449.202300422
Dobson GP. Addressing the Global Burden of Trauma in Major Surgery. Frontiers in Surgery. 2015;2: 43. doi:10.3389/fsurg.2015.00043
Geraghty AJ, Welch K. Antithrombotic agents for preventing thrombosis after infrainguinal arterial bypass surgery. The Cochrane Database of Systematic Reviews. 2011;2011(6): CD000536. doi:10.1002/14651858.CD000536.pub2
Gassman AA, Degner BC, Al-Nouri O, et al. Aspirin usage is associated with improved prosthetic infrainguinal bypass graft patency. Vascular. 2014;22(2): 105–111. doi:10.1177/1708538112473977
Bedenis R, Lethaby A, Maxwell H, et al. Antiplatelet agents for preventing thrombosis after peripheral arterial bypass surgery. The Cochrane Database of Systematic Reviews. 2015;2015(2): CD000535. doi:10.1002/14651858.CD000535.pub3
Dagher NN, Modrall JG. Pharmacotherapy before and after revascularization: anticoagulation, antiplatelet agents, and statins. Seminars in Vascular Surgery. 2007;20(1): 10–14. doi:10.1053/j.semvascsurg.2007.02.006
Comerota AJ, Thakur S. Management of anticoagulation and platelet inhibition in reconstructive vascular surgery. Vascular. 2008;16 Suppl 1: S48-54.
De Martino RR, Eldrup-Jorgensen J, Nolan BW, et al. Perioperative management with antiplatelet and statin medication is associated with reduced mortality following vascular surgery. Journal of Vascular Surgery. 2014;59(6): 1615-1621.e1. doi:10.1016/j.jvs.2013.12.013
Govsyeyev N, Nehler M, Conte MS, et al. Rivaroxaban in patients with symptomatic peripheral artery disease after lower extremity bypass surgery with venous and prosthetic conduits. Journal of Vascular Surgery. 2023;77(4): 1107-1118.e2. doi:10.1016/j.jvs.2022.11.062
Bauersachs R, Zannad F. Rivaroxaban: A New Treatment Paradigm in the Setting of Vascular Protection? Thrombosis and Haemostasis. Schattauer; 2018;118: S12–S22. doi:10.1055/s-0038-1636530
Dörffler-Melly J, Büller HR, Koopman MM, et al. Antithrombotic agents for preventing thrombosis after infrainguinal arterial bypass surgery. The Cochrane Database of Systematic Reviews. 2003;(4): CD000536. doi:10.1002/14651858.CD000536
Liu J-L, Li J-Y, Jiang P, et al. Literature review of peripheral vascular trauma: Is the era of intervention coming? Chinese Journal of Traumatology = Zhonghua Chuang Shang Za Zhi. 2020;23(1): 5–9. doi:10.1016/j.cjtee.2019.11.003
Roberts I, Shakur H, Coats T, et al. The CRASH-2 trial: a randomised controlled trial and economic evaluation of the effects of tranexamic acid on death, vascular occlusive events and transfusion requirement in bleeding trauma patients. Health Technology Assessment (Winchester, England). 2013;17(10): 1–79. doi:10.3310/hta17100
Inui T, Bandyk DF. Vascular surgical site infection: risk factors and preventive measures. Seminars in Vascular Surgery. 2015;28(3): 201–207. doi:10.1053/j.semvascsurg.2016.02.002
Brown KV, Ramasamy A, Tai N, et al. Complications of Extremity Vascular Injuries in Conflict. Journal of Trauma and Acute Care Surgery. 2009;66(4): S145. doi:10.1097/TA.0b013e31819cdd82
Vogel TR, Dombrovskiy VY, Carson JL, et al. Infectious complications after elective vascular surgical procedures. Journal of Vascular Surgery. 2010;51(1): 122–130. doi:10.1016/j.jvs.2009.08.006
Gharamti A, Kanafani ZA. Vascular Graft Infections: An update. Infectious Disease Clinics of North America. 2018;32(4): 789–809. doi:10.1016/j.idc.2018.06.003
Rodríguez-Caravaca G, Gutiérrez-Baz M, Benito-Fernández L de, et al. Antibiotic prophylaxis adequacy assessment and its influence on surgical site infection in peripheral vascular bypass surgery. Cirugía y cirujanos. Academia Mexicana de Cirugía A.C.; 2021;89(5): 618–623. doi:10.24875/ciru.20000838
Amato B, Compagna R, De Vivo S, et al. Groin Surgical Site Infection in Vascular Surgery: Systemic Review on Peri-Operative Antibiotic Prophylaxis. Antibiotics. Multidisciplinary Digital Publishing Institute; 2022;11(2): 134. doi:10.3390/antibiotics11020134
Wouthuyzen-Bakker M, van Oosten M, Bierman W, et al. Diagnosis and treatment of vascular graft and endograft infections: a structured clinical approach. International Journal of Infectious Diseases. 2023;126: 22–27. doi:10.1016/j.ijid.2022.11.011
Seretny M, Colvin LA. Pain management in patients with vascular disease. British Journal of Anaesthesia. 2016;117 Suppl 2: ii95–ii106. doi:10.1093/bja/aew212
Busser MJ, Kunju SM, Gurunathan U. Perioperative pain management in thoracic surgery: A survey of practices in Australia and New Zealand. Anaesthesia and Intensive Care. 2023;51(5): 348–358. doi:10.1177/0310057X231172787
Haney LJ, Pugh MJV, Copeland LA, et al. Persistent Pain, Physical Dysfunction, and Decreased Quality of Life After Combat Extremity Vascular Trauma. Annals of Vascular Surgery. 2021;71: 167–180. doi:10.1016/j.avsg.2020.08.104
Boric K, Boric M, Boric T, et al. Analysis of perioperative pain management in vascular surgery indicates that practice does not adhere with guidelines: a retrospective cross-sectional study. Journal of Pain Research. 2017;10: 203–209. doi:10.2147/JPR.S123894
Schjerning A-M, McGettigan P, Gislason G. Cardiovascular effects and safety of (non-aspirin) NSAIDs. Nature Reviews. Cardiology. 2020;17(9): 574–584. doi:10.1038/s41569-020-0366-z
Corder G, Castro DC, Bruchas MR, et al. Endogenous and Exogenous Opioids in Pain. Annual Review of Neuroscience. 2018;41: 453–473. doi:10.1146/annurev-neuro-080317-061522
Senderovich H, Jeyapragasan G. Is there a role for combined use of gabapentin and pregabalin in pain control? Too good to be true? Current Medical Research and Opinion. 2018;34(4): 677–682. doi:10.1080/03007995.2017.1391756
Aygin D, Kalkan ÖK, Akbayır N. Ameliyat Sonrası Erken Dönem Mobilizasyonun Hızlı İyileşmeye Katkısı. Sakarya Üniversitesi Holistik Sağlık Dergisi. Sakarya University; 2022;5(3): 392–403. doi:10.54803/sauhsd.1168814
Uğurlu AK, Kula Şahi̇n S, Seçgi̇nli̇ S, et al. Ameliyat Sonrası İlk 24 Saatte Erken Ayağa Kaldırmanın Hızlı İyileşmeye Etkisi: Sistematik Derleme. | EBSCOhost. [Online] p. 280. doi:10.5336/nurses.2016-53678
Bayir A. Erişkin Hastalarda Ağrı Yönetimi. Turkiye Klinikleri Emergency Medicine - Special Topics. Turkiye Klinikleri; 2022;8(1): 80–85.
Aydin A, Çi̇li̇ngi̇r D. Kardiyak Cerrahide Farmakolojik Ve Nonfarmakolojik Yöntemlerle Ağrı Yönetimi. https://avesis.ktu.edu.tr/yayin/63928041-8fdb-47cf-8b02-0f47211d7de5/kardiyak-cerrahide-farmakolojik-ve-nonfarmakolojik-yontemlerle-agri-yonetimi
Jansen-Chaparro S, López-Carmona MD, Cobos-Palacios L, et al. Statins and Peripheral Arterial Disease: A Narrative Review. Frontiers in Cardiovascular Medicine. 2021;8: 777016. doi:10.3389/fcvm.2021.777016
Sanders RD, Nicholson A, Lewis SR, et al. Perioperative statin therapy for improving outcomes during and after noncardiac vascular surgery - Sanders, RD - 2013 | Cochrane Library. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD009971.pub2/full
Stalenhoef AFH. The benefit of statins in non-cardiac vascular surgery patients. Journal of Vascular Surgery. 2009;49(1): 260–265. doi:10.1016/j.jvs.2008.11.070
Schanzer A, Hevelone N, Owens CD, et al. Statins are independently associated with reduced mortality in patients undergoing infrainguinal bypass graft surgery for critical limb ischemia. Journal of Vascular Surgery. 2008;47(4): 774–781. doi:10.1016/j.jvs.2007.11.056
Duwayri Y, Jordan WD. Diabetes, dysglycemia, and vascular surgery. Journal of Vascular Surgery. 2020;71(2): 701–711. doi:10.1016/j.jvs.2019.05.027
Fahy BG, Sheehy AM, Coursin DB. Glucose control in the intensive care unit. Critical Care Medicine. 2009;37(5): 1769–1776. doi:10.1097/CCM.0b013e3181a19ceb
May AK, Kauffmann RM, Collier BR. The place for glycemic control in the surgical patient. Surgical Infections. 2011;12(5): 405–418. doi:10.1089/sur.2011.019
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