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Kalsifiye Stenotik Süperfisyal Femoral Arter Lezyonlarının Tedavisinde Direksiyonel Aterektomi ile Kombine Edilmiş Paklitaksel Salınımlı Balon Anjioplasti ve Kendiliğinden Açılan Nitinol Stent Uygulamasının Karşılaştırılması

Yıl 2019, Cilt: 21 Sayı: 1, 9 - 13, 30.04.2019
https://doi.org/10.18678/dtfd.474548

Öz

Amaç: Periferik arter hastalığı insidansının artması ve periferik vasküler cerrahi sonrası istenmeyen sonuçları azaltmak için endovasküler girişimlerin sıklığı ve çeşitliliği artmıştır. Yaygın kalsifik stenotik lezyonlar, endovasküler prosedürlerin açık kalma oranlarını etkilemekte ve komplikasyon sıklığını artırmaktadır. Bu çalışmada direksiyonel aterektomi (DA) ile kombine edilmiş paklitaksel salınımlı balon anjioplasti (PEBA) ve kendiliğinden açılan nitinol stent (SENS) uygulamalarının açık kalma oranları bakımından karşılaştırılması amaçlandı.

Gereç ve Yöntemler: Namık Kemal Üniversitesi Hastanesi Kalp Damar Cerrahisi kliniğinde Mart 2013 ile Mayıs 2014 tarihleri arasında kalsifik stenotik süperfisyal femoral arter lezyonları sebebiyle endovasküler prosedür uygulanmış 56 hasta (her grupta 28 olgu) çalışmaya alındı. Olguların yaş ortalaması 65,4±7,6 olup, 10’u kadın 46’sı erkek idi. Olgular işlem öncesi ve işlem sonrası 6. aya kadar Ayak bileği-kol indeksi (ABI), Rutherford skoru (RS) ve Doppler ultrasonografi (DUSG) ile takip edildi.

Bulgular: DA ve PEBA grubunda ortalama lezyon uzunluğu 66,4±24,8 mm olup SENS grubunda ise 65,0±20,6 mm olarak tespit edildi. Olguların 6 aylık takibinde primer ve sekonder açık kalma oranları DA ve PEBA grubunda %85,7 ve %92,9 olarak saptanırken SENS grubunda ise %57,1 ve %71,4 olarak saptandı. Gruplar arasında istatistiksel olarak anlamlı bir fark mevcuttu. Her iki grupta da ABI ve RS açısından anlamlı derecede düzelme olduğu gözlendi.

Sonuç: Bu çalışmadan elde edilen sonuçlardan, DA ile kombine edilmiş PEBA’nın, başarılı erken dönem sonuçları olması, intravasküler yabancı cisim içermemesi ve cerrahi şansını anastomoz sahasını etkilemeden devam ettirmesi sebepleriyle SENS uygulamasına göre daha üstün olduğunu düşünmekteyiz.

Kaynakça

  • Pasternak RC, Criqui MH, Benjamin EJ, Fowkes FG, Isselbacher EM, McCullough PA, et al. Atherosclerotic Vascular Disease Conference: Writing Group I: epidemiology. Circulation. 2004;109(21):2605-12.
  • Rothwell PM, Coull AJ, Silver LE, Fairhead JF, Giles MF, Lovelock CE, et al. Population-based study of event-rate, incidence, case fatality, and mortality for all acute vascular events in all arterial territories (Oxford Vascular Study). Lancet. 2005;366(9499):1773-83.
  • Norgren L, Hiatt WR, Dormandy JA, Nehler MR, Harris KA, Fowkes FG, TASC II Working Group. Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). J Vasc Surg. 2007:45(Suppl 1):5-67.
  • Chavan A, Luthe L, Schmuck B. Peripheral vascular disease of iliac and femoro-popliateal arteries: state-of-the-art endoluminal revascularisation. Radiologe. 2010;50(1):16-22.
  • Karch LA, Mattos MA, Henretta JP, McLafferty RB, Ramsey DE, Hodgson KJ. Clinical failure after percutaneous transluminal angioplasty of the superficial femoral and popliteal arteries. J Vasc Surg. 2000;31(5):880-7.
  • Spaargaren GJ, Lee MJ, Reekers JA, van Overhagen H, Schultze Kool LJ, Hoogeveen YL. Evaluation of a new balloon catheter for difficult calcified lesions in infrainguinal arterial disease: outcome of amulticenter registry. Cardiovasc Intervent Radiol. 2009:32(1):132-5.
  • İnan BK, Yavuz C, Temizkan V, Uçak A, Uğur M, Yılmaz AT. Migrate olan periferik vasküler stentin cerrahi olarak çıkarılması. Anatol J Clin Investig. 2009:3(1):106-7.
  • Coşkun İ, Demirtürk OS, Tünel HA, Açıl M, Özkan U, Gülcan Ö. Stent-Related Popliteal Artery Infection After Aspiration Thrombectomy, Nitinol Stenting and Thrombolysis. Damar Cer Derg. 2012;21(2):144-9.
  • Höfling B, Pölnitz AV, Backa D, von Arnim T, Lauterjung L, Jauch KW, et al. Percutaneous removal of atheromatous plaques in peripheral arteries. Lancet. 1988:1(8582):384-6.
  • Shammas NW, Shammas GA, Helou TJ, Voelliger CM, Mrad L, Jerin M. Safety and 1-year revascularization outcome of SilverHawk atherectomy in treating in-stent restenosis of femoropopliteal arteries: a retrospective review from a single center. Cardiovasc Revasc Med. 2012;13(4):224-7.
  • Zeller T, Rastan A, Sixt S, Schwarzwälder U, Schwarz T, Frank U, et al. Long-term results after directional atherectomy of femoro-popliteal lesions. J Am Coll Cardiol. 2006;48(8):1573-8.
  • Keeling WB, Shames ML, Stone PA, Armstrong PA, Johnson BL, Back MR, et al. Plaque excision with the Silverhawk catheter: Early results in patients with claudication or critical limb ischemia. J Vasc Surg. 2007;45(1):25-31.
  • Micari A, Cioppa A, Vadalà G, Castriota F, Liso A, Marchese A, et al. 2-year results of paclitaxel-eluting balloons for femoropopliteal artery disease: evidence from a multicenterregistry. JACC Cardiovasc Interv. 2013;6(3):282-9.
  • Cioppa A, Stabile E, Popusoi G, Salemme L, Cota L, Pucciarelli A, et al. Combined treatment of heavy calcified femoro-popliteal lesions using directional atherectomy and a paclitaxel coated balloon: One-year single centre clinical results. Cardiovasc Revasc Med. 2012;13(4):219-23.
  • Lenti M, Cieri E, De Rango P, Pozzilli P, Coscarella C, Bertoglio C, et al. Endovascular treatment of long lesions of the superficial femoral artery: results from a multicenter registry of a spiral, covered polytetrafluoroethylene stent. J Vasc Surg. 2007;45(1):32-9.
  • Mewissen MW. Self-expanding nitinol stents in the femoropopliteal segment: technique and mid-term results. Tech Vasc Interv Radiol. 2004;7(1):2-5.
  • Shrikhande GV, McKinsey JF. Use and abuse of atherectomy: where should it be used? Semin Vasc Surg. 2008;21(4):204-9.
  • Rogers JH, Laird JR. Overview of new technologies for lower extremity revascularization. Circulation. 2007;116(18):2072-85.
  • Dalainas I, Nano G, Kashyap A, Anand KP, Kashyap S, Golledge J, et al. Balloon angioplasty or nitinol stents for peripheral-artery disease. N Engl J Med. 2006;355(5):521-4.
  • Shammas NW, Dippel EJ, Coiner D, Shammas GA, Jerin M, Kumar A. Preventing lower extremity distal embolization using embolic filter protection: results of the PROTECT registry. J Endovasc Ther. 2008;15(3):270-6.
  • Karnabatidis D, Katsanos K, Kagadis GC, Ravazoula P, Diamantopoulos A, Nikiforidis GC, et al. Distal embolism during percutaneous revascularization of infra-aortic arterial occlusive disease: an underestimated phenomenon. J Endovasc Ther. 2006;13(3):269-80.

Comparison of Paclitaxel Eluting Balloon Angioplasty Combined with Directional Atherectomy and Self Expandable Nitinol Stent Implantation in Treatment of Calcified Stenotic Superficial Femoral Artery Lesions

Yıl 2019, Cilt: 21 Sayı: 1, 9 - 13, 30.04.2019
https://doi.org/10.18678/dtfd.474548

Öz

Aim: The frequency and variety of endovascular interventions have increased with the rise in peripheral arterial occlusive disease incidence and to lessen undesirable outcomes after peripheral vascular surgery. Extensive calcific stenotic lesions affect patency rates of endovascular interventions and enhance complication rates. In this study we aimed to compare paclitaxel eluting balloon angioplasty (PEBA) combined with directional atherectomy (DA) with self expandable nitinol stent (SENS) implantation in terms of patency rates.

Material and Methods: Fifty-six patients (28 patients in each group) underwent endovascular interventions for calcific stenotic superficial femoral artery lesions between March 2013 and May 2014 at Cardiovascular Surgery clinic in Namık Kemal University Hospital were included in the study. Mean age was 65.4±7.6 and male to female ratio was 46/10. Patients were followed up with ankle brachial index (ABI), Rutherford score (RS) and Doppler ultrasonography (DUSG) from the pre-intervention period to sixth month after intervention.

Results: Mean lesion length in DA and PEBA group was 66.4±24.8 mm and 65.0±20.6 mm in SENS group. Primary and secondary patency rates were 85.7% and 92.9% in DA and PEBA group, and 57.1% and 71.4% in SENS group in six months follow up. There was a statistically significant difference between groups. Significant improvement was detected in terms of ABI and RS in both groups.

Conclusion: We conclude from this study results that PEBA combined with DA is better than SENS implantation, because of its successful early-term results, no intravascular foreign bodies, and continues the chance of surgery without affecting the anastomosis field.

Kaynakça

  • Pasternak RC, Criqui MH, Benjamin EJ, Fowkes FG, Isselbacher EM, McCullough PA, et al. Atherosclerotic Vascular Disease Conference: Writing Group I: epidemiology. Circulation. 2004;109(21):2605-12.
  • Rothwell PM, Coull AJ, Silver LE, Fairhead JF, Giles MF, Lovelock CE, et al. Population-based study of event-rate, incidence, case fatality, and mortality for all acute vascular events in all arterial territories (Oxford Vascular Study). Lancet. 2005;366(9499):1773-83.
  • Norgren L, Hiatt WR, Dormandy JA, Nehler MR, Harris KA, Fowkes FG, TASC II Working Group. Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). J Vasc Surg. 2007:45(Suppl 1):5-67.
  • Chavan A, Luthe L, Schmuck B. Peripheral vascular disease of iliac and femoro-popliateal arteries: state-of-the-art endoluminal revascularisation. Radiologe. 2010;50(1):16-22.
  • Karch LA, Mattos MA, Henretta JP, McLafferty RB, Ramsey DE, Hodgson KJ. Clinical failure after percutaneous transluminal angioplasty of the superficial femoral and popliteal arteries. J Vasc Surg. 2000;31(5):880-7.
  • Spaargaren GJ, Lee MJ, Reekers JA, van Overhagen H, Schultze Kool LJ, Hoogeveen YL. Evaluation of a new balloon catheter for difficult calcified lesions in infrainguinal arterial disease: outcome of amulticenter registry. Cardiovasc Intervent Radiol. 2009:32(1):132-5.
  • İnan BK, Yavuz C, Temizkan V, Uçak A, Uğur M, Yılmaz AT. Migrate olan periferik vasküler stentin cerrahi olarak çıkarılması. Anatol J Clin Investig. 2009:3(1):106-7.
  • Coşkun İ, Demirtürk OS, Tünel HA, Açıl M, Özkan U, Gülcan Ö. Stent-Related Popliteal Artery Infection After Aspiration Thrombectomy, Nitinol Stenting and Thrombolysis. Damar Cer Derg. 2012;21(2):144-9.
  • Höfling B, Pölnitz AV, Backa D, von Arnim T, Lauterjung L, Jauch KW, et al. Percutaneous removal of atheromatous plaques in peripheral arteries. Lancet. 1988:1(8582):384-6.
  • Shammas NW, Shammas GA, Helou TJ, Voelliger CM, Mrad L, Jerin M. Safety and 1-year revascularization outcome of SilverHawk atherectomy in treating in-stent restenosis of femoropopliteal arteries: a retrospective review from a single center. Cardiovasc Revasc Med. 2012;13(4):224-7.
  • Zeller T, Rastan A, Sixt S, Schwarzwälder U, Schwarz T, Frank U, et al. Long-term results after directional atherectomy of femoro-popliteal lesions. J Am Coll Cardiol. 2006;48(8):1573-8.
  • Keeling WB, Shames ML, Stone PA, Armstrong PA, Johnson BL, Back MR, et al. Plaque excision with the Silverhawk catheter: Early results in patients with claudication or critical limb ischemia. J Vasc Surg. 2007;45(1):25-31.
  • Micari A, Cioppa A, Vadalà G, Castriota F, Liso A, Marchese A, et al. 2-year results of paclitaxel-eluting balloons for femoropopliteal artery disease: evidence from a multicenterregistry. JACC Cardiovasc Interv. 2013;6(3):282-9.
  • Cioppa A, Stabile E, Popusoi G, Salemme L, Cota L, Pucciarelli A, et al. Combined treatment of heavy calcified femoro-popliteal lesions using directional atherectomy and a paclitaxel coated balloon: One-year single centre clinical results. Cardiovasc Revasc Med. 2012;13(4):219-23.
  • Lenti M, Cieri E, De Rango P, Pozzilli P, Coscarella C, Bertoglio C, et al. Endovascular treatment of long lesions of the superficial femoral artery: results from a multicenter registry of a spiral, covered polytetrafluoroethylene stent. J Vasc Surg. 2007;45(1):32-9.
  • Mewissen MW. Self-expanding nitinol stents in the femoropopliteal segment: technique and mid-term results. Tech Vasc Interv Radiol. 2004;7(1):2-5.
  • Shrikhande GV, McKinsey JF. Use and abuse of atherectomy: where should it be used? Semin Vasc Surg. 2008;21(4):204-9.
  • Rogers JH, Laird JR. Overview of new technologies for lower extremity revascularization. Circulation. 2007;116(18):2072-85.
  • Dalainas I, Nano G, Kashyap A, Anand KP, Kashyap S, Golledge J, et al. Balloon angioplasty or nitinol stents for peripheral-artery disease. N Engl J Med. 2006;355(5):521-4.
  • Shammas NW, Dippel EJ, Coiner D, Shammas GA, Jerin M, Kumar A. Preventing lower extremity distal embolization using embolic filter protection: results of the PROTECT registry. J Endovasc Ther. 2008;15(3):270-6.
  • Karnabatidis D, Katsanos K, Kagadis GC, Ravazoula P, Diamantopoulos A, Nikiforidis GC, et al. Distal embolism during percutaneous revascularization of infra-aortic arterial occlusive disease: an underestimated phenomenon. J Endovasc Ther. 2006;13(3):269-80.
Toplam 21 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Sağlık Kurumları Yönetimi
Bölüm Araştırma Makalesi
Yazarlar

Selami Gürkan 0000-0001-5391-9270

Özcan Gür 0000-0001-9321-1699

Volkan Yüksel Bu kişi benim 0000-0001-9518-2588

Yayımlanma Tarihi 30 Nisan 2019
Gönderilme Tarihi 24 Ekim 2018
Yayımlandığı Sayı Yıl 2019 Cilt: 21 Sayı: 1

Kaynak Göster

APA Gürkan, S., Gür, Ö., & Yüksel, V. (2019). Comparison of Paclitaxel Eluting Balloon Angioplasty Combined with Directional Atherectomy and Self Expandable Nitinol Stent Implantation in Treatment of Calcified Stenotic Superficial Femoral Artery Lesions. Duzce Medical Journal, 21(1), 9-13. https://doi.org/10.18678/dtfd.474548
AMA Gürkan S, Gür Ö, Yüksel V. Comparison of Paclitaxel Eluting Balloon Angioplasty Combined with Directional Atherectomy and Self Expandable Nitinol Stent Implantation in Treatment of Calcified Stenotic Superficial Femoral Artery Lesions. Duzce Med J. Nisan 2019;21(1):9-13. doi:10.18678/dtfd.474548
Chicago Gürkan, Selami, Özcan Gür, ve Volkan Yüksel. “Comparison of Paclitaxel Eluting Balloon Angioplasty Combined With Directional Atherectomy and Self Expandable Nitinol Stent Implantation in Treatment of Calcified Stenotic Superficial Femoral Artery Lesions”. Duzce Medical Journal 21, sy. 1 (Nisan 2019): 9-13. https://doi.org/10.18678/dtfd.474548.
EndNote Gürkan S, Gür Ö, Yüksel V (01 Nisan 2019) Comparison of Paclitaxel Eluting Balloon Angioplasty Combined with Directional Atherectomy and Self Expandable Nitinol Stent Implantation in Treatment of Calcified Stenotic Superficial Femoral Artery Lesions. Duzce Medical Journal 21 1 9–13.
IEEE S. Gürkan, Ö. Gür, ve V. Yüksel, “Comparison of Paclitaxel Eluting Balloon Angioplasty Combined with Directional Atherectomy and Self Expandable Nitinol Stent Implantation in Treatment of Calcified Stenotic Superficial Femoral Artery Lesions”, Duzce Med J, c. 21, sy. 1, ss. 9–13, 2019, doi: 10.18678/dtfd.474548.
ISNAD Gürkan, Selami vd. “Comparison of Paclitaxel Eluting Balloon Angioplasty Combined With Directional Atherectomy and Self Expandable Nitinol Stent Implantation in Treatment of Calcified Stenotic Superficial Femoral Artery Lesions”. Duzce Medical Journal 21/1 (Nisan 2019), 9-13. https://doi.org/10.18678/dtfd.474548.
JAMA Gürkan S, Gür Ö, Yüksel V. Comparison of Paclitaxel Eluting Balloon Angioplasty Combined with Directional Atherectomy and Self Expandable Nitinol Stent Implantation in Treatment of Calcified Stenotic Superficial Femoral Artery Lesions. Duzce Med J. 2019;21:9–13.
MLA Gürkan, Selami vd. “Comparison of Paclitaxel Eluting Balloon Angioplasty Combined With Directional Atherectomy and Self Expandable Nitinol Stent Implantation in Treatment of Calcified Stenotic Superficial Femoral Artery Lesions”. Duzce Medical Journal, c. 21, sy. 1, 2019, ss. 9-13, doi:10.18678/dtfd.474548.
Vancouver Gürkan S, Gür Ö, Yüksel V. Comparison of Paclitaxel Eluting Balloon Angioplasty Combined with Directional Atherectomy and Self Expandable Nitinol Stent Implantation in Treatment of Calcified Stenotic Superficial Femoral Artery Lesions. Duzce Med J. 2019;21(1):9-13.
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