İLİYAK ARTER TOTAL OKLÜZYONLARINDA ENDOVASKÜLER TEDAVİ: TEK MERKEZ DENEYİMİ

Abstract

Amaç: Bu çalışmada, klinik ve radyolojik olarak ana iliyak ve eksternal iliyak arterlerde total oklüzyon tanısı konulduktan sonra endovasküler yöntemler ile tedavi edilen hastalardaki deneyimin ve tedavi etkinliğinin sunulması; böylece özellikle iliyak arterlerde total oklüzyonlara yaklaşım konusunda literatüre katkı sağlanması amaçlandı.

Gereç ve Yöntem: Aralık 2012 ve Eylül 2018 tarihleri arasında hastanemiz girişimsel radyoloji ünitesine ana iliyak ve eksternal iliyak arter total oklüzyonu tanısı ile başvuran 21 hastanın (3 kadın, 18 erkek) kayıtları retrospektif olarak incelendi. Endovasküler tedavi kararı alınan ve iliyak lezyonun geçilebildiği 20 hastada primer stentleme ve ihtiyaç halinde perkütan translüminal anjiyoplasti işlemi uygulandı. İşlem sonrası hastalar 1., 3., 6., 12. aylarda ve sonrasında yıllık olarak klinik bulguların değerlendirilmesi ve renkli Doppler ultrasonografi ile, ileri tetkik gereken durumlarda ise BT anjiyografi veya dijital subtraksiyon anjiyografi ile takip edildi.

Bulgular: Çalışmaya dahil edilen ve ana iliyak (%57, n=12), eksternal iliyak (%14, n=3) ve hem ana iliyak hem de eksternal iliyak (%29, n=6) arterlerde total oklüzyonu olan toplam 21 hasta TASC (TransAtlantic InterSociety Consensus) II sınıflamasına göre değerlendirilmiş olup %66.7’si (n=14) tip B, %4.8’i (n=1) tip C ve %28.6’sı (n=6) tip D olarak sınıflandırıldı. Ortalama oklüde segment uzunluğu 8.19 mm ölçüldü (3−17 mm). Yirmi hastada toplam 35 stent (32 balonla açılan, 3 kendiliğinden açılan) kullanıldı ve 12 hastada rezidü darlık nedeniyle perkütan translüminal anjiyoplasti uygulandı. Endovasküler tedavinin teknik başarı oranı %95.2 (n=20) olarak hesaplandı. İşlem yapılan 20 hastanın ortalama takip süresi 60.6 ay (aralık: 1-68 ay) olarak bulundu. 1, 3 ve 5 yıllık primer patensi oranları sırasıyla %91.6, %71.4 ve %50 olarak hesaplandı.

Sonuç: İliyak bölgede stent ve perkütan translüminal anjiyoplasti işleminin teknik başarı ve patensi oranları yüksek olup mevcut malzeme ve yaklaşım tekniklerinin gelişmesi, uygulayan merkezlerin deneyiminin artması ile bu oranların daha da yükselmesi beklenmektedir.

Keywords

• balon anjiyoplasti,endovasküler prosedürler,iliyak arter,oklüzyon,stentler,Anjiyografi,stentler

Endovascular Treatment of Iliac Artery Total Occlusions: A Single Center Experience

Abstract

Objective: The purpose of the study is to present our experience and treatment efficacy in patients with total occlusion in common and external iliac arteries who were treated by endovascular methods after clinical and radiological diagnosis, and therefore to contribute to the relevant literature especially about the approach to the total occlusions in the iliac arteries by means of radiological intervention.

Material and Method: We retrospectively reviewed the medical records of 21 patients (3 females, 18 males) with total occlusion of common and external iliac arteries who were admitted to our interventional radiology unit between December 2012 and September 2018. Primary stenting and percutaneous transluminal angioplasty in case of need, were performed in 20 patients in whom endovascular treatment was decided and the iliac lesions could be passed. Patients were followed up by the evaluation of clinical findings and utilizing color Doppler ultrasound on the 1st, 3rd, 6th and 12th months, and by CT angiography or digital subtraction angiography when further examinations were required.

Results: A total of 21 patients with total occlusion of common iliac (57%, n=12), external iliac (14%, n=3), both common and iliac (29%, n=6) arteries were evaluated according to the TASC (TransAtlantic InterSociety Consensus) II classification, and 66.7% (n=14) of the patients were classified as type B, 4.8%(n=1) as type C and 28.6%(n=6) as type D. The mean occluded segment length was measured as 8.19 mm (range: 3-17 mm). A total of 35 stents (32 balloon expandables, 3 self expandables) were used in 20 patients and percutaneous transluminal angioplasty was performed in 12 patients due to residual stenosis. Technical success rate in endovascular treatment was calculated as 95.2% (n=20). The mean follow-up period for 20 patients was 60.6 months (range: 1-68 ay). Primary patency rates for 1, 3 and 5 years were calculated as 91.6%, 71.4%and 50%, respectively.

Conclusion: The technical success and patency rates of stent placement and percutaneous transluminal angioplasty in the iliac region are high and it is expected that these rates will increase with the development of existing materials, approach techniques and the experience of the centers applying them.

Keywords

• Angiopraphy,balloon angioplasty,endovascular procedures,iliac artery,occlusion,stents

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