ʻO ke kīʻaha koko nui loa i loko o ko kākou kino, ʻo ia ka aorta, a mākou e kapa nei he "Aorta" ma ka ʻōlelo Pelekania. E noʻonoʻo e like me ke paipu wai nui i loko o ko kākou kino. ʻO ia ka mea e hoʻokaʻawale i ke koko mai ka puʻuwai a i ke kino holoʻokoʻa. I kekahi manawa, lilo ka paia o kēia kīʻaha koko i nāwaliwali a hoʻomaka e puʻupuʻu e like me ka pōpō. ʻO kēia ka mea a mākou e kapa nei he "Aneurysm" i ka lāʻau lapaʻau. ʻO ka mea weliweli loa, ʻo ia ka hoʻonui ʻia ʻana o kēia puʻupuʻu a aia kahi manawa e pohā koke ai. No laila, i kēia lā e kamaʻilio mākou e pili ana i kahi ʻano lapaʻau hou e hiki ke pale aku i kēia kūlana weliweli me ka ʻole o ka hana ʻana i kahi ʻoki nui i ke kino a me ka liʻiliʻi o ka hoʻoikaika.
I ka ʻōlelo maʻalahi, he aha ʻo EVAR?
ʻO ke ʻano piha o EVAR ʻo ia ka `(Endovascular Aneurysm Repair)`. Ma ka ʻōlelo Sinhala, he hoʻoponopono ia i hana ʻia i loko o kahi kīʻaha koko. ʻAʻole kēia he ʻoki kino nui . ʻO ia hoʻi, ma kahi o ka hana ʻana i kahi ʻoki kino nui ma ka ʻoki ʻana i ka ʻōpū, hana ʻia kēia lāʻau lapaʻau me ka hoʻohana ʻana i kahi lua liʻiliʻi loa.
E noʻonoʻo ua pehu kahi paipu wai kahiko a kokoke e pohā. Ma kahi o ka ʻoki ʻana i ka paipu a wehe iā ia, ʻo ka mea e hana ʻia ma ʻaneʻi ua like ia me ka hoʻoponopono ʻana ma ke komo ʻana i kahi paipu lahilahi a ikaika hoʻi i loko. Hoʻokomo nā kauka i kahi paipu i hoʻolālā kūikawā ʻia (Stent Graft) i loko o ke kīʻaha koko pehu. Ua like kēia me kahi uhi kūikawā i hana ʻia me ka lole a me ka ʻupena metala. Ke hoʻokomo ʻia kēia, kahe ke koko ma o ka paipu hou. A laila, ʻaʻohe kaomi e kau ʻia ma ka paia nāwaliwali a pehu. No laila, ua hoʻopau loa ʻia ka pilikia o ka pohā ʻana.
No ke aha mākou e pono ai i ka lāʻau EVAR?
ʻO ke kumu nui a me ke kumu hoʻokahi o kēia, ʻo ia ka pale ʻana i ka haki ʻana o ka Abdominal Aortic Aneurysm . No ka mea, inā hana ʻia kēlā, he kūlana hoʻoweliweli loa ia i ke ola a me ka make.
Ke nāwaliwali ka paia o ke kīʻaha koko, ʻo ke kaomi o ke koko e komo mai ana me kēlā me kēia puʻuwai e hoʻoulu ai i kēlā wahi nāwaliwali e pehu. Ua like ia me ka pehu i loko o kahi huila. ʻAʻole hiki ke hoʻonui mau loa. I kekahi manawa, pahū ia. Inā hana ʻia kēlā, hiki i ka nui o ke koko ke kahe i loko o ke kino, a hiki ke make i loko o nā minuke.
No laila, ʻo ka hana a ka lāʻau lapaʻau EVAR, ʻo ia ke hoʻokomo i kēlā "(Stent Graft)", hoʻololi i ke kahe o ke koko, a hoʻomaha i ke kaomi ma ka paia pehu. Hoʻopau loa kēlā i ka pilikia o ka haki ʻana.
I ka ʻōlelo maʻalahi, ua like kēia me ka hoʻopau ʻana i kahi pōkā. Hoʻopau ʻoe i ka pōʻino ma mua o kona pahū ʻana.
No wai kēia lāʻau lapaʻau EVAR e kūpono ai?
ʻAʻole hana koke ʻia kēia lāʻau no nā mea āpau me ka aneurysm ʻōpū. E nānā kāu kauka i kekahi mau mea e hoʻoholo ai inā kūpono kēia lāʻau iā ʻoe.
- Inā nui kou aneurysm , a i ʻoleInā hōʻike nā scan e ulu wikiwiki ana i loko o kahi manawa pōkole.
- Inā ʻaʻole hiki iā ʻoe ke hoʻomanawanui i ka pilikia o ke ʻoki kino nui e like me ke ʻoki bypass gastric ma muli o nā kūlana olakino ʻē aʻe (e like me ka maʻi puʻuwai a i ʻole ka maʻi māmā).
- Inā olakino a ikaika nā kīʻaha koko ma luna a ma lalo o ka puʻupuʻu (no ka mea, pono kahi maikaʻi e hoʻokomo ai i ka ʻōmole hou).
Ma hope o ka noʻonoʻo ʻana i nā mea e like me kēia, hoʻoholo ke kauka ʻo ia ka lāʻau EVAR ka mea maikaʻi loa iā ʻoe.
He aha ke ʻano hana kūikawā i kapa ʻia ʻo FEVAR?
Ua like ke aʻa iliac nui i loko o ko kākou ʻōpū me ke kumu lāʻau. Hoʻomaka ia i loko o nā kīʻaha koko liʻiliʻi e lawe i ke koko i nā ʻōpū i loko o ko kākou ʻōpū (e like me nā puʻupaʻa a me nā ʻōpū). I kekahi manawa, hoʻokumu ʻia kahi aneurysm kokoke loa i kahi e lālā ai kēlā mau lālā. I kēlā hihia, ʻaʻole hiki ke hoʻokomo ʻia ka ʻōmole pololei i hoʻohana ʻia i loko o kahi EVAR maʻamau, no ka mea, ʻo ka hana ʻana pēlā e ʻoki ai i ke kahe koko i kēlā mau lālā.
No ia mau hihia paʻakikī, hoʻohana ʻia kahi ʻano hana kūikawā i kapa ʻia ʻo FEVAR (Fenestrated Endovascular Aneurysm Repair). Ma ka `(Stent Graft)` i hoʻohana ʻia ma ʻaneʻi, hana ʻia nā lua liʻiliʻi e like me ka puka makani e kūpono i nā lālā. Ma hope o ke komo ʻana o ka paipu nui, hoʻokomo ʻia kahi `(Stent)` liʻiliʻi ʻokoʻa ma o kēlā mau puka makani i loko o nā kīʻaha koko e like me ka lālā e hōʻoia i ke kahe ʻana o ke koko. ʻOiai he mea paʻakikī iki kēia, he pōmaikaʻi nui ia e hiki ai ke ho'ōla i `(Aneurysm)` ma ia mau wahi paʻakikī me ka ʻole o ka hana ʻoki kino nui.
He aha ka ʻokoʻa ma waena o EVAR a me TEVAR?
He mau lāʻau lapaʻau like kēia ʻelua. ʻO ka ʻokoʻa ma kahi o ka lāʻau lapaʻau.
- EVAR: Hana ʻia no nā aneurysms ʻōpū (ʻōpū) .
- TEVAR (Thoracic Endovascular Aneurysm Repair): hana ʻia no nā aneurysms i loko o ka umauma (thorax) .
He aha nā pōmaikaʻi o ka mālama ʻana iā EVAR?
Ke hoʻohālikelike ʻia me ke ʻoki kino nui, he nui nā pono maopopo o ka mālama ʻana iā EVAR. He hana ia e emi iki ai ka invasive.
| Pōmaikaʻi | I ka ʻōlelo maʻalahi... |
|---|---|
| Ka manawa liʻiliʻi ma ka haukapila | ʻOiai ʻo ka lōʻihi o kahi hana nui ma kahi o hoʻokahi pule, e hala ana kēia i ʻelua a ʻekolu paha lā. |
| Haʻahaʻa ka nui o ke koko i nalowale. | ʻOiai ʻaʻohe ʻoki nui, ua liʻiliʻi loa ke kahe ʻana o ke koko. |
| Emi ka ʻeha i ka wā e ho'ōla ai | ʻOiai ʻaʻohe ʻeha nui, ua liʻiliʻi loa ka ʻeha. He manawa pōkole wale nō ka mea e pono ai nā lāʻau hoʻopau ʻeha. |
| Hiki iā ʻoe ke hoʻi koke i ke ola maʻamau. | Hiki iā ʻoe ke hoʻi i ka hana i loko o hoʻokahi mahina, me ka ʻole o ke kali ʻana i nā mahina. |
| He haʻahaʻa nā pilikia i ka wā o ke ʻoki ʻana. | ʻOi aku ka haʻahaʻa o ka pilikia o ka hōʻeha puʻuwai a i ʻole ka make i ka wā o ke ʻoki ʻana ma mua o ka wā o ke ʻoki nui. |
| Ua emi ka manawa o ke ʻoki kino. | Hiki ke hoʻopau ʻia kēia lāʻau i ka manawa pōkole ma mua o ke ʻoki kino hāmama. |
Aia kekahi mau pilikia me ka mālama ʻana iā EVAR?
ʻOiai he lāʻau lapaʻau holomua a palekana hoʻi ʻo EVAR, e like me nā kaʻina hana lapaʻau āpau, aia kekahi mau pilikia liʻiliʻi e hiki mai ana. Eia naʻe, he mea kakaikahi loa kēia.
| Pōpilikia | Wehewehena |
|---|---|
| Ke kāpili ʻana o ke koko | Aia kahi pilikia o ke kūkulu ʻia ʻana o nā ʻūpā koko i loko o nā kīʻaha koko, ʻoi aku hoʻi i nā aa koko hohonu o nā wāwae (Deep Vein Thrombosis - DVT). |
| ʻEndoleak | He liʻiliʻi loa ke kahe ʻana o ke koko ma waena o ke kāpili stent i hoʻokomo hou ʻia a me ka paia o ke kīʻaha koko, e hoʻopiha hou ana i ka aneurysm me ke koko. ʻO kēia ka pilikia nui e hiki ke hana i ka wā o kēia mālama ʻana. |
| Nā pilikia ʻē aʻe | Hiki ke loaʻa nā hōʻeha puʻuwai, nā maʻi, ka hāʻule ʻana o nā puʻupaʻa, a me ke kahe nui ʻana o ke koko, akā he mea kakaikahi loa kēia. |
Pehea e hana ʻia ai ke ʻoki kino EVAR? I kēlā me kēia ʻanuʻu
ʻAe, e nānā kākou pehea e hana maoli ʻia ai kēia lāʻau lapaʻau. Ke loaʻa iā ʻoe kahi maopopo o kēia, ʻaʻohe makaʻu pono ʻole.
1. Anesthesia: ʻO ka mea mua, e hāʻawi ʻia ʻoe i ka anesthesia e hōʻoia ʻaʻole ʻoe e ʻeha a ʻoluʻolu ʻole paha. Hiki ke hoʻomoe loa ʻia ʻoe, a i ʻole ʻoe e ʻike hapa wale nō.
2. Ke komo ʻana: E hoʻohana ke kauka i nā kīʻaha koko nui ma kou ʻāpana groin (Femoral Arteries). E hana ʻia kahi ʻoki liʻiliʻi ma ka ʻili.
3. Hoʻokomo ʻia ʻana o ke catheter: ʻO ka mea aʻe, ua hoʻokomo ʻia kahi paipu lahilahi a palupalu (catheter) e loaʻa ana ka stent graft ma o ka lua i loko o ke kīʻaha koko.
4. Alakaʻi: Pono e alakaʻi ʻia kēia catheter ma ke kīʻaha koko, pololei i kahi o ka aneurysm i loko o ka ʻōpū. No ka ʻike pono ʻana i kēia, hoʻohana ke kauka i kahi ʻenehana kiʻi kūikawā e like me X-ray (Real-time imaging). ʻO ia hoʻi, hana lākou i kēia ma ka nānā ʻana i ka neʻe ʻana o ka catheter i loko o ke kino.
5. Ke kau ʻana i ka Stent Graft: Ke kau ʻia ma kahi kūpono, e hoʻolōʻihi ke kauka i ka stent graft i loko o ke catheter. A laila e hoʻonui ia i loko o ke kīʻaha koko a hoʻopili pono iā ia iho i nā paia, e hana ana i kahi ala hou a ikaika no ke kahe ʻana o ke koko.
6. Hoʻopau: Ke kau pono ʻia ka `(Stent Graft)`, e wehe pono ʻia ke catheter. He liʻiliʻi loa ka lua ma ka ʻūhā ʻaʻole pono e humuhumu ʻia . Hiki ke hoʻopili ʻia kahi mea plaster liʻiliʻi e like me ia.
ʻEhia ka lōʻihi e hoʻōla ai ma hope o ke ʻoki kino?
ʻOiai paha e ʻokoʻa ka manawa ho'ōla mai kēlā kanaka a kēia kanaka, ʻo kēia ka mea maʻamau e hana ʻia.
- Pono ʻoe e noho i ka haukapila no kekahi mau lā.
- Ma hope o ka anesthesia, hiki iā ʻoe ke ʻai a inu ma hope koke iho.
- Me ke kōkua o nā kahu maʻi, haʻi lākou iā ia e ala koke mai kahi moe a hoʻomaka e hele.
- E luhi iki ʻoe i nā lā mua ma hope o kou hoʻi ʻana i ka home, a pono ʻoe e lawe i ka lāʻau ʻeha. He mea maʻamau kēlā.
- Mai hoʻokele a hiki i ka wā e lawe ai ʻoe i nā lāʻau ʻeha .
- Hiki i ka hapa nui o nā kānaka ke hoʻi i kā lākou hana i loko o hoʻokahi mahina .
- Pono ʻoe e pale i ka hāpai ʻana i nā mea kaupaona no 4-6 mau pule .
Inā loaʻa iā ʻoe kēia mau hōʻailona, e ʻike koke i ke kauka!
Ma hope o kou hoʻi ʻana i ka home, he mea nui e makaʻala i kou kino. Inā ʻike ʻoe i kekahi o nā hōʻailona ma lalo nei, e kāhea koke aku i kāu kauka.
- ʻO ka pehu ʻana, ka ʻeha, a i ʻole ka ʻili anuanu i nā wāwae, ʻoiai nā wāwae haʻahaʻa (hiki i kēia mau hōʻailona o DVT).
- Inā ʻoe e manaʻo ana ua poniuniu a ua maule paha .
- Inā loaʻa iā ʻoe ka ʻeha nui ma kou ʻōpū, umauma, a i ʻole ke kua .
- ʻO nā palpitations ke manaʻo ʻoe e paʻi wikiwiki ana kou puʻuwai.
- Inā ʻike ʻoe i ka ʻulaʻula ma ka ʻāpana groin a i ʻole nā ʻeha wāwae ʻē aʻe .
ʻOi aku ka maikaʻi o ka mālama ʻana iā EVAR, ʻoi aku ka liʻiliʻi o ka ʻeha ma mua o ke ʻoki kino kuʻuna. Hiki iā ʻoe ke hoʻōla koke a hoʻi i ka home. Eia naʻe, ʻaʻole hiki iā ʻoe ke poina ua holomua ka mālama ʻana. E like me ka ʻōlelo a ke kauka, he mea nui e hoʻi mai i ka manawa i hoʻonohonoho ʻia a loaʻa hou kahi scan. Pēlā e hiki ai iā ʻoe ke nānā inā e hana maikaʻi ana ka `(Stent Graft)` i kau ʻia a inā he mau pilikia e like me `(Endoleak)`.
Leka Lawe-Home
- He ʻano lapaʻau hou a minimally invasive ka EVAR i hoʻohana ʻia no ka pale ʻana i ka haki ʻana o kahi aneurysm i loko o ke kīʻaha koko nui i loko o ka ʻōpū, ʻo ia hoʻi ka aorta.
- Maanei, hoʻokomo ʻia kahi graft stent i loko o ke kīʻaha koko me ka hoʻohana ʻana i kahi ʻōmole lahilahi i kapa ʻia he catheter, i hoʻokomo ʻia ma o ka ʻūhā, me ka ʻole o ka hana ʻana i kahi ʻoki nui.
- ʻOi aku ka pōkole o ka noho ʻana ma ka haukapila, ka ʻeha, a me ka manawa hoʻōla ma mua o ke ʻoki kino hāmama.
- ʻOiai ma hope o ka lāʻau lapaʻau, he mea nui e hoʻomau i ka hele ʻana no nā nānā kino e like me ke kauoha a ke kauka. E kōkua kēia i ka ʻike ʻana i nā pilikia hiki ke hiki mai i ka wā mua.
- Inā loaʻa iā ʻoe kekahi mau hōʻailona ʻē (pehu ʻana i nā wāwae, ʻeha nui, poniuniu) ma hope o ke ʻoki ʻana, e ʻimi koke i ke kōkua lapaʻau.
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