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

Abstract

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.

Keywords

• kalsifikasyon,aterektomi,stent

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

Abstract

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.

Keywords

• calcification,atherectomy,stent

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