Torasik ve Abdominal Endovasküler Aortik Onarımda Erken Dönem Tecrübemiz: Üçüncü Basamak Merkez

Abstract

Giriş: Retrospektif bu çalışmanın amaçı, endovasküler abdominal aort onarım (EVAR) ve torasik aortik onarım (TEVAR) erken dönem sonuçlarını değerlendirmek ve hastanemizin erken dönem tecrübesini incelemektir.

Hastalar ve Yöntem: Ocak 2009 ile Aralık 2011 tarihleri arasında EVAR ve TEVAR işlemi uygulanan tüm hastalar incelenmiştir. İşlem öncesi, işlem ve işlem sonrası veriler retropektif olarak değerlendirildi.

Bulgular: Çalışma periyodunda 46 hastaya TEVAR, 25 hastaya EVAR uygulandı. Endovasküler girişim yapılan hastaların ortalama yaşı 63.7 yıldı. Cihazları yerleştirme başarısı %100’dü. İlave işlem olarak TEVAR olguları içim subklaviyen revaskülarizasyonu (1, %4), aortik debranching (3, %12); EVAR olguları için femoral revaskülarizasyon (1, %2.1) işlemi uygulanmıştır. Acil olgulardaki hastane içi ölüm oranı, elektif olgulara göre daha yüksek izlendi (%13.3 vs. %5.3).

Sonuç: Torasik ve aortik endovasküler onarım erken dönem tecrübe sonuçlarımız umut vericidir. Endovasküler stent greftle aortik patolojilerin onarımı öğrenme dönemlerinde bile etkili bir işlemdir.

Keywords

• Stent greft,endovasküler abdominal aort onarımı,torasik endovasküler aortik onarım,aortik anevrizma,aortik diseksiyon

Early Experience of Thoracic and Abdominal Endovascular Aortic Repair: a Tertiary Single Centre

Abstract

Introduction: The purpose of this retrospective study was to evaluate the short-term results of endovascular abdominal aortic repair (EVAR) and thoracic aortic repair (TEVAR) and to present an overview of our early experience at our institution.

Patients and Methods: Data of all patients undergoing EVAR and TEVAR between January 2009 and December 2011 were reviewed. Preoperative, intraoperative and early postoperative data were retrospectively reviewed.

Results: During the study period, 46 EVARs and 25 TEVARs were performed. The mean age of patients undergoing endovascular intervention was 63.7 years. The deployment success rates of the procedures were 100%. Additional procedures included subclavian revascularisation (1, 4%) and aortic debranching (3, 12%) for TEVAR cases and femoral revascularisation (1, 2.1%) for EVAR cases. In-hospital mortality in emergency cases was higher than the elective cases (5.3% vs. 13.3%).

Conclusion: Our early short-term results of endovascular repair of thoracic and aortic diseases are promising. Endovascular stent grafts are effective procedures for managing aortic diseases in an inexperienced centre.

Keywords

• Stent graft,endovascular abdominal aortic repair,thoracic endovascular aortic repair,aortic aneurysm,aortic dissection

References

1. 1. Tsai TT, Trimarchi S, Nienaber CA. Acute aortic dissection: perspectives from the International Registry of Acute Aortic Dissection (IRAD). Eur J Vasc Endovasc Surg 2009:37:149-59.
2. 2. Assar AN, Zarins CK. Endovascular proximal control of ruptured abdominal aortic aneurysms: the internal aortic clamp. J Cardiovasc Surg (Torino) 2009;50:381-5.
3. 3. Feezor RJ, Martin TD, Hess Jr PJ, Beaver TM, Klodel CT, Lee WA, et al. Early outcomes after endovascular management of acute, complicated type B aortic dissection. J Vasc Surg 2009;49:561-6.
4. 4. Gowda RM, Misra D, Ranbaugh RF, Ohki T, Khan IA. Endovascular stent grafting of descending thoracic aortic aneurysms. Chest 2003:124:714-9.
5. 5. Dialetto G, Reginelli A, Cerrato M, Rossi G, Covino FE, Manduca S, et al. Endovascular stent-graft treatment of thoracic aortic syndromes: a 7-year experience. Eur J Radiol 2007;64:65-72.
6. 6. Lederle FA, Freischlag JA, Kyriakides TC, Padberg FT, Matsumura JS, Kohler TR, et al. Outcomes following endovascular vs open repair of abdominal aortic aneurysm: a randomized trial. JAMA 2009;302:1535-42.
7. 7. Endovascular aneurysm repair and outcome in patients unfit for open repair of abdominal aortic aneurysm (EVAR trial 2): randomised controlled trial. Lancet 2005;365:2187-92.
8. 8. Ay D, Erdolu B, Yumun G, Aydin U, Demir A, Ozkan H, et al. The effect of anatomical factors on mortality rates after endovascular aneurysm repair. Cardiovasc J Afr 2016;27:12-5.

9. 9. Goksel OS, Güven K, Karatepe C, Gök E, Acunas B, Cinar B, et al. Debranching solutions in endografting for complex thoracic aortic dissections. Arq Bras Cardiol 2014;103:154-60.
10. 10. Demirtaş S, Tiryakioğlu O, Çalışkan A, Güçlü O, Yümün G, Yavuz C, et al. Single center experience in endovascular aortic repair: review of technical and clinical aspects. Dicle Med J 2014;41:564-73.
11. 11. Lobato AC, Rodriguez-Lopez J, Diethrich EB. Learning curve for endovascular abdominal aortic aneurysm repair: evaluation of a 277-patient single-center experience. J Endovasc Ther 2002;9:262-8.
12. 12. Forbes TL, Derose G, Kribs SW, Harris KA. Cumulative sum failure analysis of the learning curve with endovascular abdominal aortic aneurysm repair. J Vasc Surg 2004;39:102-8.
13. 13. Arslantaş U, Pala S, Endovascular treatment of the aortic dissection. Turkiye Klinikleri J Cardiol-Special Topics 2016;9:43-7.
14. 14. Ishida M, Kato N, Hirano T, Cheng SH, Shimono T, Takeda K, et al. Endovascular stent-graft treatment for thoracic aortic aneurysms: short-to midterm results. J Vasc Interv Radiol 2004:15:361-7.
15. 15. Baum RA, Stavropoulos SW, Fairman RM, Carpenter JP. Endoleaks after endovascular repair of abdominal aortic aneurysms. J Vasc Interv Radiol 2003;14:1111-7.
16. 16. Endovascular aneurysm repair versus open repair in patients with abdominal aortic aneurysm (EVAR trial 1): randomised controlled trial. Lancet 2005;365:2179-86.
17. 17. Sampaio SM, Shin SH, Panneton JM, Adrews JC, Bower TC, Cherry KJ, et al. Intraoperative endoleak during EVAR: frequency, nature, and significance. Vasc Endovascular Surg 2009;43:352-9.
18. 18. Demers P, Miller DC, Mitchell RS, Kee ST, Sze D, Razavi M, et al. Midterm results of endovascular repair of descending thoracic aortic aneurysms with first-generation stent grafts. J Thorac Cardiovasc Surg 2004;127:664-73.
19. 19. Dake MD, Miller DC, Mitchell RS, Semba CP, Moore KA, Sakai T, et al. The “first generation” of endovascular stent-grafts for patients with aneurysms of the descending thoracic aorta. J Thorac Cardiovasc Surg 1998;116:689-703.
20. 20. Makaroun MS, Dillavou ED, Kee ST, Sicard G, Chaikof E, Bavaria J, et al. Endovascular treatment of thoracic aortic aneurysms: results of the phase II multicenter trial of the GORE TAG thoracic endoprosthesis. J Vasc Surg 2005;41:1-9.
21. 21. Cambria RP, Crawford RS, Cho JS, Bavaria J, Farber M, Lee WA, et al. A multicenter clinical trial of endovascular stent graft repair of acute catastrophes of the descending thoracic aorta. J Vasc Surg 2009;50:1255-64 e1-4.
22. 22. Fattori R, Nienaber CA, Rousseau H, Beregi JP, Heijmen R, Grabenwöger M, et al. Results of endovascular repair of the thoracic aorta with the Talent Thoracic stent graft: the Talent Thoracic Retrospective Registry. J Thorac Cardiovasc Surg 2006;132:332-9.