5 сентября 2016
СОСУДИСТЫЙ ХИРУРГ
Сосудистая хирургия является такой областью медицины, в рамках которой производится выявление заболеваний кровеносных и лимфатических сосудов, подбираются методы соответствующего лечения, а также меры профилактики недопущения такого типа заболеваний. Сосудистый хирург, в свою очередь, является специалистом, использующим по данному направлению методы малоинвазивной терапии. Под малоинвазивными методами подразумевается такое воздействие, при котором нет необходимости в больших разрезах прихирургическом вмешательстве, кроме того, такие методы обладают малой степенью травматичности при одновременной максимальной эффективности применяемого лечения.
СОСУДИСТЫЙ ХИРУРГ: ЧТО ЛЕЧИТ ЭТОТ СПЕЦИАЛИСТ?
Сосуды могут «страдать» от заболеваний самого различного типа, их поражающих, причем такие заболевания могут быть как врожденными, так и приобретенными. Сюда могут относиться опухолевые образования различных областей локализации, в частности имеются ввиду варианты, при которых в сосудистой системе образуются патологические формы сообщений между венами и артериями, в норме в принципе не существующие. В этом же случае отмечаются и соответствующие последствия, начиная от косметических дефектов и болезненности и заканчивая нарушением функций в работе органов, формированием трофических язвенных поражений и пр. Сосудистаяхирургия также включает в себя такое направление, как микрохирургия. Прежде всего, здесь можно обозначить такоехирургическое лечение, которое применяют для подвергшихся травматизации поверхностей, длительным образом не поддающихся заживлению, в такой ситуации, когда принятые в пластическойхирургии методы воздействия не могут быть реализованы для достижения требуемого результата. Кроме того, сюда же относится реплантология – воздействие, при котором пришиваются отрубленные конечности, что сопровождается частичным восстановлением их функций или же полным восстановлением.
Наиболее частой причиной обращения к сосудистомухирургу на сегодняшний день является атеросклероз. Что примечательно, раньше считалось, что это заболевание является лишь уделом пожилых людей, однако уже сегодня доказанным является тот факт, что в равной степени ему подвержены и молодые люди. При атеросклерозе в просвете сосудов начинают откладываться холестериновые бляшки, что, соответственно, приводит к сужению их диаметра. За счет данных образований, как можно понять, нормальный кровоток нарушается, из-за чего нарушается и кровоснабжение определенной системы или органа, а именно — тех из них, которые снабжаются кровью за счет пораженного сосуда. Учитывая то, что сосуды расположены везде, никогда нельзя знать наверняка, есть ли в сосудах бляшки, есть ли они в конкретном сосуде. Неизвестно это до тех самых пор, пока эта бляшка не вырастет до таких размеров, что станет существенной помехой для кровоснабжения органа. Более того, первый симптом, на это указывающий, является не только необратимым, но и последним в некоторых случаях. Соответственно, первый симптом, указывающий на поражение сосудов в области головного мозга, проявляется в форме инсульта, в то время как первым проявлением поражения сосудов сердца становится инфаркт.
На основании общего направления деятельности данного специалиста, можно выделить следующие ее направления, которые и ответят на вопрос «чем занимается ангиохирург?»:
- диагностика заболеваний, связанных с сосудистой системой человека, а также патологий, относящихся к функциям магистральных сосудов;
- лечение поражений, актуальных для сосудистой системы на фоне предшествующего травмирования при воздействии бытовых или механических факторов;
- выявление определенных онкологических заболеваний (при сосредоточении опухолевого образования в непосредственной близости к артерии или вене, а также при ее прорастании в магистральные сосуды);
- лечение, связанное с протезированием сосудов, пораженных при травмировании или во время оперативного вмешательства;
- лечение, связанное с удалением врожденных форм патологических образований с поражением сосудов (артериовенозные мальформации, гемангиомы);
- реплантология – направление микрохирургии, за счет которого возможным становится «пришивание» ампутированных конечностей (фрагментов конечностей, кистей рук и пр.);
- реализация на практике любого рода методов диагностики, хирургии и консервативной терапии, а также методик, ориентированных на профилактику по недопущению заболеваний сосудистой системы.
- аневризма аорты;
- диабетическая ангиопатия (диабетическая стопа);
- инфаркт; варикозное расширение вен; инсульт; варикоцеле;
- ИБС ишемическая болезнь сердца); артериовенозная мальформация; мраморность кожи; артериовенозная фистула; дисциркуляторная энцефалопатия; цинга;
- острый инфаркт миокарда; флебит; тромбоз; тромбофлебит;
- стеноз сонных артерий; эмболия артерий и вен; поражение сосудов, за счет которых обеспечивается кровоснабжение головного мозга (брахиоцефальные сосуды);
- облитерирующий тромбангиит (болезнь Бюргера); лифостаз; синдром Рейно;
- Синдром Такаясу (или аортоартериит); синдром Райта; газовая эмболия;
- синдром Бадда-Киари; транспозиция магистральных сосудов;
- субарахноидальное кровоизлияние и пр.
КОГДА ИДТИ НА ПРИЕМ СОСУДИСТОГО ХИРУРГА (АНГИОХИРУРГА)?
В идеале консультация сосудистого хирурга должна входить в рамки ежегодного профилактического осмотра. Определенные симптомы, в особенности, если речь идет об их сочетании, требуют обращения к этому специалисту. Выделим следующие их виды:
- частые головные боли, не обусловленные какими-либо конкретными причинами (например, простудой или гриппом и пр.);
- жжение в икрах, в стопах;
- шум в ушах, в голове;
- «мушки» перед глазами;
- ощущение «чугунных» ног, «гудение» в ногах;
- ощущение покалывания, онемения в конечностях, холода в них, аналогичные ощущения в любом другом участке тела;
- расширенные вены;
- боль в ногах во время ходьбы;
- выраженные болевые ощущения, появляющиеся в области стоп;
- пульсация в области живота;
- течность ног; появление уплотнений в области нижних конечностей, покраснение;
- кровоизлияния (вне зависимости от области локализации);
- незаживающие раны;
- появление сосудистых звездочек;
- судороги, появляющиеся как при нагрузках, так и в состоянии покоя;
- потеря чувствительности;
- длительно проявляющаяся болезненность со стороны грудной клетки, в боку, в пояснице (с возможным распространением к паху, нижним конечностям и ягодицам);
- почернение пальцев (или их потемнение, посинение);
- внезапные покачивания, потеря сознания, падения.
АНАЛИЗЫ, НЕОБХОДИМЫЕ ДЛЯ ПОСТАНОВКИ ДИАГНОЗА У СОСУДИСТОГО ХИРУРГА
Обращение к сосудистому хирургу также требует прохождения некоторых анализов, за счет которых будет получена картина функциональных особенностей кровотока и биохимический состав крови. К таким анализам крови, соответственно, относятся:
Также может возникнуть необходимость в следующих анализах:
анализ мочи (общий); коагулограмма, гемостазиограмма, уровень фибриногена, протромбиновый индекс; при наличии показаний – серологическое исследование (определение антител в составе сыворотки крови); дополнительные анализы на консультации сосудистого хирурга назначает он сам.
ДИАГНОСТИКА СОСУДИСТОГО ХИРУРГА: ОСНОВНЫЕ МЕТОДЫ
Для диагностики заболеваний с поражением кровеносных сосудов сосудистый хирург исследует данные осмотра пациента, а также данные ЭКГ, анализов крови и некоторых других специфических исследований. К последним в частности относятся следующие их варианты:
ЛЕЧЕНИЕ У СОСУДИСТОГО ХИРУРГА: ОСНОВНЫЕ ПРИНЦИПЫ
На основании имеющихся знаний, касающихся строения системы кровеносных сосудов, характерных черт, присущих ее функциональности, а также на основании специфики проявления патологии в конкретном случае, сосудистый хирург проводит оценку всех экзо- и эндогенных факторов, провоцирующих заболевание.
После того, как будет проведено соответствующее ангиологическое исследование, данный специалист, выделив причину, заболевание спровоцировавшую, ставит диагноз. Уже на основании результатов и собственно диагноза подбирается тактика в дальнейшем реализуемых направлений терапии. В основном такая терапия является комбинированной, в нее входит как медикаментозное лечение, так и лечение компрессионное, а также склеротерапия.
Достаточно распространенными методами лечения также являются криотерапия, магнитотерапия, электронейростимуляция, пневмомассаж, лечебная физкультура и пр. Нередко, если существует риск прогрессирования патологии, проводится оперативное лечение, конкретный метод зависит от специфики заболевания (минифлебэктомия, венэктомия, внутрисосудистая лазерная коагуляция и т.д.).
Сосудистая хирургия или ангиология является разделом клинической хирургии. Сфера ангиологии — заболевания кровеносных сосудов человеческого организма, то есть артерий и вен. Кто такой сосудистый хирург? Он же – ангиолог или флеболог – это врач, который специализируется на диагностике, лечении и профилактике заболеваний сосудов. Только специализация ангиолога — артерии, а флеболога — вены. Специалист по сосудистой хирургии или ангиохирург использует методы малоинвазивной терапии для лечения заболеваний сосудов. Малоинвазивными называют методы, при которых в процессе хирургического лечения минимизируется размер разрезов, что делает операцию малотравматичной для пациента, облегчая реабилитационный период, при этом достигается максимальная эффективность лечения.
Чем занимается сосудистый хирург?
Вооруженный всеобъемлющими познаниями в области строения, особенностей и патологии функционирования системы кровеносных сосудов человека, сосудистый хирург — при обращении каждого пациента — должен оценить все эндогенные или экзогенные факторы возникновения заболевания.
После проведения ангиологического исследования сосудистый хирург определяет причину возникшей сосудистой патологии и ставит точный диагноз. В зависимости от конкретного диагноза врачом выбирается оптимальная тактика лечения. Как правило, терапия заболеваний сосудов комбинированная и включает не только медикаментозное лечение, но и флебосклерозирующие методики (склеротерапия), компрессионное лечение. Широко используется и физиотерапия — электронейростимуляция, дарсонвализация, магнито- и криотерапия, пневмомассаж и лечебная физкультура.
Во многих случаях — при угрозе прогрессирования болезни — сосудистый хирург прибегает к оперативному лечению (венэктомии, минифлебэктомии, внутрисосудистой лазерной коагуляции и др.).
Что лечит сосудистый хирург?
Сосудистые заболевания бывают врожденными и приобретенными, могут развиваться на фоне других системных заболеваний, гормонального дисбаланса, или же возникать после травматического повреждения сосудов. Сфера деятельности сосудистого хирурга также включает онкологические образования, расположенные вблизи крупных магистральных сосудов, которые могут создавать патологические сообщения между венами и артериями. В число последствий подобных заболеваний входят как косметические дефекты, так и функциональные нарушения в органах, за кровоснабжение которых отвечают пораженные сосуды.
Сосудистая хирургия также включает в себя такое направление, как микрохирургия. Прежде всего, здесь можно обозначить такое хирургическое лечение, которое применяют для подвергшихся травматизации поверхностей, длительным образом не поддающихся заживлению, в такой ситуации, когда принятые в пластической хирургии методы воздействия не могут быть реализованы для достижения требуемого результата. Кроме того, сюда же относится реплантология – воздействие, при котором пришиваются отрубленные конечности, что сопровождается частичным восстановлением их функций или же полным восстановлением.
Наиболее частой причиной обращения к сосудистому хирургу на сегодняшний день является атеросклероз. Что примечательно, раньше считалось, что это заболевание является лишь уделом пожилых людей, однако уже сегодня доказанным является тот факт, что в равной степени ему подвержены и молодые люди. При атеросклерозе в просвете сосудов начинают откладываться холестериновые бляшки, что, соответственно, приводит к сужению их диаметра. За счет данных образований, как можно понять, нормальный кровоток нарушается, из-за чего нарушается и кровоснабжение определенной системы или органа, а именно — тех из них, которые снабжаются кровью за счет пораженного сосуда.
В большинстве случаев атеросклероз протекает бессимптомно, так как о наличии атеросклеротических бляшек можно судить только по негативным последствиям сосудистых поражений. Так, если при закупорке сосуда атеросклеротической бляшкой нарушается кровоснабжение, и возникают деструктивные изменения в тканях, по патологии данного органа можно предположить сосудистое заболевание. Эта ситуация очень опасна, поскольку зачастую атеросклероз обнаруживается на такой стадии, когда возникают необратимые патологические процессы. Для некоторых пациентов первый симптом атеросклероза является одновременно и последним – в случае инфаркта или инсульта, то есть поражения сосудов сердца или мозга.
На основании общего направления деятельности данного специалиста, можно выделить следующие ее направления, которые и ответят на вопрос «чем занимается ангиохирург?»:
- Диагностика заболеваний, связанных с сосудистой системой человека, а также патологий, относящихся к функциям магистральных сосудов;
- Лечение поражений, актуальных для сосудистой системы на фоне предшествующего травмирования при воздействии бытовых или механических факторов;
- Выявление определенных онкологических заболеваний (при сосредоточении опухолевого образования в непосредственной близости к артерии или вене, а также при ее прорастании в магистральные сосуды);
- Лечение, связанное с протезированием сосудов, пораженных при травмировании или во время оперативного вмешательства;
- Лечение, связанное с удалением врожденных форм патологических образований с поражением сосудов (артериовенозные мальформации, гемангиомы);
- Реплантология – направление микрохирургии, за счет которого возможным становится «пришивание» ампутированных конечностей (фрагментов конечностей, кистей рук и пр.);
- Реализация на практике любого рода методов диагностики, хирургии и консервативной терапии, а также методик, ориентированных на профилактику по недопущению заболеваний сосудистой системы.
Соответственно, исходя из специфики деятельности ангиохирурга, можно выделить ряд заболеваний, попадающих под компетенцию этого специалиста:
- Атеросклеротические поражения сосудов – атеросклероз нижних конечностей, тромбоз почечных артерий, атеросклероз сосудов головного мозга;
- Ишемическая болезнь сердца;
- Аневризма аорты;
- Артериовенозные мальформации;
- Инфаркт миокарда;
- Врожденная или травматическая артериофенозная фистула;
- Поражение сосудов, обеспечивающих мозговое кровообращение;
- Трофические язвенные поражения кожи;
- Стеноз сонных артерий;
- Диабетическая ангиопатия;
- Цинга;
- Флебит, тромбоз и тромбофлебит;
- Инсульт;
- Варикоцеле;
- Эмболия вен;
- Артериальная газовая эмболия;
- Варикозное расширение вен;
- Дисциркуляторная энцефалопатия;
- Воспалительный тромбоз небольших артерий и поверхностных вен;
- Мраморность кожи;
- Облитерирующий тромбангиит;
- Синдром Райта;
- Нарушение оттока лимфы – лимфостаз;
- Разрыв аневризмы и субарахноидальное кровоизлияние;
- Хроническая ишемия мозга, недостаточность церебрального кровообращения;
- Воспаление аорты и её разветвлений – синдром Такаясу;
- Нарушение венозного оттока в печени – синдром Бадда-Киари;
- Аутоиммунный синдром, характеризующийся альвеолярными легочными кровотечениями и гломерулонефритом – синдром Гудпасчера или системный капиллярит;
- Транспозиция магистральных сосудов;
- Расслоение аорты при синдроме Марфана;
- Болезнь Рейно – поражение сосудов дистальных отделов конечностей, пальцев рук и ног.
Когда идти на приём сосудистого хирурга (ангиохирурга)?
В идеале консультация сосудистого хирурга должна входить в рамки ежегодного профилактического осмотра. Определенные симптомы, в особенности, если речь идет об их сочетании, требуют обращения к этому специалисту. Выделим следующие их виды:
- Тяжесть в голенях и стопах, отечность и ощущение жжения в ногах;
- Покалывание и онемение дистальных отделов конечностей и любых других частей тела;
- Боли в мышцах голени (икроножных мышцах) в процессе ходьбы;
- Слабость в руках при физической нагрузке;
- Головокружение, шум в ушах, нарушения координации и сознания;
- Потемнение кончиков пальцев, они могут чернеть и приобретать синеватый оттенок;
- Язвенные поражение на коже, долго не заживающие повреждения;
- Головные боли, не связанные с другими заболеваниями;
- Пятна и темные точки перед глазами;
- Пульсирующие ощущения в районе живота;
- Кровоизлияния в любой области тела;
- Возникновение судорог даже в состоянии покоя, усиливаются при физических нагрузках;
- Расширенные вены на ногах, болезненные ощущения в стопах при ходьбе;
- Возникновение варикозных сеток или телеангиоэктазий;
- Уплотнения, локализованные в нижних конечностях, их покраснение и болезненность или, напротив, потеря чувствительности;
- Болезненные ощущения в боку, грудной клетке и в поясничной области, которые могут распространяться вниз по ягодицам и через паховую область к ногам.
Какие анализы нужно сдать при обращении к сосудистому хирургу?
Обращение к сосудистому хирургу также требует прохождения некоторых анализов, за счет которых будет получена картина функциональных особенностей кровотока и биохимический состав крови. К таким анализам крови, соответственно, относятся:
- Биохимический анализ крови. На основании этого анализа определяются функциональные параметры, присущие общему состоянию внутренних органов и систем. Особую роль играет в этом анализе ряд показателей, связанных с холестерином. В частности это общий уровень холестерина, показатель жиров (триглицеридов), показатель высокой и низкой плотности (ЛПВП).
- Общий анализ крови. На основании данных этого анализа определяется состояние, актуальное для стенок сосудов, выделяется уровень лейкоцитов, гемоглобина, эритроцитов, СОЭ (скорость оседания эритроцитов), индекс и объем эритроцитов, показатель, указывающий на риск развития у пациента атеросклероза – коэффициент атерогенности, вычисляемый на основании соотношения общего показателя по холестерину и показателя высокой плотности липопротеинов.
Также может возникнуть необходимость в следующих анализах:
- Общий анализ мочи – назначают при диагностике большинства заболеваний, моча исследуется на уровень глюкозы, билирубина, кетоновых тел, определяется её pH, наличие клеток крови, солей, паразитических организмов, бактерий и грибков;
- Коагулограмма (анализ свертываемости крови);
- Гемостазиограмма – определяется уровень фибриногена, протромбиновое время и протромбиновый индекс;
- Агрегатограмма тромбоцитов (анализ активности тромбоцитов крови);
- Липидограмма (при хронической патологии периферийных артерий);
- Анализ крови на С-реактивный белок и иммуноглобулины IgG и IgM (также при хронических заболеваниях периферийных артерий);
- Серологический анализ крови – позволяет определить инфекционную причину сосудистых заболеваний, исследуется сыворотка крови на предмет наличия антител.
В процессе диагностики у ангиохирурга может возникнуть необходимость в дополнительных исследованиях для точной постановки диагноза, направление на анализы даёт врач.
Основные методы диагностика сосудистого хирурга
Для диагностики заболеваний с поражением кровеносных сосудов сосудистый хирург исследует данные осмотра пациента, а также данные ЭКГ, анализов крови и некоторых других специфических исследований. К последним в частности относятся следующие их варианты:
- Ультразвуковое дуплексное сканирование (МРТ). Такой метод диагностики дает возможность получить общее представление о состоянии сосудов за счет двухмерного их изображения, в котором доступна к рассмотрению структура их стенок, особенности их проходимости, размеры, а также специфика кровотока, актуальная для сосудистого русла.
- УЗДГ, или ультразвуковая Допплерографиядопплерография. Этот метод диагностики дает возможность произвести объективную оценку функционального состояния периферической системы кровообращения и главных артерий. Также за счет УЗДГ можно определить актуальное состояние артериального кровотока в области нижних конечностей (по-другому это направление в данной диагностике обозначается как определение лодыжечно-плечевого индекса).
- Ангиография. Такой метод исследования является рентгенологическим, за счет его применения можно точно определить, где находится суженный или закупоренный сосуд. Коронарная ангиография. В этом случае рентгенологическое исследование ориентировано на изучение камер сердца и коронарных артерий.
- Церебральная ангиография. Основная область рентгенологического исследования в этом случае – сосуды головного мозга.
- Электрокардиограмма – оценивается работа сердечной мышцы в суточной динамике.
- Эхокардиограмма – ультразвуковое исследование работы сердечной мышцы.
- Эндоскопия.
- Эндоскопические методы исследования сосудов или ангиоскопия позволяет оценить состояние их внутренней поверхности, определить склонность к развитию атеросклероза.
- Эхография сосудов печени.
- УЗИ с исследованием внутренних органов, в особенности тех из них, которые отвечают за выработку гормонов (надпочечники, почки, щитовидная железа).
- Сонография области сосудов нижних конечностей.
- Антропометрия – рассчитывают индекс массы тела, измеряют длину тела на ростомере, определяют окружность грудной клетки и живота для оценки общего состояния организма на основе антропометрических показателей.
- Консультация врачей узкого профиля.
Основные принципы лечения сосудистого хирурга
После оценки всех внешних и внутренних факторов, спровоцировавших сосудистой заболевание, ангиолог назначает курс лечения, который может включать медикаментозную и компрессионную терапию, оперативное вмешательство, склеротерапию.
Склеротерапия применяется в лечении варикозного расширения вен и сосудистых новообразований, в сосуд вводят специальное вещество, что вызывает склеивание его стенок и предотвращает распространение патологического процесса.
Другие методы лечения сосудистых заболеваний – магнитная терапия, пневмомассаж, криотерапия, электронейростимуляция, а также упражнения лечебной физкультуры. При необходимости хирургического вмешательства, ангиолог назначает венэктомию, минифлебоэктомию или лазерную коагуляцию сосуда, в зависимости от типа патологии.
Советы врача сосудистого хирурга
Согласно последним данным Международного общества флебологов (Union Internationale de Plebologie), хронической венозной недостаточностью страдают 35-65% жителей индустриально развитых стран мира. К наиболее распространенным патологиям сосудов относится варикозная болезнь вен, которая особенно часто возникает у женщин. Статистика свидетельствует: симптомы данной болезни имеют более 60% женщин после 45-50 лет. Деформированные вены, извивающимися синими «жгутами» просвечивающие под кожей, не только портят внешний вид. Без лечения варикозной болезни развиваются очень тяжелые сосудистые осложнения, в первую очередь, тромбофлебит, а также трофические язвы и тромбоэмболии.
Среди предрасполагающих к появлению варикозной болезни факторов необходимо отметить следующие:
- генетически обусловленная слабость стенок вен и дисфункция венозных клапанов (то есть наследственная предрасположенность);
- излишняя масса тела;
- позиционные нарушения венозного оттока (у людей, длительно находящихся в вынужденном ортостазе при «сидячей» или «стоячей» работе, а также во время частых и продолжительных авиаперелетах);
- курение;
- обувь на высоких каблуках;
- чрезмерные физические нагрузки и перегревание (сауна, горячие ванны, солярий, пляж);
- беременность и роды;
- интенсивная гормонозаместительная терапия или длительное применение гормональных контрацептивов).
Все эти факторы могут вызывать нарушение тока крови по венам, ее застой и повышение венозного давления, что приводит к расширению, деформации и частичной или полной дисфункции сосудов ног.
Терапия варикозной болезни вен должна проводиться при первых же ее симптомах. Так как тромбофлебит, к которому приводит данное заболевание, является уже воспалением стенок вен с образованием тромбов. Часто тромбы отрываются от стенки сосуда и мигрируют по сосудистому руслу. И если он попадает в легочную артерию, то случается смертельно опасная тромбоэмболия легочной артерии. Так что венозный тромбоз — это реальная угроза жизни.
Ангиохирург специализируется на выявлении патологических процессов, охватывающих сосуды человеческого тела: кровеносные и лимфатические. По итогам диагностики врач определяет тактику лечения и способы. Специалисты данной области занимаются профилактикой заболеваний сосудов.
Компетенция ангиохирурга, какие болезни он лечит
Главная специализация сосудистого хирурга – сосуды человеческого тела, по которым движется кровь либо лимфа. Эта сфера медицины предполагает изучение их строения, особенностей работы, наряду с патологическим процессами, которые могут развиваться в сосудах. Для каждого случая выбирается консервативный путь устранения патологических процессов. Часто роль ангиохирурга выполняет торакальный хирург, получивший дополнительную специализацию.
Распространенные в практике ангиохирурга недуги:
- варикозное расширение вен тела;
- инсульт;
- проявления диабетической стопы;
- варикоцеле и синдром Рейно;
- синдром Бюргера либо тромбангииты облитерирующей формы;
- заболевание Такаясу либо аортоартериит;
- газовые эмболии, лимфостаз;
- цинга;
- кровоизлияния субарахноидального типа;
- инфаркт;
- атеросклероз;
- аневризма аорты;
- тромбозы, тромбофлебит;
- синдром Райта;
- ишемические болезни сердечной мышцы;
- фистулы артериовенозные;
- синдром Бадд-Киари;
- эмболия артерий либо вен;
- стенозы сонной артерии;
- мраморность поверхности кожи;
- всевозможные патологические поражения вен, артерий, влекущие дестабилизацию поступления крови к мозгу и прочие.
Все проблемы сосудов имеют приобретенный либо врожденный характер. Развитие патологических процессов начинается из-за недугов системного типа, травмирования сосудов или гормональных сдвигов.
Ангиохирурги принимают участие в лечении онкологии, сформированных в близости от магистральных сосудов, которые становятся причиной нарушения артерий и вен.
Коротко об ангиохирурге можно узнать из видео:
Особенности приема ангиохирурга
Правила записи к специалисту этого профиля устанавливаются индивидуально.
Перед посещением доктора нужно подготовиться к визиту. Принять душ и собрать результаты проведенных ранее исследований, если они имеют отношение к пораженной области. Врачу нужно предъявить направления к нему, выписанные специалистами при их наличии.
Прием предполагает беседу с пациентом. Доктор спросит о жалобах и обстоятельствах их возникновения, длительность проявления симптома, далее выполняется осмотр.
По итогам первичного приема ангиохирург назначит ряд обследований для постановки и уточнения диагноза. По их результатам будет выбрана тактика лечения и его основные компоненты.
Какие симптомы требуют обращения к ангиохирургу?
В сосудистой хирургии, равно как в другой отрасли медицины, важно обращение к доктору. При любых подозрительных проявлениях стоит обращаться к врачу.
Специалисты рекомендуют посетить сосудистого хирурга при появлении симптомов:
- онемение, покалывание любой области тела;
- изменение оттенка кончиков пальцев – потемнение, проявления черноты;
- головные боли, которые не относятся к иным недугам;
- пульсация в области живота;
- регулярные судороги под физической нагрузкой и в состоянии покоя;
- появление варикозной сетки;
- отечность, жжение, тяжесть области стоп либо голеней;
- нарушения координации, шум в ушах. Головокружения;
- поражения кожных покровов язвенного характера;
- появление пятен перед глазами;
- любые кровоизлияния;
- расширение вен нижних конечностей;
- болезненность либо утрата чувствительности ног.
Информативные диагностические методики
Обследование пациента начинается с осмотра лабораторных анализов, инструментальных исследований. Данные сосудистые хирурги получают по результатам следующих исследований крови:
- биохимическое, клиническое исследования позволяют оценить холестерин, гемоглобин, состояние стенок кровеносных сосудов и прочие показатели;
- оценка активности тромбоцитов;
- изучение свертываемости крови.
Изредка дополнительно назначаются специальные лабораторные исследования вроде анализа мочи, оценки уровня фибриногена и прочих.
Инструментальная диагностика для сосудистой хирургии
Среди инструментальных методик наиболее полные сведения ангиохирурги получают посредством следующих исследований:
- МРТ-ангиография для оценки кровотока русла сосуда;
- ультразвуковая допплерография для оценки функциональных особенностей кровотока конечностей, выявления мест закупорки сосудов;
- коронарная ангиография при оценке сосудов, отвечающих за кровоснабжение сердца;
- ЭКГ для получения суточной динамики функционирования сердца;
- ЭХК сосудов;
- антропометрия – вычисление индекса массы тела человека;
- ангиография рентгенологическая выявляет закупоренный участок;
- ангиография церебральная – оценка состояния сосудов мозга, их работы;
- УЗИ основных органов;
- эндоскопическое изучение внутренних стенок сосудов;
- эхокардиограмма сердца;
- доплер-сонография вен области ног, при необходимости оценки реального кровотока.
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Основные методики лечения сосудистой хирургии
В зависимости от типа заболевания и развития патологического процесса, возможно консервативное либо хирургическое лечение. Первое предполагает назначение различных лекарственных препаратов, бинтование с применение эластичного бинта (выполняется при варикозе), исправление состояний, провоцирующих нарушения функционирования сосудов.
Если консервативное лечение не эффективно или заболевание дошло до серьезно стадии развития, обращаются к хирургическим вмешательствам
Оперативные вмешательства в ангиохирургии
Современные сосудистые хирурги обращаются к методикам малоинвазивных вмешательств. Это предполагает выполнение минимальных надрезов, что предопределяет минимальную травматичность такой операции при высокой ее эффективности.
Современная микрохирургия не предполагает простых вмешательств – продолжительность любой из них составляет несколько часов непрерывной работы.
Наибольшую популярность на практике сегодня имеют:
- минифлебэктомия;
- лазерная внутрисосудистая коагуляция вен;
- реплантация.
Лазерная внутрисосудистая коагуляция относится к вариантам лечения посредством ультразвука. Для ее выполнения достаточно местной анестезии – швы и разрезы при этом отсутствуют. Уже через несколько часов по окончании операции пациента отпускают домой.
Минифлебэктомия получила наиболее широкое практическое применение. Операция предполагает удаление тех участков сосудов, которые наиболее пострадали при развитии патологического процесса. Основное ее достоинство сводится к тому, что техника предполагает выполнение прокола вместо разреза, поэтому место вмешательства остается практически незаметным для человеческого глаза. Именно через это отверстие выводится поврежденный сосуд.
Когда обращаться за консультацией к ангиохирургу
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