He tirohanga ki te aorta i roto i te uma? Me ako tātou mō te maimoatanga TEVAR (Thoracic Endovascular Aortic Repair)

Kua rongo koe mō te oko toto nui rawa atu, tino hira hoki o tō tinana? Ka karangatia e mātou ko te aorta . Whakaarohia he rite ki te paipa wai matua e kawe ana i te toto puta noa i tō tinana. Engari i ētahi wā, ka ngoikore te pakitara o tēnei aorta, ka tīmata te pupuhi ki waho pērā i te poihau. I roto i te rongoā, ka karangatia e mātou he aneurysm . He rite ki te paipa wai tawhito e pupuhi ana ki waho. Ki te pahū tēnei poihau, ka tino morearea pea mō tō oranga. Engari kaua e manukanuka, me te whanaketanga o te pūtaiao hauora, he tino whai hua ngā maimoatanga mō ēnei āhuatanga. I tēnei rā, kei te kōrero tātou mō tētahi tikanga maimoatanga motuhake e mahia ana me te kore he pokanga nui.

He aha rawa te TEVAR?

Ki te whakarapopototanga, he maimoatanga hou, he iti noa te whakaekenga a te TEVAR (Thoracic Endovascular Aortic Repair) e whakamahia ana hei whakatika i ngā pakaru o te aorta thoracic, inā koa ko ngā aneurysms.

I mua, i rongoatia tēnei mate mā te pokanga nui, tuwhera, me te whakatuwhera i te uma. He tino uaua, he roa te wā e ora ai, ā, he nui ngā mōrearea. Engari i nāianei, mō ngā tūroro e tika ana, kei te piki haere te whiriwhiri a ngā tākuta i tēnei tikanga TEVAR. He poto ake te wā whakaora, he iti ake te mōrearea o ngā raruraru nui, ā, he tino whakamarie ake mō te tūroro. Mā tō tākuta e whakatau mēnā he tika tēnei maimoatanga māu i runga i ngā āhuatanga pēnei i te hanganga o ō oko toto.

He aha ngā āhuatanga e whakamahia ai te maimoatanga TEVAR?

Ko te tikanga TEVAR te tikanga matua e whakamahia ana e ngā taote pokanga mō ētahi momo kino ki te aorta.

Me pēhea taku whakarite i mua i tēnei pokanga?

Mā tō tākuta tēnei e whakamārama taipitopito atu ki a koe. Me noho rite koe mō ngā mea pēnei i:

• Te whakamahinga o te rongoā: Mena kei te tango koe i te rongoā mō te toto toto tiketike, te cholesterol rānei, me whakamahi kia rite ki ngā tohutohu.
• Āta karohia te kai paipa: Ki te kai paipa koe, me mutu rawa tō mahi i mua i te pokanga.
• Ngā rongoā kē atu: Kōrerotia ki tō tākuta ngā rongoā kē atu e tangohia ana e koe i tēnei wā (hei tauira, ngā rongoā whakaiti toto). Me mutu pea te tango mō te wā poto, me whakarerekē rānei, mēnā e tika ana, i runga anō i āna tohutohu.
• Ngā whakamātautau i mua i te pokanga: Me mahi he maha ngā whakamātautau i mua i te pokanga.

Ngā whakamātautau i mua i te pokanga

Ko tētahi o ngā whakamātautau tino nui ko te angiogram CT . Mā tēnei ka taea te whakaputa i tētahi whakaahua mārama, toru-ahu o te rahi, te wāhi, me te hauora o tō aorta me ētahi atu uaua toto e hono ana ki reira. Kia angitu ai te pokanga TEVAR, me nui te wāhi i roto i ō uaua toto kia taea ai te whakauru i te ngongo angiangi (catheter) e whakamahia ana mō te maimoatanga ki roto i te aorta.

I te nuinga o te wā ka whakauruhia e ngā tākuta tēnei ngongo mā roto i te uaua femoral, e rere ana mā roto i te hope o te waewae. Engari, ki te whaiti, ki te ārai rānei taua uaua toto i ngā putunga cholesterol (pēra), me kimi e rātou tētahi atu ara. He mea nui te matawai CT hei whakarite i ēnei mea katoa.

Mā ēnei whakamātautau koe e āwhina ki te whiriwhiri i te rahi me te momo tika o te tākai stent mō te wāhanga kua pakaru o tō aorta.

Te āhua o te mahi pokanga TEVAR

I te wā e whakahaerehia ana tēnei maimoatanga, ka whai te tīma pokanga i ēnei mahi:

1. Whakamoemiti: Ka hoatu he whakamoemiti whānui, he whakamoemiti ā-rohe rānei ki a koe me te whakamoemiti kia kore ai koe e mamae, ā, kia pai hoki te noho puta noa i te pokanga.

2. Te tiaki i te tuaiwi:I ētahi wā (ehara i te katoa), ka whakamahia pea he ngongo angiangi (he paipa wai lumbar) e tango ana i te iti o te wai cerebrospinal mai i te taurakira hei ārai i ngā kino mai i te hekenga o te rere o te toto ki te taurakira i te wā o te pokanga.

3. Tapahi iti: Ka mahia he tapahi iti rawa ki te kiri i te rohe o te huha o te waewae, e tata ana ki te uaua o te femur.

4. Te whakaurunga o te ngongo: Mā roto i tēnei tapahi, ka tukuna he waea angiangi (waea ārahi) i roto i te uaua toto kia puta rā anō i te wāhanga pakaru o te aorta. Kātahi ka whakauruhia he ngongo angiangi e kiia nei ko te catheter me te stent graft i roto ki runga i tēnei waea. Ka mahia katoatia tēnei i raro i te arataki a tētahi tikanga motuhake rite ki te hihi-X ( fluoroscopy ).

5. Te whakatakotoranga o te stent: Ka arahina te catheter ki te wāhi tika o te pakaru, ā, ka tukuna te stent grafted i roto. Ka tuwhera pērā i te puna, ka piri pūmau ki ngā pakitara o te aorta.

6. Mahi: Ka mahi tēnei tākai stent hei arai hou mō te aorta. Mēnā he aneurysm, ka rere te toto mā roto i tēnei arai hou. Mā tēnei ka tangohia te pēhanga mai i te pakitara ngoikore mai i te toto. Mā tēnei ka ārai i te nui haere me te pahū.

7. Te otinga o te pokanga: Whai muri i te whakatakotoranga o te stent, ka tangohia te catheter, ka tuituihia te tapahi iti i te hope ki ngā tuitui, ā, ka tāpirihia he takai.

I te nuinga o te wā, e rua hāora te roa o tēnei tukanga katoa.

He aha ngā painga o te maimoatanga TEVAR?

Koinei ngā take e pai ake ai ngā tākuta ki te tikanga TEVAR i te pokanga tuwhera.

• He poto rawa te wā whakaora me te noho hōhipera.
• Nā te mea kāore he tapahi nui hei tango i te ū, ka iti ake te mamae.
• He iti ake te toto e puta i te wā e pokanga ana.
• He rite tonu ngā hua angitu ki te pokanga tuwhera.
• He iti te mōrearea o ngā raruraru nui, te mate rānei (tata ki te 98% te ōrau ora me TEVAR, ki te whakaritea ki te 88%-94% me te pokanga tuwhera).
• He iti noa te kino mai i te iti o te rere o te toto ki ētahi atu okana (te ischemia o te pito o te okana).

He tūponotanga kei roto i tēnei maimoatanga?

Pērā i ngā pokanga katoa, kei reira ētahi tūponotanga, engari he tino onge.

• Endoleak: Kei te turuturu tonu te toto huri noa i te tākai stent ki roto i te aneurysm.
• Mate urutā: Mate urutā i te wāhi i pokangahia.
• Te nekehanga o te hononga: Ka neke paku te stent i whakanohoia mai i tōna tūranga taketake.
• Pararutiki: He tino onge, ka ngaro te mahi a ngā waewae nā te iti o te rere o te toto ki te taurakira.
• Te whakaeke ngakau, te whiu rānei.

Kōrero ki tō tākuta mō ēnei mōrearea me ngā mahi ka taea e koe te mahi hei whakaiti i aua mōrearea.

Te whakaora me te whai i muri mai

I muri i te pokanga, ka noho koe ki te wāhanga tiaki nui (ICU) mō te rā kotahi, e rua rānei. Whai muri i tēnā, ka whakawhitia koe ki te wāhanga noa, ā, ka taea e koe te hoki ki te kāinga i roto i te rā kotahi, i te wiki rānei. Ina hoki koe ki te kāinga, me tiaki ēnei mea:

• Kaua e taraiwa mō te 1-2 wiki.
• Kaua e tomo ki roto i te kaukau wai kia ora rā anō te motu o te hope (kāore he aha te take ki te kaukau).
• Kaua e hiki ake i te 5 kg mō te 1-2 wiki.

Ki te puta ngā tohu o te mate manawa (hei tauira, te mamae nui o te uma) te whiu rānei (hei tauira, te piko o te taha kotahi o te mata, te uaua ki te kōrero), haere tonu ki te Tari Ohotata (ETU) o te hōhipera tata.