Endovasküler Aort Anevrizma Tamiri: Erken Ve Geç Dönem Vasküler Komplikasyonları

Year 2018, , 1 - 10, 12.03.2018

İsmail Cem Sormaz , Şevki Murat Aksoy

https://doi.org/10.18017/iuitfd.381017

Abstract

Amaç: İnfrarenal abdominal aort anevrizmasının
(AAA) 5,5 cm çapın üzerine çıktığı olgularda rüptürün önlenmesi amacı ile bir
girişim yapılması önerilmektedir. Yirmi yıldan uzun süredir uygulanan
endovasküler stent ile aort anevrizması tamiri, daha kısa yoğun bakımda kalış
süresi, daha az kanama ve daha kısa ameliyat ve hastanede yatış süresi gibi
avantajlarla ön plana çıkmaktadır. Ancak bu metotda da erken ve geç dönem
komplikasyonlar gelişmektedir. Bunlar arasında da vasküler komplikasyonlar
morbiditeyi ve mortaliteyi arttırtan bir tabloyu oluşturmaktadır. Bu çalışmada
Endovasküler Aort Anevrizma Tamiri (EVAR) uygulanan olguların erken ve geç
dönem vasküler komplikasyonları değerlendirilecektir.

Gereç ve Yöntem: Bu çalışmaya Haziran
2000-Ocak 2010 tarihleri arasında infrarenal AAA nedeni ile endovasküler aort
onarımı uygulanan ardışık 79 olgu dahil edildi. 
Olguların arşivden dosyaları çıkartıldı ve poliklinik takipleri
retrospektif olarak incelendi. Demografik veriler ve anevrizmanın özellikleri
erken dönem ve geç mortalite ve morbidite ve vasküler komplikasyonlar oranları
incelendi.

Bulgular: Olguların ortalama yaşı 67,4±2,49
(33-86) idi. Olguların büyük bölümü erkekti (%85). Perioperatif mortalite %1,2
olarak saptandı. Rüptür bir olguda görüldü (%1,2). Tip I, tip II ve tip V
endoleakler sırasıyla %5, %7,2 ve  %3,7
olarak saptandı. Anevrizma çapı %8,8 olguda artış gösterdi, %65 olguda küçüldü
ve %27 olguda stabil kaldı. Dokuz olguda (%11) greft bacak trombozu, 3 (%3,6)
olguda migrasyon ve 1 (%1,2) olguda yalancı anevrizma gelişti. Tip Ia endokaçağı
olan bir hastaya cerrahi konversiyon uygulandı. Ortalama takip süresi 26,7 ay
(6 ay-10 yıl) olarak saptandı. On ikinci ay, 24. ay ve 48. aylarda genel sağkalım
beklentisi sırasıyla %91,2, %82,1 ve %70,7 olarak tespit edildi.

Sonuç: AAA’nın endovasküler stent greft ile
onarımı sonrası perioperatif mortalite ve morbidite düşüktür fakat uzun dönem
takiplerde ek girişim gerektirecek komplikasyonların çıkabileceği akıldan çıkarılmamalı
ve hastalar aynı titizlikle ömür boyu takip edilmelidir. Komplikasyon oranları
yüksek olmasına rağmen her komplikasyona girişim yapılmasına gerek yoktur ve komplikasyonlar
endovasküler yolla çözülebileceği için mortalite ve morbiditesi de düşüktür. 

Keywords

Endovasküler aort anevrizma tamiri, abdominal aort anevrizması, vasküler komplikasyon

Vascular Complications of Endovascular Aortic Aneurism Repair: Short and Long Term Follow-Up

Abstract

Objective: An intervention is recommended
in patients, who present with an infrarenal abdominal aortic aneurysm (AAA) of
more than 5.5 cm in diameter. Endovascular repair, which has been carried out
more than 20 years provides reduced perioperative mortality rates and shorter
intensive care and hospital stay, and less bleeding. However, it is not without
complications in the short and long term. Vascular complications constitute a
major part of them and may contribute to the mortality and mobidity rates. This
study aims to evaluate the incidence of vascular complications of Endovascular
Aortic Aneurysm Repair (EVAR) in short and long term.

Materials and Methods: This study included
79 consecutive patients, who have undergone endovascular repair for an
infrarenal abdominal aortic aneurysm, between June 2000- Jan 2010. The archive
files and follow-up data of the patients were analyzed. Demography of patients,
aneurysm spesifications, mortality and morbidity rate in short and long term
and vascular complications were analyzed.

Results: The mean age of the patients were
67.4±2.49 (33-86). The majority of the patients was male (85%). Perioperative
mortality was 1.2%. Rupture occurred in a patient (1.2%) during the follow-up.
Type I, type II and type V endoleak were present in 5%, 7.2% and 3.7%,
respectively. Sac enlargement occured in 8.8% of the patients, whilst 65% of
the aneurysm shrinked and 27% stayed stable in diameter. Limb thrombosis
occured in 9 (11%) patients, migration in 3 (3.6%) patients and pseudoaneurysm
in 1 (1.2%) patient. A conversion to open surgery was carried out for a Type Ia
endoleak. The mean follow-up was 26.7 mo (6 mo-10 years). The probability of
survival was 91.2%, 82.1% and 70.7% at 1st, 2nd and 4th years respectively.

Conclusion: Perioperative mortality and
morbidity rates are low following endovascular repair for an AAA. However, it
should be noted that follow-up can be troublesome anytime with vascular
complications, which may necessitate an interventiom. Therefore, a life-long
meticulous follow-up is essential. Although the incidence of vascular
complications may be high, not every vascular complication needs to be
repaired. Furthermore, many of the complications can be managed by endovascular
means with lower rates of mortality and morbidity.

Keywords

Endovascular aortic aneurism repair, abdominal aortic aneurysm, vascular complication

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