{"id":10284,"date":"2020-03-31T08:45:16","date_gmt":"2020-03-31T08:45:16","guid":{"rendered":"https:\/\/jurmed.ro\/medici\/?p=10284"},"modified":"2020-03-31T08:45:16","modified_gmt":"2020-03-31T08:45:16","slug":"recomandarile-societatii-romane-de-chirurgie-vasculara-pentru-organizarea-activitatii-operatorii-in-perioada-pandemiei-covid-19","status":"publish","type":"post","link":"https:\/\/jurmed.ro\/medici\/recomandarile-societatii-romane-de-chirurgie-vasculara-pentru-organizarea-activitatii-operatorii-in-perioada-pandemiei-covid-19\/","title":{"rendered":"Recomand\u0103rile Societ\u0103\u021bii Rom\u00e2ne de Chirurgie Vascular\u0103 pentru organizarea activit\u0103\u021bii operatorii \u00een perioada pandemiei COVID-19"},"content":{"rendered":"

Aceste recomand\u0103ri sunt actualizate permanent, \u00een func\u021bie de directivele oficiale \u0219i de evolu\u021bia situa\u021biei pe plan na\u021bional.<\/p>\n

Pandemia de COVID-19 ne-a schimbat brusc \u0219i dramatic vie\u021bile. Declararea st\u0103rii de urgen\u021b\u0103 a \u00eenchis \u0219colile, restaurantele, a anulat evenimentele sportive \u0219i culturale.<\/p>\n

Aceste timpuri sunt, de asemenea, extrem de stresante pentru corpul medical, dar \u0219i pentru pacien\u021bii no\u0219tri, fa\u021b\u0103 de care am depus un jur\u0103m\u00e2nt s\u0103 \u00eei \u00eengrijim \u0219i s\u0103 \u00eei trat\u0103m. Sunt multe lucruri confuze, dar \u00eenv\u0103\u021b\u0103m de la colegii no\u0219tri chinezi, italieni \u0219i treptat din toat\u0103 lumea, c\u0103 putem rupe lan\u021bul de transmitere a bolii prin igien\u0103 personal\u0103, folosirea echipamentelor de protec\u021bie \u0219i distan\u021bare social\u0103 (https:\/\/www.who.int\/docs\/defaultsource\/coronaviruse\/who-rights-roles-respon-hw-covid 19.pdf?sfvrsn=bcabd401_0).<\/p>\n

Sunt multe \u00eentreb\u0103ri f\u0103r\u0103 r\u0103spuns pe moment, dar este clar c\u0103 pacien\u021bii asimptomatici, afla\u021bi \u00een perioada de incuba\u021bie, pot fi contagio\u0219i, iar testele virale negative nu exclud infec\u021bia. Orice pacient poate fi poten\u021bial contaminant sau contaminabil.<\/p>\n

Este evident\u0103 nevoia ca spitalele s\u0103 \u00ee\u0219i p\u0103streze disponibilitatea terapie intensiv\u0103 (TI) pentru pacien\u021bii ce o vor necesita. \u00cen consecin\u021b\u0103, fiecare specialitate trebuie s\u0103 prioritizeze interven\u021biile care impun monitorizare postoperatorie de TI \u0219i care pot fi reprogramate, f\u0103r\u0103 a aduce vreun prejudiciu important pacientului. Ca urmare, majoritatea interven\u021biilor de chirurgie electiv\u0103 trebuie am\u00e2nate (tratamentul endovascular al claudica\u021biei, tratamentul varicelor, tratamentul bolii carotidiene asimptomatice etc.), iar durata acestei am\u00e2n\u0103ri nu poate fi estimat\u0103 la ora actual\u0103.<\/p>\n

Urm\u00e2nd modelul Societ\u0103\u021bilor Franceze de Chirurgie Vascular\u0103 \u0219i Endovascular\u0103, Italiene \u0219i Americane de Chirurgie Vascular\u0103, Societatea Rom\u00e2n\u0103 de Chirurgie Vascular\u0103 propune categoriile de indica\u021bii operatorii de urgen\u021b\u0103, care trebuie efectuate, \u00een m\u0103sura posibilit\u0103\u021bilor, de c\u0103tre fiecare serviciu de chirurgie vascular\u0103. Pentru a se asigura permanen\u021ba \u00eengrijirii nediscriminatorii a tuturor patologiilor, este recomandat\u0103 at\u00e2t tratarea prioritar\u0103 a urgen\u021belor c\u00e2t \u0219i men\u021binerea accesului la blocul operator a pacien\u021bilor non-COVID 19.<\/p>\n

Indica\u021bie de opera\u021bie<\/strong>
\nUrgen\u021b\u0103 vital\u0103<\/strong> (necesit\u0103 rezolvare \u00een decurs de ore)
\n– anevrismele aortice rupte sau rapid evolutive, disec\u021bia aortic\u0103 tip B, pseudoanevrisme
\n– traumatismele vasculare cu hemoragie \u0219i\/sau ischemie<\/p>\n

– s\u00e2ngerare de la nivelul unui bypass, acces vascular, fistul\u0103, grefon vascular
\n– ischemie acut\u0103 mezenteric\u0103
\n– ischemia acut\u0103 a membrelor inferioare (Rutherford 1, 2a, 2b)<\/p>\n

Urgen\u021b\u0103 critic\u0103<\/strong> (necesit\u0103 rezolvare \u00een 1-7 zile)
\n– stenozele carotidiene simptomatice
\n– anevrisme de aort\u0103 abdominal\u0103 (> 7 cm) sau anevrisme periferice voluminoase
\n– infec\u021biile protezelor vasculare f\u0103r\u0103 sindrom septic, \u0219oc hemoragic sau iminen\u021b\u0103 de ruptur\u0103
\n– ischemia mezenteric\u0103 cronic\u0103
\n– hipertensiune renovascular\u0103 simptomatic\u0103 sau insuficien\u021b\u0103 renal\u0103
\n– tromboz\u0103 venoas\u0103 profund\u0103 iliofemural\u0103 masiv\u0103
\n– sindrom de apertur\u0103 toracic\u0103 arterial\u0103 sau venoas\u0103 simptomatic cu ocluzie acut\u0103<\/p>\n

Boala acut\u0103<\/strong> (necesit\u0103 rezolvare \u00een 30 de zile, indica\u021bia implic\u0103 judecata clinic\u0103)
\n– revascularizarea ischemiei cronice ce amenin\u021b\u0103 membrul inferior (a\u0219a-numita chronic limbthreatening
\nischemia), func\u021bie de stadiul WIfI
\n– revascularizarea stenozelor de grad \u00eenalt a unor interven\u021bii anterioare
\n– tromboz\u0103 venoas\u0103 profund\u0103 iliofemural\u0103 la pacientul cu risc redus
\n– anevrisme viscerale mari, asimptomatice
\n– accesul pentru hemodializ\u0103 (complica\u021bii care pot determina pierderea abordului vascular preexistent sau necesitatea cre\u0103rii unui abord vascular pentru nefrologi)<\/p>\n

 <\/p>\n

Recomandare de am\u00e2nare a interven\u021biilor elective, p\u00e2n\u0103 la controlarea situa\u021biei COVID-19<\/strong>
\n– claudica\u021bie
\n– stenoza carotidian\u0103 asimptomatic\u0103
\n– vene varicoase
\n– sindromul May-Thurner asimptomatic
\n– sindrom de apertur\u0103 toracic\u0103 cu simptome neurologice
\nIndica\u021bia final\u0103 de programare \u0219i tratament este stabilit\u0103 pe baza disponibilit\u0103\u021bilor locale, \u00een urma evalu\u0103rii clinice \u0219i paraclinice a pacientului, fiind obligatorie aprecierea atent\u0103 a cazurilor la care am\u00e2narea poate agrava boala.<\/p>\n

Pentru situa\u021biile ambigue SRCV st\u0103 la dispozi\u021bia medicilor speciali\u0219ti la COVID-19@srcv.ro<\/p>\n

Conf. Dr. Radu Popa\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Prof. Dr. Mihai Ionac\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 \u00a0 \u00a0 \u00a0 Dr. Adrian Muresan
\nPre\u0219edintele SRCV\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Secretarul general al SRCV\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 Pre\u0219edinte ales SRCV<\/p>\n

 <\/p>\n","protected":false},"excerpt":{"rendered":"

Aceste recomand\u0103ri sunt actualizate permanent, \u00een func\u021bie de directivele oficiale \u0219i de evolu\u021bia situa\u021biei pe plan na\u021bional. Pandemia de COVID-19 ne-a schimbat brusc \u0219i dramatic vie\u021bile. Declararea st\u0103rii de urgen\u021b\u0103 […]<\/p>\n","protected":false},"author":9,"featured_media":10286,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"footnotes":""},"categories":[1],"tags":[],"class_list":["post-10284","post","type-post","status-publish","format-standard","has-post-thumbnail","category-stiri-noutati"],"yoast_head":"\nRecomand\u0103rile Societ\u0103\u021bii Rom\u00e2ne de Chirurgie Vascular\u0103pentru organizarea activit\u0103\u021bii operatorii \u00een perioada pandemiei COVID-19<\/title>\n<meta name=\"description\" content=\"Recomand\u0103rile Societ\u0103\u021bii Rom\u00e2ne de Chirurgie Vascular\u0103pentru organizarea activit\u0103\u021bii operatorii \u00een perioada pandemiei COVID-19\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, 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