Holo ke ākea peripheral - wāwae

ʻO ke bypass artery bypass kahi kīʻaha e reroute i ka hāʻawi koko a puni kahi aʻa i ālai ʻia i kekahi o kou mau wāwae. Hiki i nā waihona momona ke kūkulu i loko o nā aʻa a ālai iā lākou.

Hoʻohana ʻia kahi graft e pani a kāpae paha i ka ʻāpana i ālai ʻia o ke aʻa. ʻO ke kīkē he paipu ea ia, a i ʻole he kīʻaha koko (vein) i lawe ʻia mai kou kino (ʻo ka pinepine i ka ʻaoʻao ʻē aʻe) i ka wā o ke kaʻina like.

Hiki ke hana ʻia i ke kahakaha by peripheral artery i hoʻokahi a ʻoi paha o nā kīʻaha koko aʻe:

• Aorta (ke aʻa nui i hele mai kou puʻuwai)
• ʻO ke aʻa i kou pūhaka
• ʻO ke aʻa i kou ʻūhā
• ʻO ke aʻa ma hope o kou kuli
• ʻO ke aʻa i kou wāwae haʻahaʻa
• ʻO Artery i kou ʻūlima

Ma ke kahakaha holoʻokoʻa o nā aʻa.

• E loaʻa iā ʻoe ka lāʻau lapaʻau (anesthesia) i ʻole ʻoe e ʻeha. ʻO ke ʻano anesthesia e loaʻa iā ʻoe e kaukaʻi ʻia i nā aʻa e mālama ʻia.
• E ʻokiʻoki kāu kaukipoki ma luna o ka ʻāpana o ke aʻa i ālai ʻia.
• Ma hope o ka hoʻoneʻe ʻana i ka ʻili a me ke kiko ma waho o ke ala, e kau ka mea ʻokiʻoki i nā mea paʻa i kēlā me kēia hopena o ka ʻāpana i ālai ʻia o ke aʻa. Humuhumu ʻia ke kihi ma kahi.
• E hōʻoia ka kaukō lapaʻau he kahe maikaʻi ke koko i kou palena. A laila e pani ʻia kāu ʻoki. Loaʻa paha iā ʻoe kahi x-ray i kapa ʻia he arteriogram e hōʻoia i ka hana o ka hoʻopili.

Inā ʻoe e keʻakeʻa i ke kīʻaha e mālama i kāu aorta a me kou aʻa iliac a i ʻole aorta a me nā aʻa femoral ʻelua (aortobifemoral):

• E loaʻa paha iā ʻoe ka anesthesia ākea. ʻAʻole ʻoe e noʻonoʻo a ʻaʻole hiki ke ʻeha. A i ʻole, loaʻa paha iā ʻoe ka epidestia a i ʻole ke anesthesia spinal. E hoʻokomo ke kauka i kou iwi kuamoʻo me ka lāʻau e hoʻoholo ai i kou pūhaka i lalo.
• E ʻokiʻoki kāu kaukipō i kāu ʻokiʻoki ma waena o ka ʻōpū a hiki i nā aʻa aorta a me nā ʻili.

Inā ʻoe e keʻakeʻa i ke kīʻaha e mālama i kou wāwae haʻahaʻa (femoral popliteal):

• Loaʻa paha iā ʻoe ka anesthesia ākea. ʻAʻole ʻoe e noʻonoʻo a hiki ʻole ke ʻeha. Hiki iā ʻoe ke loaʻa i kahi anesthesia epidural a i ʻole spinal. E hoʻokomo ke kauka i kou iwi kuamoʻo me ka lāʻau e hoʻoholo ai i kou pūhaka i lalo. Loaʻa i kekahi poʻe ka anesthesia kūloko a me kahi lāʻau e hoʻomaha ai iā lākou. Hoʻomaʻamaʻa nā anesthesia kūloko wale nō i ka wahi e hana ʻia ana.
• E ʻokiʻoki kāu kauka lāʻau i kou wāwae ma waena o kou aʻa a me kou kuli. E kokoke ia i ka paʻa i kou aʻa.

ʻO nā ʻōuli o ke ākea ākea ākea i hōʻeha ʻia, ʻeha, a kaumaha paha i kou wāwae e hoʻomaka a hele a maikaʻi paha ke hele ʻoe.

ʻAʻole paha ʻoe e pono e kāpae i ke kaha inā hele wale kēia mau pilikia ke hele wāwae ʻoe a hele hele ke hoʻomaha ʻoe. ʻAʻole paha ʻoe e pono i kēia ʻoki ʻana inā hiki iā ʻoe ke hana i ka hapa nui o kāu hana i kēlā me kēia lā. Hiki i kāu kauka ke hoʻāʻo mua i nā lāʻau a me nā lāʻau ʻē aʻe.

ʻO nā kumu no ka hana ʻana i ka ʻaoʻao ākea o ka wāwae.

• Loaʻa iā ʻoe nā hōʻailona e kāohi iā ʻoe mai ka hana ʻana i kāu hana o kēlā me kēia lā.
• ʻAʻole maikaʻi kāu mau ʻōuli me nā lāʻau ʻē aʻe.
• He ʻeha kou ʻeha (ʻeha) a ʻeha paha ma kou wāwae e hoʻōla ʻole.
• Loaʻa kou maʻi a gangrene paha i kou wāwae.
• He ʻeha kou i kou wāwae mai kou mau aʻa liʻiliʻi, ʻoiai ʻoe e hoʻomaha ana a i ʻole i ka pō.

Ma mua o ke kāpili ʻana, e hana kāu kauka i nā hoʻokolohua kūikawā e ʻike ai i ka nui o ka paʻa ʻana.

Nā pilikia no kekahi anesthesia a me nā ʻoki kino:

• Nā hopena āpau i nā lāʻau
• Nā pilikia hanu
• Hoʻopaʻa ke koko i nā wāwae e hele paha i nā akemāmā
• Nā pilikia hanu
• Ka hōʻeha puʻuwai a i ʻole hōʻeha

ʻO nā pilikia no kēia ʻoki kino penei:

• ʻAʻole holo ka Bypass
• Hoʻopilikia i ke aʻalolo e hōʻeha i ka ʻeha a i ʻole ka helu ʻana i kou wāwae
• Poino i nā mea pili kokoke i ke kino
• Ka hōʻino i ka ʻōpū i ka wā o ke ʻoki aorta
• Kahe nui ke kahe
• ʻO ka maʻi i keʻokiʻoki
• Ka hōʻeha i nā aʻalolo kokoke
• Nā pilikia pili i ka moekolohe ma muli o ka hōʻino ʻia o ke aʻalolo i ka wā o ke kahakaha aorta
• ʻOki ʻoki e wehe
• Pono no kahi ʻoki bypass ʻelua a i ʻole kahi ʻoki wāwae
• Maʻi hohola
• Make

E loaʻa iā ʻoe kahi hoʻokolohua kino a me nā hoʻokolohua olakino he nui.

• Pono ka hapa nui o ka poʻe e nānā i ko lākou puʻuwai a me nā māmā ma mua o ka bypass peripheral artery bypass.
• Inā loaʻa ʻoe i ka maʻi diabetes, pono ʻoe e ʻike i kāu kauka mālama ola e hōʻoia.

E haʻi mau i kāu mea hoʻolako i nā lāʻau āu e lawe nei, a me nā lāʻau, nā mea hoʻopihapiha, a me nā mea kanu āu i kūʻai ai me ka ʻole o ka lāʻau.

I loko o 2 mau pule ma mua o kou ʻoki kino:

• Nonoi ʻia paha ʻoe e haʻalele i ka lawe ʻana i nā lāʻau i mea e paʻakikī ai ke kō ʻana o kou koko. Hoʻopili kēia i ka aspirin, ibuprofen (Advil, Motrin), clopidogrel (Plavix), naprosyn (Aleve, Naproxen), a me nā lāʻau ʻē aʻe like.
• E nīnau i kāu mea hāʻawi i nā lāʻau e pono ai e lawe i ka lā o kou ʻoki ʻana.
• Inā puhi ʻoe, pono ʻoe e hoʻokū. E noi i kāu mea hāʻawi mai i kōkua.
• E hoʻomaopopo mau i kāu mea hoʻolako e pili ana i kekahi anuanu, flu, fever, breakout herpes, a i ʻole nā ​​maʻi ʻē aʻe āu e loaʻa ai ma mua o kāu ʻoki.

Mai inu i kekahi mea ma hope o ke aumoe i ka pō ma mua o kāu ʻoki ʻana, me ka wai.

I ka lā o kou ʻoki kino:

• E lawe i nā lāʻau a kāu mea hāʻawi i kauoha aku ai iā ʻoe e lawe me kahi wahi wai ʻuʻuku.
• E haʻi aku kāu mea lawelawe iā ʻoe i ka wā e hōʻea ai i ka haukapila.

Ma hope pono o ke kaha ʻana, e hele ʻoe i ka lumi hoʻāla, kahi e nānā pono ai nā kahu maʻi iā ʻoe. Ma hope o kēlā e hele nō ʻoe i kahi keʻena mālama maʻi (ICU) a i ʻole kahi lumi hōkele maʻamau.

• Hiki paha iā ʻoe ke hoʻolilo i 1 a i ʻole 2 mau lā i kahi moe inā pili ke ʻoki i ke aʻa nui i loko o kou ʻōpū i kapa ʻia ʻo aorta.
• Noho ka hapa nui o ka poʻe i ka haukapila no 4 a 7 mau lā.
• Ma hope o ka bypass femoral popliteal, e hōʻemi ʻoe i ka manawa a i ʻole manawa manawa i ka ICU.

Ke ʻōlelo mai kāu mea hoʻolako ua maikaʻi, ʻae ʻia ʻoe e hele i waho o kahi moe. E hoʻonui mālie ʻoe i kahi e hiki ai iā ʻoe ke hele wāwae. Ke noho nei ʻoe i kahi noho, e hāpai i kou mau wāwae i luna o kahi noho a i kahi noho ʻē aʻe paha.

E nānā pinepine ʻia kāu puʻukū ma hope o kāu ʻoki ʻana. E hōʻike ka ikaika o kou pulsa i ka maikaʻi o ka hana o kāu bypass graft. ʻOiai ʻoe i ka haukapila, e haʻi koke aku i kāu mea hāʻawi inā ʻoluʻolu ka wāwae i hana ʻia ke ʻoki, nānā a mae a ʻulaʻula paha, ʻano palaka, a inā he mau hōʻailona hou aʻe kāu.

E loaʻa iā ʻoe ka lāʻau ʻeha inā pono ʻoe.

Hoʻomaikaʻi ke kīʻaha Bypass i ke kahe o ke koko i nā aʻa no ka hapanui o ka poʻe. ʻAʻole paha ʻoe i loaʻa hou i nā ʻōuli, ʻoiai ke hele wāwae ʻoe. Inā loaʻa iā ʻoe nā ʻōuli, hiki iā ʻoe ke hele i kahi mamao loa ma mua o ka hoʻomaka.

Inā loaʻa iā ʻoe nā ālai i nā aʻa he nui, ʻaʻole hoʻomaikaʻi hou ʻia kāu mau ʻōuli. ʻOi aku ka maikaʻi o ka wānana inā mālama maikaʻi ʻia nā ʻano olakino ʻē aʻe e like me ka maʻi kō. Inā puhi ʻoe, he mea nui loa e haʻalele.

Holo ala ʻo Aortobifemoral; Femoropopliteal; Popliteal wahine; Holo ala ʻo Aorta-bifemoral; Holo ka Axillo-bifemoral; Ilio-bifemoral bypass; Holo wahine-wahine; Holo ka wāwae wāwae

• Hoʻokomo ʻia ka Angioplasty a me stent - nā aʻa ākea - hoʻokuʻu
• Nā lāʻau Antiplatelet - nā mea kūpaka P2Y12
• ʻO ka aspirin a me ka maʻi puʻuwai
• ʻO Cholesterol a me ka nohona
• Cholesterol - lāʻau lapaʻau
• Ke kaohi nei i kou kiʻekiʻe o ke koko
• Holo ke ākea peripheral - wāwae - hoʻokuʻu

Bonaca MP, Creager MA. Nā maʻi o ke aʻa peripheral. I: Zipes DP, Libby P, Bonow RO, Mann DL, Tomaselli GF, Braunwald E, eds. ʻO ka maʻi puʻuwai ʻo Braunwald: He puke aʻo no ka lāʻau Cardiovascular. 11th hua. Piladelapia, PA: Elsevier; 2019: chap 64.

Kinlay S, Bhatt DL. Hoʻomaʻamaʻa i ka maʻi non voronary vascular obstructive maʻi. I: Zipes DP, Libby P, Bonow RO, Mann DL, Tomaselli GF, Braunwald E, eds. ʻO ka maʻi puʻuwai ʻo Braunwald: He puke aʻo no ka lāʻau Cardiovascular. 11th hua. Piladelapia, PA: Elsevier; 2019: chap 66.

Pūʻulu no ka ʻoki ʻana i ke kīpikipiki ʻo Verior Low Extremity Guidelines Group; Conte MS, Pomposelli FB, et al. ʻO nā kaiaulu no nā ʻōkuhi ʻoki lāʻau lapaʻau no ka atherosclerotic occlusive maʻi o nā ʻaoʻao lalo: ka mālama ʻana i ka maʻi asymptomat a me ka claudication. ʻO J Vask Surg. 2015; 61 (3 Hōʻawi): 2S-41S. PMID: 25638515 www.ncbi.nlm.nih.gov/pubmed/25638515.

Nā lālā o ke kōmike kākau, Gerhard-Herman MD, Gornik HL, et al. ʻO 2016 AHA / ACC Alakaʻi e pili ana i ka hoʻokele o nā mea maʻi me ka maʻi o ke aʻa o ke aniani o lalo: hōʻuluʻulu mana. ʻO Vasc Med. 2017; 22 (3): NP1-NP43. PMID: 28494710 www.ncbi.nlm.nih.gov/pubmed/28494710.