REFERAT CHRONIC VENOUS INSUFFICIENCY
DISUSUN OLEH: AMANDA ULFAH DEMILI NIM 030.11.020
PEMBIMBING: Dr. AGNES INDARTI, SPB(KV
KEPANITRAAN KLINIK ILMU BEDAH FAKULTAS KEDOKTERAN UNIVERSITAS TRISAKTI RUMAH SAKIT TNI AL Dr. MINTOHARD!O
DAFTAR ISI
HALAMAN DAFTAR DAFTAR ISI........................................... ISI.................................................................. ................................................................... ............................................ i KATA KATA PENGANTAR...... PENGANTAR............................. .............................................. .............................................. .............................................iii ......................iii BAB I PENDAHULUAN............................ PENDAHULUAN................................................... ..............................................................1 .......................................1 BAB II PEMBAHASAN............................... PEMBAHASAN...................................................... ...................................................... ............................... ......2 2.1. DEFINISI....................................... DEFINISI.............................................................. .............................................. .......................................... .......................2 ....2 2.2. EPIDEMIOLOGI........... EPIDEMIOLOGI.................................. .............................................. ..............................................................2 .......................................2 2.3. FAKTOR FAKTOR RISIKO........................................ RISIKO............................................................... .......................................................2 ................................2 2.4. ETIOLOGI..................................... ETIOLOGI............................................................ .............................................. .......................................... .......................2 ....2 2.4.1. KONGENITAL....... KONGENITAL.............................. .............................................. ...........................................................2 ....................................2 2.4.2. PRIMER.................................... PRIMER........................................................... .............................................. .........................................2 ..................2 2.4.3. SEKUNDER............................. SEKUNDER.................................................... ........................................................ ................................. ........3 ........ 3 2.5. PAT PATOFISIOLOGI................................. OFISIOLOGI........................................................ .............................................. ........................................3 .................3 2.6. MANIFESTASI MANIFESTASI KLINIS......................................... KLINIS................................................................ ............................................6 .....................6 2.7. DIAGNOSIS.................................... DIAGNOSIS........................................................... ................................................................... ............................................ 8 2.8. DIAGNOSIS BANDING.................................... BANDING........................................................... ................................................11 .........................11 2.9. PEMERIKSAAN PENUNJANG................................... PENUNJANG.......................................................... .....................................11 ..............11 2.9.1. NONIN!A NONIN!ASI!E TEST.................................... TEST........................................................... ........................................ .................11 11 2.9.2. IN!A IN!ASI!E TEST.................................. TEST......................................................... ....................................................13 .............................13 2.1". PENAT PENATALAKSANAAN................... ALAKSANAAN.......................................... .............................................. .........................................15 ..................15 2.11. KOMPLIKASI................................ KOMPLIKASI....................................................... .................................................................. ........................................... 18 2.12. PROGNOSIS............................... PROGNOSIS...................................................... .............................................. ...............................................18 ........................18 BAB III ANAT ANATOMI DAN FISIOLOGI................. FISIOLOGI........................................ ................................................. .......................... ...19 3.1. SISTEM SIRKULASI..................................... SIRKULASI............................................................ ....................................................19 .............................19 3.2. !ENA.................................. !ENA......................................................... .............................................. .............................................. ..................................21 ...........21 3.2.1. ANAT ANATOMI !ENA.................................. !ENA......................................................... ..................................................21 ...........................21 1
3.2.2. FISIOLOGI !ENA.................................. !ENA......................................................... .......................................... .........................25 ......25 BAB I! KESIMPULAN............ KESIMPULAN.................................... ............................................... .............................................. .................................29 ..........29 BAB ! DAFTAR DAFTAR PUSTAKA.... PUSTAKA........................... .............................................. .........................................................3" ..................................3"
2
KATA PENGANTAR
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1
BAB II PEMBAHASAN 2.1.
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4
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5
!I *)*(,i/'+ *$, 0*++ %)*'(# &+ ,#% #,i 0(i *,+i*'%i% %)i '* i;(%i% '#,i 0+ #,%*(%i. P*(,# 0ii+ ;/? *$, ',i+i% &+ % 0) *($0i 'i; ;*;*() *'+i%* %*)*(i '#) &+ i+')**+ %$ ;%(#'%i @*+ %$ 0+ 0i%#+%i )) # ';i+%i. M+i*%%i ',i+i% # )0 !I 0,/ 0i,%i @*+ *0* +&*(i #+'i 0+ )*(#;/+ )0 '#,i. !*+ @(i'% 0,/ @*+ %#)*(i%i, &+ *+,i 0i,%i 0+ %*-( )((*%i *;*%( 0+ ;*(;*,' 0i%*(i 0i%*+%i (+%@*(% &+ *+&*;;'+ )*;*+0#++ &+ *(,i/ 0+ 0) 0i),)%i. E0* ;*(#, 0i 0*(/ )*(i,,*,( 0+ %*'i+ '*% *(+#+ 0(i '##,%i -i(+. N&*(i #+'i 0i0*%'(i)%i'+ %*;i #+'i &+ *(% ;*( # +&*(i %**,/ ;*(0i(i , 0+ *+/i,+ %**,/ #+'i 0ii+i'+. O;%(#'%i @*+ 0, *+&*;;'+ -,#0i-i @*+ # '( )0 #+'i &+ *($0i 0*++ )*(*('+. P*(#;/+ )0 '#,i &+ *($0i 0,/ /i)*()i*+%i 'i; 0*)%i%i /*%i0*(i+ 0+ 0*(ii% *'%*#%. Fi;(%i% #+'i+ *($0i )0 '#,i 0+ %#;'#+ =,i)0*(%-,*(%i%>. T*(0) )*+i+'+ (i%i' *($0i+& %*,#,ii% #,%*(%i #+'i 0+ )*+&*;#/+ ,#' &+ ,;. M+i*%%i ',i+i% !I 0) 0i,i/ )0 ',%ii'%i ',i+i%. K,%ii'%i EAP =Clinical, Etiology, Anatomic,
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7
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8
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9
E@,#%i )*( )0 )%i*+ 0*++ !I *(0i(i 0(i )*+*+#+ 0 i0'+& (*,#'% ;%(#'%i # '*0#+&. D*++ )*(,++ #,(%#+0 0)),*( %*0*(/+ 0i0)'+ i+(%i 0+& (*,#'% )0 *) )*(*#+ %*+*(, 0*(/ )),i* 0+ @*+ *)i %*( ;%(#'%i )0 %**+ *()),i*, # i,**(, =%)i 8"9" 0(i $#,/ )%i*+>. ( %*0*(/+ 0, *i,i/ )**(i'%+ &+ *) 0,/ 0*++ *;i i+@*%i%i 0i+%i% 0, 3 i+'< 3. Ti+' 1< *,i)#i )**(i'%+ ',i+i% =++*%i% )**(i'%+ i%i' &i# *@,#%i %i('#,%i (*(i %*( )**(i'%+ @*+ 0*++ 0)),*( %*0*(/+> 4. Ti+' 2< *,i)#i )**(i'%+ ++i+@%i =0#),* %-++i+ ),*i%(i> 5. Ti+' 3< *,i)#i )**(i'%+ i+%i =%-*+0i+ 0+ 0*%-*+0i+ phlebography )*+#'#(+ *'++> K*i i+' i+i 0) 0i+'+ )0 )*+*+#+ ',%ii'%i ',i+i% 0(i EAP i%,+&< '*,% "1 (i+& i0' *(,i/ # *(; )*+&'i @*+ *,+i*'%i% # @*+ (*i'#,(. D, /, i+i )**(i'%+ i+' 1 ;i%+& %#0/ -#'#). K*,% 2 0i+ 0i0) @(i%*% @*+ +) *0* # )*(#;/+ '#,i #+#' @(i%*% @*+ %*+ + -#'#) 0*++ i+' 1 )i ,*;i/ ;i' 0*++ 0i,'#'+ )**(i'%+ #+'i. H)i( %*# @(i%*% )(i*( *(%#' '*,)' i+i. P%i*+ 0*++ @(i%*% @*+ &+ ';#/ 0+# )*(+/ *+0*(i D!T %*;i'+& 0i,'#'+ 0#),* %-++i+ 0+ ;i, /%i,+& *+#+$#'+ 10
(*,#'% # ;%(#'%i )0 %i%* @*+ 0, ' %*;i'+& 0i,'#'+ i+@*%i%i )0 i+' 3. K*,% 3 ;i, *0* 0*++ # +) @(i%*% @*+ 0+ i0' 0 )*(#;/+ '#,i. I+@*%i%i i+' 2 0i)*(,#'+ #+#' *+*+#'+ 0 i0'+& (*,#'% # ;%(#'%i )*+&*;; *0*. 2.8.
Di+%i% B+0i+ Di;*0'+ 0*++ %#;+ (*(i *+/#+ S#;+ (*(i *+/#+ U,'#% i%'*i #,i 0(i #$#+ $(i '*(/
S#;+ @*+ *+/#+ U,'#% %%i% 0i 0*(/ ,*#,#% *0i,i%
#i D%( #,'#% )#- L*;i/ +&*(i )0 ,/ /(i ;i, ''i
D%( #,'#% *(/ L*;i/ +&*(i ;i, #+'i 0i+#+
0ii+i'+ E0* $(+ 0
E0* *(#)'+ *$, # )0 %i+
D*+&# +0i '*-i, i0' 0 P*(#;/+ ?(+ '#,i *(+#+ )%i%i
/(i D*+&# +0i 0 P*(#;/+ ?(+ '#,i i0' *(+#+
K,#0i'%i i+*(i*+
)%i%i N&*(i ;i, ;*(0i(i , ;*('#(+ ;i, ;*($,+
Di;*0'+ 0*++ )*+&*;; *0* &+ ,i+ . 'i; )*+&'i %i%*i' %*)*(i , $+#+ %i+0( +*(i' %i(%i% /*)i% ;. 'i; )*+#++ ; %*)*i B NSAID Di;*0'+ 0*++ D!T # ;%(#'%i @*+ ,i++& Di;*0'+ 0*++ '*,i++ ,', ,i+ R#)#( 'i% )),i* (;*'+ %('+*i#% ,&)/*0* 2.9. P**(i'%+ P*+#+$+ 2.9.1. Non-invasive test: a. D#),* %-++i+ T*'+i' i+i 0i#+'+ #+#' *+'+i(%i 0i+%i% !I %*( *+*/#i *i,i 0+ i+' '*)(/+&. M*+';i+%i'+ B0* ii+ 0(i @*+ %#)*(i%i, 0+ 0, 0*++ )**(i'%+ 0)),*(. P**(i'%+ i+i 0) *;*(i'+ i+(%i 0i ;i+ + %i%* @*+ %#)*(i%i, 0, %*( )*(( &+ *('*+. P**(i'%+ 0#),* @*+ %+0( 0,/ #+#' *+&i+'i('+ D!T # ;%(#'%i @*+ ,i++&. K)(*%i;i,i% @*+ &+ 0i,i/ 0*++ ,i(+ 0,/ '#+-i #+#' *+&i+'i('+ (;%i%. A(/ ,i(+ 0i)*(i'% 0, )%i%i 3" (*@*(%* T(*+0*,*+;*( % 0i,'#'+ +#@*( )(@'i %*)*(i @,%@ +#@*( # %**,/ )*+*'++ )0
11
#+'i. P*+#++ i+,%i0*,%i -# 0i+ 0i,'#'+ 0*,%i -# %*-( -*) )0 )%i%i ;*(0i(i 0) *+i+0#'%i *($0i+& (*,#'%. A0+& (*,#'% 0) 0i+i,i 0*++ (/ 0(i ,i(+ '(*+ ,i(+ %i+ii'+ '* (/ ''i *+i+0i'%i'+ 0+& (*,#'%. D#(%i 0(i (*,#'% 0i'*+, 0*++ rel!" time. #el!" time "51 0*i' *+&'+ 0+& (*,#'% %*'i+ , 0#(%i (*,#'% ' %*'i+ ;*( )*+&'i *(%*;#. T*)i 0 /#;#++ &+ ,*/ +( '*)(/+ )*+&'i 0*++ 0#),* %-++i+ ;i' %*-( 0i)*(i'% 0*++ ,*i%(i # 0i,i/ )0 +i*%%i ',i+i%. ,#)#+ 0+& '*'#(++ i+i *)i 0#),* %-++i+ 0) *+*+#'+ )0 @*+ &+ + &+ *($0i '*,i++ '#) %*/i+ 0) %*;i )*0+ 0, *()i.
b. Air plethysmography M)# *+#'#( i ')+*+ =(*,# ;%(#'%i 0+ '*,i++ #+%i )) > &+ %-*( ;*(% *+&*;;'+ /i)*(*+%i @*+ %*;i 'i; 0(i (#% ;,i' @*+ &+ *(+#. A, i+i *(0i(i % '(#+ i+ ;*(;*+#' )i) &+ *+*,i,i+i %*,#(#/ #+'i %*)+$+ 35 -. K(#+ +i+ 0ii%i #0( %)i 6 H 0+ 0i/#;#+'+ 0*++ %## , ',i;(%i. I%i @,#* @*+ )0 #+'i +(, 0,/ 8"15" ,. + ;i% +i' /i++ 4"" , )0 !I. Air plethysmography *;*(i'+ i+(%i &+ 0i0) 0(i %*,#(#/ #+'i %*-( '*%*,#(#/+ 0i0)'+ '*%+ ;/? ;*(+& (*,#'% ;*(/#;#++ 0*++ 0*($ )*+&'i+&. D*++ *'+i' ',#%i
12
)0 !I *(0) /i)*(*i &+ '+ *+i+' %*%#i 0*++ ;*(+& )*+&'i.
2.9.2. $nvasive test . Amb!latory veno!s press!re =A!P> A0,/ -( *(;i' #+#' *+#'#( /i)*(*+%i @*+. P0 ;%*(@%i *'++ @*+ 0i ''i ;*('#(+ )0 % ;*($,+ '*#0i ;*(+%#(+%#( '*;,i '* +i,i +(, );i, ;*(/*+i. T*'+i' i+i 0i,'#'+ 0*++ *+#%#'+ $(# '* @*+ )*0i% 0+ 0i%;#+'+ 0*++ (+%0#%*( &+ *;*(i'+ *'++. T*'++ $# 0i+i( %*;*,# 0+ %*%#0/ )*%++ c! )0 )*(*,++ ''i #+#' *;*0'+ (*,#'% @*+ 0, # @*+ %#)*(i%i,. A;+ *'++ A!P =+(,+& 0,/ 2" %)i 3" H> 0+ ?'# )*+i%i+ =+(,+& 0,/ 182" 0*i'>.
b. Phlebography Phlebography # @*+(i *(0i(i 0(i ascen%ing 0+ %escen%ing. Ascen%ing phlebography P**(i'%+ i+i )*(,# 0i,'#'+ )0 @(i%*% &+ ';#/ )%-
)*(%i )%i*+ 0*++ @(i%*% #+i,*(, 0+ # )%i*+ &+ ;*(##( 2" /#+ %*( )0 '*#+'i++ D!T #+#' *+i,i @*+ )*(( 0i 0*(/ '+,i% /#+*( 0i *#(. G;(+ ,*;( 0i 0) %**,/ *+#%#'+ %,/ %# @*+ 0i''i 0+ *+&#+i'+ '+(% '*0,+& %*0+'+ #+#' *)*('+ @(i%*% # i+%#i%i*+%i %i%* @*+ 13
0, 0i,'#'+ )*+*'++ 0i 0*(/ ,*,#%. P**(i'%+ i+i #+#' *)*(,i/'+
@*+
&+
+(,
*+*%'+
+i
0+
*;*0'+ )*+&'i+& )'/ )(i*( # %*'#+0*(.
&escen%ing phlebography T#$#+ )**(i'%+ i+i 0,/ #+#' *)*(,i/'+ (*,#'% )0 @*+ *)i # @*+ 0, %*( #+#' *+*+#'+ ii' '*;-(+ 0(i )+#, '* #+'i ;?/ 0+ 0(i @*+ 0, '* @*+ *)i # %#)*(i%i,. J# 0i#+'+ #+#' *+0)'+ i+(%i *+*+i ,',i%%i +i 0+ (,i '#) @*+ *+'%i( ,#%+& (*,#'% *+;('+ +i@*+ )0 '%#% &+ %#'( 0+ *;*0'+ )*+&'i @*+ )(i*( 0*++ %*'#+0*(. A0 5 ,++ (*,#'% ,*;(i 0i,#'i%'+ %*;i ;*(i'#< o G,++ "< i0' 0 (*,#'% 0i ;?/ )*(*#+ @*+ o
*(,i% %#)*(i%i, 0+ )(#+0 G,++ 1< (*,#'% '* 0, @*+ *(,i% %#)*(i%i, )i
o
i0' 0i ;?/ %**+/ )/ G,++ 2< (*,#'% '* 0, @*+ *(,i% %#)*(i%i, )i
o
i0' %)i @*+ )),i* ='#) @*+ )),i* ')**+> G,++ 3< (*,#'% %)i )*(%i% 0i;?/ ,## ='#) @*+ 0i
o
#+'i ;?/ ')**+> G,++ 4< (*,#'% %)i '* #i =0(i *(, )),i* #+'i ;?/>
2.1". P*+,'%++ T*()i ?, )0 !I 0,/ '+%*(@i #+#' *+#(+i *$, 0+ *+-*/ )*('*;++ '),i'%i 0+ )((*%i )*+&'i. P0 !I *'+i%* &+ ),i+ *++$, 0,/ ;*('#(++& @,#* ,i(+ 0(/ %*( ;*(;/+& $#,/ ,i(+
14
@,#* ' *()i 0i(/'+ '*)0 )*+#(++ *'++ /i0(0i+i' +( ')i,*( &i# 0*++ *,*@%i #+'i )*+;/+ *'++ +( %*, 0*++ ')(*%i )*+;/+ *'++ %i' +( ')i,*( 0*++ )*+#++ ; 0i#(*i'. S## ';i+%i 0(i 0# # %*# -( *(%*;# *(#)'+ *()i 0%( ;i ''i &+ ;*+'' 0, %*, ;*+#'. T,'%+ &+ %)*%ii' *(+#+ )0 '*)(/+ )*+&'i ',%ii'%i ',i+i% EAP i+' 4 %)i 6 %*(i+ *;##/'+ )*+,'%++ &+ i+@%i. P%i*+ )0 i+' i+i );i, i0' *('(*'%i ;*(i%i' #+#' *($0i+& #,%*(%i #,%*(%i &+ (*'#(*+ 0+ #,'#% @*+ &+ i0' %*;#/ 0*++ i+*'%i &+ )((*%i 0+ ,&)/*0*. Elastic compression stoc'ing *(#)'+ *()i ?, #+#' %*# ',%ii'%i ',i+i% EAP. U'#(+ &+ *) %+ )*+i+ 0, '*;*(/%i,+ )*(?+. P*+#'#(+ /(#% *+-+#'+ i+(%i *+*+i *'++ )+$+ 0+ 0i**(. P*+#'#(+ *'++ ;*(0%('+ '*)(/+ ',i+i% *'++ 2"3" H #+#' EAP '*,% 23 *'++ 3"4" H #+#' EAP '*,% 46 0+ *'++ 4"5" H #+#' #,'#% @*+ &+ (*'#(*+. U'#(+ )+$+ &+ ,*;i/ %*(i+ 0i#+'+ 0,/ %*i+i ,## '(*+ '*)#/+ )%i*+ ,*;i/ ;*%( 0+ 0*'# 0, *(i++'+ *$,. P*+#++ %*i+i )/ # )i++ #+'i+ 0i)*(,#'+ #+#' *0* &+ ,*;i/ i+i 0(i ,## *)i stoc'ing i+i ,*;i/ %#,i #+#' 0i#+'+. P*+#'#(+ 0i**( 0i,'#'+ '*i' ''i i0' 0, '*0+ ;*+''.
15
P*(?+ '#,i 0+ ,#' 0i,'#'+ '(*+ )*('*;++ )*+&'i !I 0) ;*(#$#+ )0 +#+ i+*(i% '#,i ,*/ '(*+ i# )*+i+ #+#' *;# (* &+ *('*+ *) ,*;) #+#' *+#(+i (i%i' '*(#%'+ '#,i 0+ '*#+'i++ i+*'%i. P0 %%i% 0*(ii% 0) 0i;*(i'+ %*(i0 )i',. U+#' #,'#% @*+ 0) 0i;*(i'+ 0(*%%i+ 0*++ /i0(',i0 #+#' *++(, 0(i+%* -i(+ )0 ,#'. S',*(*()i 0) 0i*()'+ )0 ;*;*() ;*+#' EAP. T*()i i+i 0) 0i;*(i'+ %*;i *()i )(i*( # 0i';i+%i'+ 0*++ )(%*0#( )*;*0/+ #+#' *+(*'%i !I. B*;*() *+ %',*(%i% 0,/ %0i# ',(i0 &+ /i)*(+i% 0i+ %',*(+ i+i *+&*;;'+ 0*/i0(%i )0 %*, (* 0*++ -( (0i*+ *'++ %i' &+
,*;i/ ;*%(
*+'i;'+
i(
,*;i/
-*)
#+#'
*,*?i
*;(+
%*i)*(*;*,. S',*(+ ,i+ %*)*(i %0i# *(0*-&, %#,* ),i0-+, 0+ %0i# ((/#* ;*(#+%i %*)*(i 0**(*+. A*+*+ %',*(+ i+i *;*+#' %',*(%i% # )*+*(%+ )0 %*, (* %*/i+ %*, *(%*;# *+,i 0*%(#'%i 0i+ )0 @*+ &+ *+,i @(i'% # *,+i*'%i% @*+ *(%*;# *(0*%(#'%i %*/i+ ,i(+ 0(/ *,*?i $,#( @*+ &+ ,*;i/ %*/. Ablative therapy with en%oveno!s ra%iore(!ency an% laser 0,/ *()i 0*++ *+*(i *(, &+ ;*(%, 0(i (0i(*'#*+%i # ,%*( #+#' ;,i*(%i @*+. T*'+i' i+i %*(i+ 0i*()'+ )0 (*,#'% @*+ %*+ + 0+ *(#)'+ ,*(+i 0(i *'+i' ;*0/ stripping. E+*(i )+% *i-# i+$#(i *(, )0 0i+0i+ @*+ &+ '*#0i+ *($0i (;%i% 0+ i;(%i%. K),i'%i 0(i *'+i' i+i 0,/ i+$#(i +*(@#% %*+#% 0+ D!T. T*'+i' i+i 0i,'#'+ 0*++ +*%*%i #+#' *+-*/ *($0i+& ,#' ;'( )0 '#,i 0+ *+#(+i +&*(i.
16
T*()i *+0@%'#,( 0i,'#'+ #+#' *+*;,i'+ ,i(+ @*+ 0+ *+#(+i ;%(#'%i 0*++ *,'#' %*+ )0 @*+. T*'+i' ;*0/ /+& 0i,'#'+ )0 ''i ;*+'' &+ '*0++& ;#(#' %*',i 0+ *(#)'+ %## *()i &+ *(i++'+ %*)*(i )0 )%i*+ &+ %)i *+,i 0i%;i,i% # #,'#% @*+ &+ i0' *+&*;#/ ?,#)#+ 0*++ )*+;+ '%i,. T#$#+ )*;*0/+ ;#'+ #+#' *++i *()i '+%*(@i )i #+#' *;#+& ,*;i/ *i%i*+. Li%i %(i))i+ 0+ ,*;*'i 0) 0i,'#'+ )0 %*# i+'+ ',%ii'%i ',i+i% EAP 0*++ (*,#'% @*+ %#)*(i%i, 0+ *()i i+i *+#+$#'+ )*('*;++ ;i' )0 /*0i+i' 0+ *+#(+i *$, %*( *;+# )*+&*;#/+ #,'#% @*+. D*++ 0i,'#'+ ,i%i i+i )0 saphenoemoral )!nction 0+ 0i,'#'+ ,*;*'i )0 @*+ @(i'% &+ ;*(/#;#++ 0*++ @*+ %*+ &+ i+')**+. *!bascial en%oscopic perorator s!rgery +*EP* 0i,'#'+ 0*++ *,i%i @*+ )*(( *)i 0) ;*('i; *($0i+& *'++ i+i )0 @*+ %#)*(i%i,. O,*/ '(*+ i# ,i%i )0 @*+ )*(( &+ i+')**+ 0i,'#'+ 0*++ '%*% @*+ &+ $#/ 0(i 0*(/ &+ *+,i ,i)0*(%',*(%i% # #,'#% @*+. R*'+%(#'%i '#) @*+ # @,@#,),%i *,/ *+#+$#'+ )*(;i'+ )0 i+')*+ '#) %*'i( 59 0+ ?'# ;*;% (*'#(*+%i #,'#% 0, 3" ;#,+ %*;+&' 63. K),i'%i 0(i @,@#,)%i 0,/ )*(0(/+ '(*+ )%i*+ *) 0i;*(i'+ +i'#,+ D!T *;,i )(# 0+ i+*'%i )0 ,#'. E0#'%i )0 )%i*+ %#)& *()i *(%*;# 0) ;*(/%i, %*-( )i, %*)*(i *+i+i'+ *'%(*i% ;?/ % ;*(i%i(/ *+#(+i ;*(0i(i # 0#0#' , 0+ *+#(+i ;*( ;0+.
17
2.11. K),i'%i D**) !*i+ T/(;%i% E;,i )(# M*#0/'+ *($0i+& i+*'%i 2.12. P(+%i% A0 @i< 0 ;+ A0 #+-i+< 0#;i 0 ;+ A0 %+i+< 0#;i 0 ;+
BAB III ANATOMI DAN FISIOLOGI
3.1. Si%* %i('#,%i # %i%* '(0i@%'#,( *++('+ +#(i*+ 0+ '%i*+ '* %*,#(#/ #;#/. T*(0i(i 0(i i ')+*+ 0%( &i#< 1. J+#+ %*;i )) &+ *,'#'+ *'++ *(/0) 0(/ #+#' *+i;#,'+ (0i*+ *'++ &+ 0i)*(,#'+ ( 0(/ 0) *+,i( '* $(i++. D(/
18
%*)*(i -i(+ ,i+ *+,i( 0(i 0*(/ ;*(*'++ ,*;i/ i+i '* 0*(/ ;*(*'++ ,*;i/ (*+0/ %*%#i )*+#(#++ (0i*+ *'++. 2. P*;#,#/ 0(/ ;*(#+%i %*;i %,#(+ #+#' *+(/'+ 0+ *+0i%(i;#%i'+ 0(/ 0(i $+#+ '* %*# ;i+ #;#/ 0+ '*#0i+ *+*;,i'++& '* $+#+. 3. D(/ ;*(#+%i %*;i *0i# (+%)(%i *) ;/+;/+ &+ 0i%,#('+ 0i,(#'+ # 0i*+0)'+. D(/ ;*($,+ %*-( '+i+# *,,#i %i%* %i('#,%i '* 0+ 0(i $+#+ *,,#i 0# ,*+'#+ @%'#,( *()i%/ '*0#+& ;*(?, 0+ ;*('/i( 0i $+#+. T*(0i(i 0(i %i('#,%i )(# 0+ %i('#,%i %i%*i' 0i+ %i('#,%i )(# *(0i(i 0(i ,*+'#+ *(##) @%'#,( &+ *++'# 0(/ +( $+#+ 0+ )(# %*0+'+ %i('#,%i %i%*i' *(0i(i 0(i @%'#,( &+ *++'# 0(/ +( $+#+ 0+ %i%* (+. D(/ &+ '*;,i 0(i %i('#,%i %i%*i' %#' '* (i# '++ *,,#i @*+ -@. D(/ &+ %#' '* (i# *(%*;# '*;,i 0(i $(i++ #;#/ 0+ *,/ *($0i )*(#'(+ O2 '* %*, 0+ O 2 '* 0(/. D(/ &+ *,/ *+,i 0*'%i*+%i *(%*;# *+,( 0(i (i# '++ '* @*+(i'*, '++ &+ *)+& '*,#( *,,#i (*(i )#,+,i% '* )(#. Di 0, )(# *($0i '%i*+%i 0+ '*/i,++ O 2 '*#0i+ 0i ,i('+ '* (i# 'i(i *,,#i @*+ )#,+,i%. D(/ '& '%i*+ i+i ,,# %#' '* @*+(i'*, 'i(i 0+ '*#0i+ 0i))'+ '* %*# %i%* 0i #;#/ '*-#,i )(#. D(/ &+ 0i)) ,*/ %i%i 'i(i $+#+ 0i;i;i 0, ;*(;i )*(;+0i++ '* (+(+ %i%*i' 0, ;*(;i )*(;+0i++ '* (+(+ %i%*i' *,,#i )*;#,#/)*;#,#/ 0(/ &+ *(%#%#+ %*-( )(,*, 0+ ;*(-;+ 0(i (. Si('#,%i %i%*i' 0+ )(# %i+%i+ *(0i(i 0(i %i%* )*;#,#/ 0(/ &+ *(##). A(*(i &+ *++'# 0(/ 0(i $+#+ '* $(i++ ;*(-;+-;+ *+$0i )*;#,#/)*;#,#/ 0(/ &+ %*'i+ '*-i, 0*++ ;*(;i -;+ *+&,#('+ 0(/ '* ;*(;i ;i+ #;#/. S*?'# (*(i '*-i, *+-)i (+ &+ 0i)*(0(/i+& (*(i *(%*;# ;*(-;+-;+ *+$0i ;+&' (*(i,. Di 0, (+ (*(i, ;*(-;+ -;+ *+$0i ')i,*( *) %*# )*(#'(+ +( 0(/ 0+ %*,%*, %*'i(+& *($0i. K)i,*(')i,*( '*;,i *+&# #+#' *;*+#' @*+#, &+ *(#% ;*(;#+ *;*+#' @*+ '*-i, &+ '*,#( 0(i (+. !*+@*+ '*-i, '*#0i+ ;*(%# *;*+#' @*+ &+ ,*;i/ ;*%( &+ '/i(+& *+,i('+ 0(/ '* $+#+.
19
20
3.2. !ENA D(/ *+i+,'+ ')i,*( *%#'i %i%* @*+ #+#' 0i;? '*;,i '* $+#+. !*+ *i,i'i 0i+0i+ &+ $#/ ,*;i/ i)i% 0*++ ),% &+ ,*;i/ %*0i'i 0i;+0i+ (*(i %*/i+ %+ #0/ *(*+ 0+ (?+ ',)%. 3.2.1. ANATOMI !ENA T#+i' i+i @*+ *(%#%#+ 0(i *+0*,i# nonthrombogenic 0*++ 0%(+& 0,/ *;(+ ;%,i% 0+ ,i+ *,%i'. E+0*, *)(0#'%i '( (*,'%+ %*)*(i +i(i '%i0 0+ )(%%i',i+ 0i+ *)*(/+'+ '*0+ nonthrombogenic )0 )*(#'+ *+0*, 0*++ -( *+i+/i;i%i (*%i ),*,*. E,%i+ 0+ ),% &+ *(,*' 0i #+i' *0i *;*(i'+ '*%*)+ #+#' @*+ 0) *(#;/ ',i;*(+& 0*++ )*(#;/+ *'++ i+i,. T#+i' 0@*+ii *(0i(i 0i ',*+ %*( *,%i+ 0+ i(;(;,%. L*;i/ ;+&' )0 @*+@*+ ;*%(. !*+ *i,i'i '#)'#) &+ $#,/+& ,*;i/ ;+&' 0i *'%(*i% 0i%, 0i;+0i+ 0*++ )('%i,. P0 @*+ -@ i+*(i( @*+ i,i' '#+i% @*+ )( 0+ %i+#%%i+#% '(+i,i% @*+@*+ *(%*;# i0' *i,i'i '#). S*i) '#) *(0i(i 0(i 0# 0#+ '#) &+ *(%#%#+ 0(i $(i++ i' 0+ 0i##)i ,*/ *+0*,i#.
!*+ E'%(*i% B?/ !*+ )0 *'%(*i% ;?/ 0i;i *+$0i %#)*(i%i, 0, 0+ )*((. !*+ %#)*(i%i, *(,*' 0i% ,)i%+ %i &+ ),i+ % 0(i #+'i 0+ )/ 0+ *(0i(i 0(i @*+ %)/*+ + 0+ @*+ %)/*+ )(@. !*+ %)/*+ + ;*(%, 0(i ('#% @*+ 0(%# )*0i% '* +*(i( ,*,#% *0i,i% %#' '* @*+ *(,i% '#+i% 4 - i+*(i( 0+ ,*(, 0(i #;*('*, )#;i%. !*+ %)/*+ )(@ ;*(%, 0(i ,*(, ('#% 0(%# )*0i% '* ;i )%*(i(. S*(i+ ',i @*+ i+i *+*;#% %% )),i* 0i+( ,*(, 0+ *0i, #%'#,#% %(-+*i#% 0+ ;*(;#+ 0*++ @*+ )),i*. T*) ;*(/*+i @*+ %)/*+ )(@ ;*(@(i%i *)i ,*;i/ %*(i+ ;*(/#;#++ 0*++ @*+ %)/*+ + # @*+ *(,i% )(#+0#%. !*+ &+ ,*;i/ 0, *+i'#i $,#( (*(i 0i *'%(*i%. P0 #+'i ;?/ *(0) @*+ &+ ;*()%++ &+ )(,*, 0*++ (*(i i;i,i% +*(i( (**(i i;i,i% )%*(i( 0+ (*(i )*(+*#% #+#' ;*(;#+ 0i %% )),i* *;*+#' @*+ )),i*. !*+ )),i* ;*(,+$# *,*?i 0#'( /i#% 0+ *+$0i @*+ *(,i%. P0 #+'i % @*+ *(,i% ;*(% @*+ *(,i%
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)(#+0#% *;*+#' @*+ *(,i% '#+i% 0+ *+$0i @*+ i,i' *'%*(+ )0 ,i*+# i+#i+,i%. !*+@*+ )*(( *+/#;#+'+ @*+ %#)*(i%i, 0+ 0,. !*+ )*(( &+ )*+i+ 0, ',i+i% 0,/ @*+ --'* 0+ ;&0. !*+ --'* *+/#;#+'+ ('#% @*+ &+ ;*(%, 0(i @*+ %)/*+ + 0+ @*+ i;i,i% )%*(i(. !*+ ;&0 *+/#;#+'+ @*+ %)/*+ + 0*++ @*+ 0, '#(+ ,*;i/ 1" - 0i;?/ ,## 0+ 12 - *0i, 0(i i;i. !*+@*+ )*(( i+i *+$0i @(i-*% # i+%#i%i*+%i )0 '*0+ @*+ &+ i+%#i%i*+%i. Si+#% @*+%#% ;*(0i+0i+ i)i% 0+ ;*(,'%i 0i +( #%-#,#% %,*#% 0+ %(-+*i#%. Si+#%%i+#% i+i i0' *i,i'i '#) 0+ 0i/#;#+'+ 0*++ @*+ &+ '*-i, 0+ ;*('#) #+#' *-*/ (*,#'%. D(/ 0, $#,/ ;*%( 0) 0i%i)+ 0i %i+#% @*+%#%. D*++ '+('%i (+' 0(/ 0i))'+ '* @*+ # 0+ 0i,i('+ *+#$# $+#+.
!*+ E'%(*i% A% Di;i *+$0i @*+ 0, 0+ %#)*(i%i,. !*+ 0, )0 *'%(*i% % ;*()%++ 0+ *+i'#i 0(i (*(i+&. !*+ %#)*(i%i, *(0i(i 0(i @*+ %*,i' 0+ ;%i,i'. !*+ %*,i' ;*(%, 0(i ,*(, )*(*,++ ++ )*(#'+ 0*)+ 0(i ,*++ ;?/. P0 ,*++ % @*+ %*,i' ;*('/i( 0i %% i+(-,@i-#,( *+*;#% %i -,@i)*-(, #+#' *+%+'+ 0i @*+ '%i,(i%. !*+ ;%i,i' 22
;*($,+ *0i, 0(i ,*++ ;?/ 0+ *+*;#% %i 0, '*#0i+ ;*(;#+ ;*(% @*+ ;('i,i% #+#' *+$0i @*+ '%i,(i%. !*+ -#;ii *0i ;*(;#+ 0*++ @*+ %*,i' 0+ ;%i,i' 0i )*(#'+ 0*)+ 0(i %i'#. !*+ '%i,(i% *+$0i @*+ %#;',@i )0 ,*(, 0(i ;% i )*(. P0 ;% *0i, 0(i #%'#,#% %-,*+#% +*(i( @*+ %#;-,@i ;*(;#+0*++ @*+ $##,(i% i+*(+ #+#' *+$0i @*+ ;('i%*,i'. !*+ ;('i%*,i' '++ 0+ 'i(i ;*(;#+ *+$0i @*+ -@ %#)*(i( &+ ++i '+ *+%+'+ i%i+& 0i (i# '++.
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3.2.2. FISIOLOGI !ENA S(#'#( i+i *+0#'#+ #+%i # 0(i @*+ &i# *+*;,i'+ 0(/ '* $+#+ 0+ (*%*(@i( #+#' *+-*/ '*,*;i/+ @,#* i+(@%'#,(. H, i+i 0i*+#'+ ,*/ ')%i% 0+ ,i(+ ;,i' @*+. K)%i% @*+ 0,/ @,#* 0(/ &+ 0) 0i)#+ ,*/ @*+. H, i+i ;*(+#+ )0 0i%*+%i;i,i% 0i+0i+ @*+. P0 @,#* 0(/ &+ '+%+ %*i(i+ 0*++ )*+i+'+ ')%i% @*+ %*'i+ ;+&' 0(/ &+ *+*) 0i @*+ 0+ i0' 0i'*;,i'+ '* $+#+. %*/i++ @*+ 0) ;*(#+%i %*;i (*%*(@i( 0(/ &i# );i, '*;##/+ 0(/ (*+0/ @*+@*+ 0) *+&i)+ 0(/ *'%( %*;i -0++ '(*+ %i @*+ &+ #0/ 0i(*+'+. A,i(+ ;,i' @*+ *+-# '*)0 @,#* 0(/ &+ %#' i)i) (i# )*( *+i 0(i @*+. B*%(+& # ,$# ,i(+ *,,#i %## )*;#,#/ ;*(;+0i+ ,#(#% 0*++ (0i*+ *'++. S*;i+ ;*%( & )*+0(+ &+ 0ii;#,'+ $+#+ )0 0(/ *,/ /i,+ )0 % 0(/ *+-)i %i%* @*+ '(*+ 0+& (i'%i 0i %*)+$+ )*($,++ 0(/ *(# '*i' 0(/ *,,#i (*(i, &+ *i,i'i (*%i%*+%i i+i. P0 % 0(/ *%#'i %i%* @*+ *'++ 0(/ (( /+& 17H. N#+ '(*+ *'++ (i# *+0*'i " H %i/ *(0) & &+ '*-i, *)i 0*'# #+#' *+0(+ 0(/ *+,i( *,,#i %i%* @*+. Ji' *'++ (i# *+i+' %*-( ),i% (0i*+
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*'++ @*+ '* (i# '+ ;*('#(+ %*/i+ ,i(+ ;,i' @*+ '+ ;*('#(+ 0+ 0(/ *(;*+0#+ 0i %i%* @*+. D, '*0+ i%i(/ @*+@*+ *++0#+ ,*;i/ 0(i 6" @,#* 0(/ ,. A);i, %i)++ *(%*;# 0i;##/'+ '('( *'%(i+%i' *+0(+ 0(/ 0(i @*+ '* $+#+ %*/i+ 0) 0i )) '* $(i++. F'('( *'%(i+%i' *(%*;# 0,/< 1. E*' %i)i% )0 ,i(+ ;,i' @*+ Si#,%i %i)i% *+i;#,'+ @%'+%(i'%i @*+ &+ -#'#) *+i+''+ (0i*+ *'++ #+#' *+0(+ ,*;i/ ;+&' 0(/ 0(i @*+ '* $+#+. @%'+%(i'%i @*+ *+i+''+ ,i(+ ;,i' @*+ 0*++ *+#(+i ')%i% )*+i%i+ @*+ ,*/ '(*+ )*+&*)i+ @*+ **(% '* ,#( ,*;i/ ;+&' 0(/ &+ %#0/ *(0) 0i @*+ %*/i+ ,i(+ 0(/ *,,#i @*+ *+i+'. 2. E*' 'i@i% (+' )0 ,i(+ ;,i' @*+ P) (+' 0,/ %,/ %# -( *+,i('+ #+#' *+,i('+ %i)+ 0(/ 0i @*+ '* $+#+ %*?'# ;*(*('. P*+i+'+ ,i@i% *+0(+ ,*;i/ ;+&' 0(/ '*,#( 0(i @*+ #+#' %#' '* $+#+. P) (+' $# *,?+ **' (@i%i )0 %i%* @*+.
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3. E*' '#) @*+ )0 ,i(+ ;,i' @*+ K#)'#) i+i *#+'i+'+ 0(/ ;*(*(' '* 0*)+ '* (/ $+#+ 0+ *+-*/ 0(/ *+,i( '*;,i '* $(i++. K#)'#) i+i $# ;*()*(+ *,?+ **' (@i%i &+ 0ii;#,'+ ,*/ )%i%i ;*(0i(i.
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4. E*' 'i@i% )*(+)%+ A'i; 'i@i% )*(+)%+ *'++ 0i 0, (+ 00 (( 5 H 0i ;?/ *'++ %*(. K(*+ %i%* @*+ 0i #+'i 0+ ;0*+ *+0) *'++ %*( +(, *($0i (0i*+ *'++ *'%*(+, +( @*+@*+ ;?/ 0*++ @*+ &+ 0 0i 00. P*(;*0+ *'++ i+i *) 0(/ 0(i @*+@+ ;i+ ;?/ *+#$# @*+@*+ 00 %*/i+ ,i(+ ;,i' @*+ *+i+'. M*'+i%* %i,i% ,i(+ ;,i' @*+ i+i 0i'*+, %*;i )) (*%)i(%i '(*+ *($0i 'i; 'i@i% )*(+)%+. 5. E*' )*+/i%)+ $+#+ S*, '+('%i @*+(i'*, '#)'#) (i@*+(i'#,*( =A!> *((i' '* ;?/ %*/i+ (+ (i# *;*%(. A'i;+& *'++ (# %*-( #(#+ 0i ;?/ " H *+&*;;'+ )*+i+'+ (0i*+ *'++ @*+ '* (i# 0+ ,i(+ ;,i' @*+. S*,i+ i# *'%)+%i -*) (+ @*+(i'*, %*, (*,'%%i @*+(i'*, *+-i)'+ *'++ +*i %**+( 0i @*+(i'*, %*/i+ 0(/ *(%*0 0(i (i# 0+ @*+ *'++ @*+(i'*, &+ +*i *+i+''+ (0i*+ *'++ @*+ (i#@*+(i'*, 0+ *+i+''+ ,i(+ ;,i' @*+.
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28
BAB IV KESIMPULAN
/(+i- !*+#% I+%#i-i*+-& 0,/ '+0i%i 0i+0i+ # '#) )0 @*+ #+'i i0' ;*'*($ %*-( **'i %*/i+ *($0i '*0+ i+%#i%i*+%i 0+ *+i;#,'+ /i)*(*+%i @*+ #+'i. K+0i%i /i)*(*+%i @*+ #+'i 0) *+&*;;'+ ;*(;i *$, %*)*(i +&*(i *0* #,%*(%i 0+ )*(#;/+ )0 '#,i. M+i*%%i ',i+i% !I 0) 0i,i/ )0 ',%ii'%i ',i+i%. K,%ii'%i EAP =Clinical, Etiology, Anatomic,
Pathophysiology>
0i'*;+'+ ,*/ '+%*+%#%
i+*(+%i+, #+#' %*;i ;%i% 0i+%i% 0+ )*+;+ !I. T*()i ?, )0 !I 0,/ '+%*(@i #+#' *+#(+i *$, 0+ *+-*/ )*('*;++ '),i'%i 0+ )((*%i )*+&'i. P0 !I *'+i%* &+ ),i+ *++$, 0,/ ;*('#(++& @,#* ,i(+ 0(/ %*( ;*(;/+& $#,/ ,i(+ @,#* ' *()i 0i(/'+ '*)0 )*+#(++ *'++ /i0(0i+i' +( ')i,*( &i# 0*++ *,*@%i #+'i )*+;/+ *'++ +( %*, 0*++ ')(*%i )*+;/+ *'++ %i' +( ')i,*( 0*++ )*+#++ ; 0i#(*i'. S## ';i+%i 0(i 0# # %*# -( *(%*;# *(#)'+ *()i 0%( ;i ''i &+ ;*+'' 0, %*, ;*+#'. T*'+i' ;*0/ /+& 0i,'#'+ )0 ''i ;*+'' &+ '*0++& ;#(#' %*',i 0+ *(#)'+ %## *()i &+ *(i++'+ %*)*(i )0 )%i*+ &+ %)i *+,i 0i%;i,i% # #,'#% @*+ &+ i0' *+&*;#/ ?,#)#+ 0*++ )*+;+ '%i,. T#$#+ )*;*0/+ ;#'+ #+#' *++i *()i '+%*(@i )i #+#' *;#+& ,*;i/ *i%i*+. E0#'%i )0 )%i*+ %#)& *()i *(%*;# 0) ;*(/%i, %*-( )i, %*)*(i *+i+i'+ *'%(*i% ;?/ % ;*(i%i(/ *+#(+i ;*(0i(i # 0#0#' , 0+ *+#(+i ;*( ;0+.
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