
mahadhamani kaa punarjeevit endovascular gubbara avrodh

mahadhamani (riboa) kaa punarjeevit endovascular gubbara avrodh gambhir roop seey ghayal aghaat rogiyon key punarjeevan key dauran kii jaane vaali ack nyuntam aakramak prakriya haye. mool roop seey mahadhamani cross clamping key saath aapaatkaaleen vaksh-vikriti key cumm aakramak vikalp key roop mein vikasit, riboa koo gair-sampeedit trunkle yaa junctional raktasraav key teji seey niyantran koo praapt karane key liye kiya jaataa haye. reboa koo pahale samanya femoral dhamani (see. aff. aeye.) taka pahunch praapt karke aur mahadhamani key bheetar ack catheter koo aage badhaakar kiya jaataa haye. catheter key safal sthaan parr, ack avarodhit gubbara yaa tou avrohi vaksh mahadhamani (kshetra 1) yaa avarakt udar mahadhamani (kshetra 3) key bheetar phool sakata haye. reboa raktasraav key pravaah mein vriddhi kartaa haye aur hriday soochkaank, mastishk perfusion aur coronary perfusion mein sudhaar kartaa haye. halanki reboa nishchit raktasraav niyantran kii aavashyakta koo samaapt naheen kartaa haye, yeh praarambhik punarjeevan key dauran ack asthaayi upaay key roop mein kaam curr sakata haye. reboa key laabhon key bavjood, mahatvapurna sthaaniya aur pranaaleegat ischemic jokhim hain. maankeekrit riboa prakriyaatmak sanketon kii sthaapana aur ischemic chot key jokhim koo cumm karna chala rahee jaanch key vishay hain. haalaanki iss takneek koo vayask rogiyon mein safaltapurvak tainaat kiya gayaa haye, lekin abhee taka bachchon mein iska adhyayan naheen kiya gayaa haye.
chikitsa upayog.
dardanaak chot.
dhad aur junctional kshetron mein gair-sampeedit dardanaak chot key kaaran honey vaalaa gambhir raktasraav aghaat nagrik aur sainya aghaat peediton key beach mrityu kaa ack pramukh kaaran banaa huaa haye. ack charam seema parr chot key kaaran honey vaale paridhiya raktasraav key vipareet, dhad aur junctional kshetron mein dardanaak chotein seedhe dabaav yaa tournamenticute anuprayog key liye sanshodhit naheen hain. kyonki gair-sampeedit dhad raktasraav baahari hastakshepon key liye sanshodhan yogya naheen hain, yeye chotein lagbhag 90 pratishat rakt-bahirgaman mauton key liye jimmedaar hain. gambhir raktasraav koo yaa tou samvahani embolisation yaa kshati niyantran shalya chikitsa takneekon jaise kii pett kii packing yaa gair-aavashyak angon koo hataane key saath prabandhit kiya jaataa haye. haalaanki, hriday sambandhi patan key jokhim mein gambhir raktasraav key sadame vaale rogiyon mein, mahadhamani cross clamping key saath aapaatkaaleen vaksh-vikriti kii jaa sakati haye, halanki parinam aamtaur parr kharaab hotey hain.
punah tainaati.
reboa koo mahadhamani cross-clamping key saath aapaatkaaleen vaksh-vikriti key liye ack teji seey tainaat, nyuntam aakramak vikalp key roop mein vikasit kiya gayaa thaa. haalaanki prakriya key liye koee ekal sanket mandand naheen haye, yeh aamtaur parr rakt utpaad punarjeevan key liye gambhir raktasraav pratyaavartan key saath dhad mein kund yaa bhedak dardanaak choton vaale rogiyon key liye kiya jaataa haye. riboa koo aam femoral dhamani taka pahunch praapt karke aur mahadhamani key bheetar ack phulaane yogya gubbare key saath ack chhote seey endovascular catheter koo dalkar kiya jaataa haye. avarodhit gubbare kii mudrasfeeti parr, avrohi mahadhamani mein rakt pravaah yaa tou aanshik roop seey yaa poori tarah seey baadhit hotaa haye joe baad mein neeche kii or raktasraav koo rokta haye. reboa upkaran kaa samayojya catheter design raktasraav key sandigdh srot key aadhar parr mahadhamani key bheetar gubbare kii parivartansheel sthiti kii anumati detaa haye. avrohi vaksh mahadhamani mein kshetra 1 kii sthiti diaphram key neeche rakt pravaah koo cumm karati haye aur pett, shroni aur nichale chhoron key bheetar raktasraav koo kaafee cumm karati haye. vaikalpik roop seey, avarakt avrohi udar mahadhamani key bheetar kshetra 3 kii niyukti shroni aur nichale chhoron key bheetar raktasraav koo cumm karati haye jabaki pett key bheetar rakt kii aapoorti koo sanrakshit karati haye. halanki reboa nishchit shalya chikitsa prabandhan kii aavashyakta koo pratisthaapit naheen kartaa haye, yeh mastishk aur myocardial perfusion koo sanrakshit karane key liye asthaayi roop seey cardiac index koo badhaakar ack asthaayi upaay key roop mein kaary curr sakata haye. safal riboa pariniyojan key turant baad, rogiyon koo aapaatkaaleen shalya chikitsa hastakshep key liye maanaa jaanaa chaahiye.
chala rahee jaanch.
gambhir raktasraav aghaat key upchaar mein reboa kii suraksha aur prabhavkarita chala rahey shodh kaa ack kshetra haye. praarambhik adhyayanon ney mrityu darr key sambandh mein paraspar virodhi detta kii soochana dee aur mahadhamani cross clamping key saath aapaatkaaleen vaksh-vikriti kii tulanaa mein riboa kaa koee spasht laabh sthaapit karane mein whiffle rahey. haalaanki, reboa upkaran key design sudhaar aur lagaatar vikasit hoe rahey rogi chayan maandandon ney baad mein reboa parinamon mein sudhaar kiya haye. vartamaan saahitya gambhir raktasraav aghaat vaale rogiyon mein riboa pariniyojan key uttarjeevita laabh koo darshaata haye jinhen cardiopulmonary resuscition (see. pee. aar.) kii aavashyakta naheen hoti haye. haalaanki, hriday sambandhi patan seey pahale tainaat kiye jaane parr apani sabse badee prabhavkarita kaa pradarshan karane key bavjood, haal key aankadon ney bhee (see. pee. aar.) key dauran tainaat kiye jaane parr vaadaa dikhaaya haye. mahadhamani cross clamping aur cardiac massage key saath aapaatkaaleen thoracotomy kii tulanaa mein reboa upkaran key saath bund cardiopulmonary sampeedan ney behtar cardiac sampeedan ansh aur anta-jwaariya kaa pradarshan kiya haye. isake alawa, kuchh kendron ney gambhir raktasraav aghaat key liye pragati key jokhim vaale hypotension vaale rogiyon mein riboa tainaati koo badhaava diyaa haye, lekin joe abhee taka mahadhamani cross clamping key saath aapaatkaaleen vaksh-vikriti key maandandon koo puuraa naheen karate hain. reboa parinamon mein parivartansheelta sambhavatah sansthaagat rogi chayan aur sanket mandand mein parivartansheelta koo darshaati haye joe chala rahey mulyankan kii aavashyakta koo ujagar karati haye.
pramukh prakriyaatmak kadam.
samanya femoral dhamani taka pahunch sabse pahale ultrasound nirdeshit, khuli yaa twachiya takneek kaa upayog karke praapt kii jaati haye. phir riboa upkaran koo yaa tou kshetra 1 (avrohi vaksh mahadhamani) yaa kshetra 3 (avarakt udar mahadhamani) key bheetar rakhaa jaataa haye, isase pahale kii avarodhit gubbare koo khaara key saath phoolaaya jaae. safal nishchit raktasraav niyantran parr, avaruddh gubbare koo dheere-dheere vikshepit kiya jaataa haye aur rogi koo baar-baar raktasraav yaa chayapachaya vikriti key liye nigrani kii jaati haye. anta mein, riboa aavaran koo hataa diyaa jaataa haye aur rogi koo pahunch sthal kii jatilataon yaa sambhaavit ischemic jatilataon key liye nigrani kii jaati haye.
riboa pariniyojan key pramukh prakriyaatmak charan neeche dee gaee talika mein soochibaddh hainh
sambhaavit jatilataaen.
reboa upkaran kii nyuntam aakramak prakriti key bavjood, isake upayog seey judey mahatvapurna jokhim hain. yadyapi mahadhamani kaa avrodh hriday aur coronary perfusion koo sanrakshit karane key liye asthaayi roop seey hriday soochkaank koo badhaa sakata haye, lekin neeche kii or ischemia kaa ack mahatvapurna jokhim haye joe sthaaniya ischemic parivartanon yaa pranaaleegat chayapachaya vikriti kaa kaaran bunn sakata haye. anga vichhedan, chayapachaya amlata, aur gambhir pratikshep chot jaisi mahatvapurna jatilataon koo riboa upayog key saath report kiya gayaa haye aur yeye chala rahey shodh key vishay hain. halanki akaadamik yaa shalya chikitsa samudaayon key bheetar koee nishchit sahamati naheen haye, kaee kendra chikitsakiya roop seey mahatvapurna ischemia key jokhim koo cumm karane key liye jaba bhee sambhav hoe 30 minut seey cumm key gubbare key avrodh samay kii sifarish karate hain. vaikalpik roop seey, kuchh sansthanon ney downstream ischemia key prabhaav koo cumm karane key liye aanshik mahadhamani avrodh yaa rook-rook curr gubbare key apasfeeti kii sifarish kii haye. halanki rook-rook curr gubbare kii apasfeeti karna takniki roop seey cumm kathin haye, mahadhamani key aanshik avrodh koo aniyantrit raktasraav koo cumm karane key liye pradarshit kiya gayaa haye, jabaki saath hii doorasth ischemia koo seemit kartaa haye aur surakshit avrodh samay koo badhaata haye.
atirikt sambhaavit jatilataaen neeche soochibaddh hainh

