Akut alt ekstremite nativ arteriyel tıkanıklarında tromboembolektomi sonrası amputasyon ve mortalitenin belirleyicileri; erken müdahalenin etkisi: Retrospektif kohort çalışma

Year 2020, , 1124 - 1127, 01.12.2020

Selim Durmaz

https://doi.org/10.28982/josam.750145

Abstract

Amaç: Akut arter tıkanıklığı, ekstremite canlılığını tehdit eden ani bir ekstremite kan akımının tıkanması durumudur. Akut arter tıkanıklığında, ampütasyon riskini ortadan kaldırmak için erken / acil müdahale gerekir, ancak bu vakalardan bazılarında tanı gecikmiştir. Bu çalışmanın amacı, cerrahi zamanlamanın amputasyon insidansına etkisini ve ekstremite kaybı riskini etkileyen diğer faktörleri değerlendirmektir.
Yöntemler: Tromboembolektomi uygulanan 154 hasta incelendi. Hastalar üç gruba ayrıldı: Grup 1: semptomlar 12 saatten daha kısa süreli, Grup 2: semptomlar 12 saatten fazla ancak bir haftadan kısa süreli, Grup 3: semptomlar bir haftadan daha uzun süreli. Gruplar ve kohort ampütasyon ve mortaliteye göre değerlendirildi.
Bulgular: Grup 1'de amputasyon insidansı diğer iki gruba göre anlamlı olarak daha düşüktü (P<0.05). Ancak; Grup 2 ve Grup 3 arasında amputasyon insidansı farklı bulunmadı. Hastane içi mortalite insidansları da gruplar arasında istatistiksel olarak farklı değildi. Kategorik ve sürekli değişkenler değerlendirildiğinde, ampütasyon riski ile artan yaş, kadın cinsiyet, diyabet ve iliak oklüzyon arasında anlamlı ilişki bulundu (P<0,05). Kadınlarda ve kardiyak aritmi bulunan olgularda hastane içi mortalite riski daha yüksek bulundu (P<0,05).
Sonuç: Erken cerrahi embolektomi, uzuv kurtarmada daha başarılıdır. Diyabetiklerde, kadınlarda, yaşlılarda ve proksimal arter tıkanıklığında amputasyon riski artmaktadır.

Keywords

Amputasyon, Balon Embolektomi, Akut arter tıkanıklığı

Determinants of amputation and mortality following thromboembolectomy in native acute lower limb arterial occlusions, the influence of early intervention: A retrospective cohort study

Abstract

Aim: In acute arterial occlusion, there is a sudden blockage of blood flow to the extremity, threatening its viability. Early/emergency intervention is required to eliminate the risk of amputation, but some of these cases receive a delayed diagnosis. The aim of this study is to evaluate the influence of surgical timing on the incidence of amputation and other factors affecting the risk of extremity loss.
Methods: A total of 154 patients who underwent thromboembolectomy were analyzed. The patients were categorized into three groups, as follows: Group 1 included patients with symptoms present for less than 12 hours, Group 2 comprised those with symptoms present for more than 12 hours but less than one week, and Group 3 included patients with symptoms present for more than one week. The groups were evaluated in terms of amputation and mortality.
Results: The incidence of amputation was significantly lower in Group 1 compared to the other two groups (P<0.05), and similar between Groups 2 and 3. In-hospital mortality did not significantly differ between the groups. When categorical and continuous variables were evaluated, a significant relationship was found between the risk of amputation and increasing age, female gender, diabetes, and iliac occlusion (P<0.05). The risk of in-hospital mortality was higher in females and in cases with cardiac arrhythmia (P<0.05).
Conclusion: Early surgical embolectomy is more successful in limb salvage. The risk of amputation is increased in diabetics, females, the elderly, and in proximal arterial occlusion.

Keywords

Amputation, Balloon embolectomy, Acute arterial occlusion

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