İliak Arter ve Alt Ekstremite Periferik Arter Hastalıklarında Endovasküler Tedavi

Abstract

Giriş ve Amaç: Periferik arter hastalıklarının tedavisinde konvansiyonel cerrahi yaklaşımlara ek olarak endovasküler tedavi yöntemi giderek daha fazla kullanılmaktadır. Bu çalışma, periferik arter hastalığında kullandığımız endovasküler tedavi yöntemlerini değerlendirmeyi amaçlamaktadır. Gereç ve Yöntemler: Endovasküler yöntemle tedavi edilen hastaların yirmi dördü retrospektif olarak analiz edildi. Hastaların 19’ unda aralıklı klodikasyon, 4'ünde istirahat ağrısı, bilateral popliteal arter anevrizması olan bir hastada da, diz eklemlerinin arkasında ağrı vardı. Yirmi hasta erkek ve 4'ü kadındı. Yaş ortalaması 55,26± 10,95 (38-81) yıl idi. Fontaine Evrelendirmesi’ ne göre klinik değerlendirme yapıldı. Hastalar ayak bileği-brachial arter indeksi (ABI), bilateral alt ekstremite arteriogramları ve Doppler muayeneleri ile işleme alındı. Endovasküler tedavi uygulanan hastaların 10’ unda TASCII-A, 5'inde TASCII-B ve 9’ unda da TASCII-C lezyonları vardı. Tüm hastalar arteriyel doopler taraması ile takip edildi. Bulgular: Onbir hastaya Bioabsorbable stent kondu. Üç hastaya balon anjiyoplasti yapıldı. Üç hastada nitinol stent uygulandı. Altı hastaya subintimal ilerlenip gerçek lümende balon anjiyoplasti yapıldı. Bilateral popliteal ve sağ anterior tibial arter anevrizması olan 1 hastaya kaplı stent greft ile anevrizma onarımı yapıldı. Olguların %100'ünde hemodinamik başarı sağlandı. Preoperatif 0,67±0,13 (0,4-0,95) ve bir yıl sonra 0,94±0,07 (0,8-1) ABI analizi istatistiksel olarak anlamlı bulundu (p<0,05). Sonuç: Tüm hastalarda işlem sonrası erken dönemde başarı sağlandı. Postoperatif dönemde hasta semptomları belirgin olarak düzeldi ve postoperatif klinik takipte sorun olmayan hastalar tam olarak tedavi edilmiş bir şekilde taburcu edildi. Hastaların takibi sırasında damarsal bir problem görülmedi.

Keywords

• Periferik vasküler hastalık
• Endovasküler Tedavi
• alt ekstremite iskemisi

Endovascular therapy of peripheral arterial disease involving iliac artery and distal lower extremity arteries

Abstract

Objective: Methods of endovascular therapy have been increasingly used in addition to conventional surgical approaches in the treatment of peripheral arterial diseases. This study aims to evaluate to the endovascular treatment methods that we use in patients with peripheral arterial disease. Materials and Methods: We retrospectively analyzed twenty-four of patients were treated with endovascular method. Nineteen of the patients had intermittent claudication, 4 had rest pain and one patient with bilateral popliteal artery aneurysms had pain at the back of bilateral knee joints. Twenty patients were male and 4 were female. The mean age was was 55,26± 10,95( 38-81) years. Evaluations included clinical assesment according to Fontaine stages. Doppler examinations with ankle-brachial index (ABI) and bilateral lower extremity arteriograms. Ten of the patients who underwent endovascular therapy had a lesion in TASCII-A group, 5 had a TASCII-B lesion, and TASCII-C lesions were present in 9 patients. All patients were followed prospectively with arterial duplex scan. Results: Bioabsorbable stent was implanted in 11 patients. Balloon angioplasty was performed in 3 patients. A self-expandable nitinol stent was deployed in 3 patients. Subintimal balloon angioplasty was performed in 6 patients. An aneurysm repair was performed with stent graft in 1 patient who had bilateral popliteal and right anterior tibial artery aneurysms. Initial technical and hemodynamic success was achieved in 100% of cases. Preoperative 0,67±0,13 (0,4-0,95) and after one year later 0,94±0,07 (0,8-1) analysis for ABI revealed statistically significant (p<0,05). Conclusion: Urgent success was achieved in all patients. Patient symptoms were markedly improved at the postoperative period and the patients with event-free postoperative clinical course were discharged with complete recovery. No vascular problems were observed during the follow-up of the patients.

Keywords

• Endovascular therapy
• Peripheral vascular disease
• lower limb ischemia
• subintimal angioplasty
• stents

References

1. Referans1. Dormandy J, Rutherford RB: Management of peripheral arterial disease (PAD). TransAtlantic Inter-Society Consensus (TASC). J Vasc Surg 31(Pt 2):S1-S296, 2003
2. Referans2. Amanvermez Şenarslan, D , YILDIRIM, F , TETİK, Ö . "Evaluation of Early and Mid-term Results of TEVAR Procedures with Various Etiology."Celal Bayar Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi6(2019 ): 283-288
3. Referans3. Chisci E, Perulli A, Iacoponi F, Setacci F, de Donato G, Palasciano G, et al. Benefit of revascularisation to critical limb ischaemia patients evaluated by a patientoriented scoring system. Eur J Vasc Endovasc Surg 2012;43:540-7.
4. Referans4. 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 S: S5–S67.
5. Referans5. Go AS, Mozaffarian D, Roger VL, et al; American Heart Asso¬ciation Statistics Committee and Stroke Statistics Subcommittee. Executive summary: heart disease and stroke statistics – 2014 update: a report from the American Heart Association. Circulation. 2014;129(3):399–410.
6. Referans6. Giles KA, Pomposelli FB, Spence TL, et al. Infrapopliteal angioplasty for critical limb ischemia: relation of TransAtlantic InterSociety Consen¬sus class to outcome in 176 limbs. J Vasc Surg. 2008;48(1):128–136.
7. Referans7. Selvin E, Marinopoulos S, Berkenblit G, et al. Meta-analysis: glycosy¬lated hemoglobin and cardiovascular disease in diabetes mellitus. Ann Intern Med. 2004;141(6):421–431.
8. Referans8. Stone NJ, Robinson JG, Lichtenstein AH, et al. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atheroscle¬rotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;129(25 Suppl 2):S1–S45.

9. Referans9. Owens CD, Ho KJ, Kim S, et al: Refinement of survival prediction in patients undergoing lower extremity bypass surgery: stratification by chronic kidney disease classification. J Vasc Surg 45:944-952, 2007.
10. Referans10. Heidland UE, Heintzen MP, Michel CJ, Strauer BE: Risk factors for the development of restenosis following stent implantation of venous bypass grafts. Heart 85:312-317, 2001
11. Referans11. Adam DJ, Beard JD, Cleveland T, et al: Bypass versus angioplasty in severe ischaemia of the leg (BASIL): multicentre, randomised controlled trial. Lancet 366(9501):1925-1934, 2005.
12. Referans12. Taylor SM, York JW, Cull DL, Kalbaugh CA, Cass AL, Langan EM. Clinical success using patient-oriented outcome measures after lower extremity bypass and endovascular intervention for ischemic tissue loss. J Vasc Surg. 2009;50(3):534–541; discussion 541.