Year 2019, Volume 21 , Issue 1, Pages 44 - 51 2019-04-30

Endovascular Treatment of Iliac Artery Total Occlusions: A Single Center Experience
İLİYAK ARTER TOTAL OKLÜZYONLARINDA ENDOVASKÜLER TEDAVİ: TEK MERKEZ DENEYİMİ

HasanAli DURMAZ [1]


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.

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.

  • 1. Müller AM, Langwieser N, Bradaric C, Haller B, Fusaro M, Ott Ilka et al. Endovascular treatment for steno-occlusive iliac artery disease: safety and long-term outcome. Angiology. 2018;69(4):308-15.
  • 2. Neisen MJ. Endovascular management of aortoiliac occlusive disease. Semin Intervent Radiol. 2009;26(4):296-302.
  • 3. Norgren L, Hiatt WR, Dormandy JA, Nehler MR, Harris KA, Fowkes FG. Inter-society consensus for the management of peripheral arterial disease (TASC II). J Vasc Surg. 2007;45:5-67.
  • 4. Clair DG, Beach JM. Strategies for managing aortoiliac occlusions: access, treatment and outcomes. Expert Rev Cardiovasc Ther. 2015;13(5):551-63.
  • 5. Jaff MR, Christopher JW, William RH, Gerry RF, John D, Mahmood R et al. An update on methods for revascularization and expansion of the TASC lesion classification to include below-the-knee arteries: a supplement to the inter-society consensus for the management of peripheral arterial disease (TASC II). Ann Vasc Dis. 2015;20(5):465-78.
  • 6. Adili F, Balzer K, Betz T, Billing A, Böckler D, Brixner D et al. A current practice of first-line treatment strategies in patients with critical limb ischemia. J Vasc Surg. 2015; 62:965-73.
  • 7. Hans SS, DeSantis D, Siddiqui R, KhouryM. Results of endovascular therapy and aortobifemoral grafting for Transatlantic Inter-Society type C and D aortoiliac occlusive disease. Surgery. 2008;144(4):583-9.
  • 8. Jongkind V, Akkersdijk GJ, Yeung KK, Wisselink W. A systematic review of endovascular treatment of extensive aortoiliac occlusive disease. J Vasc Surg. 2010;52:1376-83.
  • 9. Ye W, Liu CW, Ricco JB, Mani K, Zeng R, Jiang J. Early and late outcomes of percutaneous treatment of Transatlantic Inter-Society Consensus class C and D aorto-iliac lesions. J Vasc Surg. 2011;53:1728-37.
  • 10. LeVille CD, Kashyap VS, Clair DG, Bena JF, Leyden SP, Greenberg RK et al. Endovascular management of iliac artery occlusion: extending treatment to transatlantic inter-society consensus class C and D patients. J Vasc Surg. 2006;43(1):32-9.
  • 11. Indes JE, Mandawat A, Tuggle CT, Muhs B, Sosa JA. Endovascular pro¬cedures for aorto-iliac occlusive disease are associated with superior short-term clinical and economic outcomes com¬pared with open surgery in the inpatient population. J Vasc Surg. 2010;52:1173-9.
  • 12. Indes JE, Pfaff MJ, Farrokhyar F, Brown H, Hashim P, Cheung K et al. Clinical outcomes of 5358 patients undergoing direct open bypass or endovascu¬lar treatment for aortoiliac occlusive disease: a systematic review and meta-analysis. J Endovasc Ther. 2013;20:443-55.
  • 13. Clair DG, Adams J, Reen B, Feldman R, Starr J, Diaz-Cartelle J et al. The EPIC nitinol stent system in the treatment of iliac artery lesions: one-year results from the ORION clinical trial. J Endovasc Ther. 2014;21:213-22.
  • 14. Mousa AY, Beauford RB, Flores L, Faries P, Patel P, Fogler R. Endovascular treatment of iliac occlusive disease: review and update. Vascular. 2007;15(1):5-11.
  • 15. Gardiner GA Jr, Sullivan KL, Halpern EJ, Parker L, Beck M, Bonn J et al. Angiographic assessment of initial balloon angioplasty results. J Vasc Interv Radiol. 2004;15:1081-7.
Primary Language tr
Subjects Health Care Sciences and Services
Journal Section Articles
Authors

Orcid: 0000-0003-3230-9240
Author: HasanAli DURMAZ (Primary Author)
Institution: ANKARA DIŞKAPI YILDIRIM BEYAZIT SAĞLIK UYGULAMA VE ARAŞTIRMA MERKEZİ
Country: Turkey


Dates

Publication Date : April 30, 2019

Bibtex @research article { kutfd490136, journal = {Kırıkkale Üniversitesi Tıp Fakültesi Dergisi}, issn = {1302-3314}, eissn = {2148-9645}, address = {}, publisher = {Kirikkale University}, year = {2019}, volume = {21}, pages = {44 - 51}, doi = {10.24938/kutfd.490136}, title = {İLİYAK ARTER TOTAL OKLÜZYONLARINDA ENDOVASKÜLER TEDAVİ: TEK MERKEZ DENEYİMİ}, key = {cite}, author = {DURMAZ, HasanAli} }
APA DURMAZ, H . (2019). İLİYAK ARTER TOTAL OKLÜZYONLARINDA ENDOVASKÜLER TEDAVİ: TEK MERKEZ DENEYİMİ. Kırıkkale Üniversitesi Tıp Fakültesi Dergisi , 21 (1) , 44-51 . DOI: 10.24938/kutfd.490136
MLA DURMAZ, H . "İLİYAK ARTER TOTAL OKLÜZYONLARINDA ENDOVASKÜLER TEDAVİ: TEK MERKEZ DENEYİMİ". Kırıkkale Üniversitesi Tıp Fakültesi Dergisi 21 (2019 ): 44-51 <https://dergipark.org.tr/en/pub/kutfd/issue/38689/490136>
Chicago DURMAZ, H . "İLİYAK ARTER TOTAL OKLÜZYONLARINDA ENDOVASKÜLER TEDAVİ: TEK MERKEZ DENEYİMİ". Kırıkkale Üniversitesi Tıp Fakültesi Dergisi 21 (2019 ): 44-51
RIS TY - JOUR T1 - İLİYAK ARTER TOTAL OKLÜZYONLARINDA ENDOVASKÜLER TEDAVİ: TEK MERKEZ DENEYİMİ AU - HasanAli DURMAZ Y1 - 2019 PY - 2019 N1 - doi: 10.24938/kutfd.490136 DO - 10.24938/kutfd.490136 T2 - Kırıkkale Üniversitesi Tıp Fakültesi Dergisi JF - Journal JO - JOR SP - 44 EP - 51 VL - 21 IS - 1 SN - 1302-3314-2148-9645 M3 - doi: 10.24938/kutfd.490136 UR - https://doi.org/10.24938/kutfd.490136 Y2 - 2019 ER -
EndNote %0 Kırıkkale Üniversitesi Tıp Fakültesi Dergisi İLİYAK ARTER TOTAL OKLÜZYONLARINDA ENDOVASKÜLER TEDAVİ: TEK MERKEZ DENEYİMİ %A HasanAli DURMAZ %T İLİYAK ARTER TOTAL OKLÜZYONLARINDA ENDOVASKÜLER TEDAVİ: TEK MERKEZ DENEYİMİ %D 2019 %J Kırıkkale Üniversitesi Tıp Fakültesi Dergisi %P 1302-3314-2148-9645 %V 21 %N 1 %R doi: 10.24938/kutfd.490136 %U 10.24938/kutfd.490136
ISNAD DURMAZ, HasanAli . "İLİYAK ARTER TOTAL OKLÜZYONLARINDA ENDOVASKÜLER TEDAVİ: TEK MERKEZ DENEYİMİ". Kırıkkale Üniversitesi Tıp Fakültesi Dergisi 21 / 1 (April 2019): 44-51 . https://doi.org/10.24938/kutfd.490136
AMA DURMAZ H . İLİYAK ARTER TOTAL OKLÜZYONLARINDA ENDOVASKÜLER TEDAVİ: TEK MERKEZ DENEYİMİ. Kirikkale Univ Tip Fak Derg. 2019; 21(1): 44-51.
Vancouver DURMAZ H . İLİYAK ARTER TOTAL OKLÜZYONLARINDA ENDOVASKÜLER TEDAVİ: TEK MERKEZ DENEYİMİ. Kırıkkale Üniversitesi Tıp Fakültesi Dergisi. 2019; 21(1): 51-44.