Alt Ekstremite İskemisi Nedeniyle Endovasküler Girişim Planlanan Hastaların Klinik Sonuçları ve Koroner Arter Hastalığı Açısından Değerlendirilmesi

Year 2018, , 266 - 271, 29.06.2018

Kevser Tural

https://doi.org/10.31832/smj.358761

Abstract

Amaç: Bu çalışmada, endovasküler
girişim planlanan periferik tıkayıcı arter hastalığı teşhisi konulan hastalarda
koroner arter hastalığı ve klinik sonuçları incelendi.

Gereç ve Yöntemler: Ocak 2013 ile Ağustos
2017 tarihleri arasında alt
ekstremite arterlerinin herhangi birisinde %70 ya da daha fazla stenoz
nedeniyle endovasküler girişim planlanan ve aynı zamanda koroner anjiografisi yapılan 114
periferik arter hastalığı olgusu çalışmaya dahil edilmiştir. Hastalar koroner
arter stenoz derecesine göre üç gruba ayrıldı. Grup 1: Koroner arter stenozu olmayanlar
veya <%40 stenozis olanlar, Grup 2: ≥ 40% ve <70% stenozis olanlar,
Grup 3: ≥70% stenozis
olanlar. Gruplar yaş, cinsiyet, lipit profilleri (total kolesterol, LDL,HDL,
trigliserit), ek hastalıklar (hipertansiyon, diabetes mellitus, kronik obstruktif
akciğer hastalığı), alt ekstremite amputasyonu ve mortalite açısından retrospektif
olarak karşılaştırılmıştır.

 

Bulgular: Ortalama yaş 66.56±11.65’tir. Olguların 100’ü (%87.7) erkekti.
Olguların 8'sinde (%7.0) %40-70 arası darlık olan koroner arter hastalığı,
75'inde (%65.8) %70'in üzerinde darlık olan önemli koroner arter hastalığı
saptandı. Olguların 61'i
(%53.5) hipertansiyon, 31'i (%27.2) diyabetes mellitus, 78'ü (%68.4)
dislipidemi, 10'u (%8.8) kronik obstrüktif akciğer hastalığına sahipti. Mortalite
oranı bir yıllık takibi yapılabilen hastalarda %17.5 (20 hasta) bulundu. Grup
1’de yaş ortalaması diğer iki gruptan istatistiksel olarak anlamlı düşük çıktı.
Gruplar arasında diğer klinik sonuçlar açısından anlamlı fark bulunmadı.

Sonuç: Periferik tıkayıcı arter hastalığı olan hastalarda
koroner arter hastalığı prevalansının yüksek olması nedeniyle bu hastalarda
tarama amaçlı rutin koroner arter anjiografi yapılması kardiyovasküler
mortalite ve morbiditenin azaltılması açısından önemlidir.

 

Keywords

Periferik arter hastalığı, koroner arter hastalığı, koroner arter anjiografi

Evaluation of Clinical Outcomes and Coronary Artery Disease in Patients Scheduled for Endovascular Intervention due to Lower Extremity Ischemia

Abstract

Objectives:
 In this study, clinical outcomes and
coronary artery disease in patients diagnosed with peripheral occlusive artery disease
who were scheduled to have an endovascular intervention procedure were
investigated.

 

Materials and Methods:
114 peripheral artery disease patients who were planned to undergo an endovascular
intervention due to stenosis of 70% or more in any one of lower limb arteries
between January 2013 and August 2017 and underwent coronary artery angiography at the same time were included in this
study. Patients were divided into three groups according to the degree of the
stenosis in their coronary arteries. Group 1: patients without CAD or having
<40% of stenosis, Group 2: patients having 40% or more but less than 70% of stenosis, Group 3: patients with ≥70% of stenosis. The groups
were retrospectively compared
in terms of age, gender, lipid profiles (total cholesterol, LDL, HDL, and
triglyceride), other diseases (hypertension, diabetes mellitus, and chronic
obstructive pulmonary disease), lower extremity amputation, and mortality.

Results: The mean age was 66.56 ±
11.65. 100 of the cases (87.7%) were male. Eight of the cases (7.0%) had
coronary artery disease with a stenosis of 40-70%, and 75 patients (65.8%) had
significant coronary artery disease with stenosis of 70% and above. 61 (53.5%)
of the cases had hypertension, 31 (27.2%) had diabetes mellitus, 78 (68.4%)
cases had dyslipidemia,  and 10 (8.8%)
cases had chronic obstructive pulmonary disease. The mortality rate was 17.5%
(20 patients) in patients who could be followed up for one year. The mean age
of group 1 was statistically significantly lower than the other two groups. No
significant difference was found between the groups in terms of other clinical
outcomes.

Conclusion: Because of the high incidence
of coronary artery disease in patients with peripheral occlusive artery
disease, it is important to screen these patients via routine coronary artery angiography to decrease cardiovascular mortality and
morbidity.

Keywords

Peripheral artery disease, coronary artery disease, coronary artery angiography

References

• 1) Mohler E 3rd, Giri J; ACC; AHA. Management of peripheral arterial disease patients: comparing the ACC/AHA and TASC-II guidelines. Curr Med Res Opin 2008; 24(9):2509-22.
• 2) Pecci R, De La Fuente Aguado J, Sanjurjo Rivo AB, Sanchez Conde P, Corbacho Abelaira M. Peripheral arterial disease in patients with chronic obstructive pulmonary disease. Int Angiol 2012; 31(5):444-53.
• 3) Nishijima A, Yamamoto N, Yoshida R, Hozawa K, Yanagibayashi S, Takikawa M, et al. Coronary Artery Disease in Patients with Critical Limb Ischemia Undergoing Major Amputation or Not. Plast Reconstr Surg Glob Open 2017; 5(6):e1377.
• 4) Her K, Choi C, Park Y, Shin H, Won Y. Concomitant peripheral artery disease and asymptomatic coronary artery disease: a management strategy. Ann Vasc Surg 2008 ;22(5):649-56.
• 5) Duran NE, Duran I, Gürel E, Gündüz S, Göl G, Biteker M, et al. Coronary artery disease in patients with peripheral artery disease. Heart Lung. 2010; 39(2):116-120.
• 6) Chowdhury MM, Makris GC, Tarkin JM, Joshi FR, Hayes PD, Rudd JHF, et al. Lower limb arterial calcification (LLAC) scores in patients with symptomatic peripheral arterial disease are associated with increased cardiac mortality and morbidity. PLoS One 2017 ;12(9):e0182952.
• 7) Fowkes FG, Murray GD, Butcher I, Heald CL, Lee RJ, Chambless LE, et al. Ankle brachial index combined with Framingham Risk Score to predict cardiovascular events and mortality: a meta-analysis. JAMA 2008; 300(2):197-208.
• 8) Amrock SM, Abraham CZ, Jung E, Morris PB, Shapiro MD. Risk Factors for Mortality Among Individuals With Peripheral Arterial Disease. Am J Cardiol. 2017; 120(5):862-867.
• 9) Hertzer NR. Basic data concerning associated coronary disease in peripheral vascular patients. Ann Vasc Surg 1987;1(5):616-20.
• 10) Sigvant B, Hasvold P, Kragsterman B, Falkenberg M, Johansson S, Thuresson M, et al. Cardiovascular outcomes in patients with peripheral arterial disease as an initial or subsequent manifestation of atherosclerotic disease: Results from a Swedish nationwide study. J Vasc Surg 2017; 66(2):507-514.
• 11) Sigvant B, Lundin F, Wahlberg E. The risk of disease progression in peripheral arterial disease is higher than expected: a meta-analysis of mortality and disease progression in peripheral arterial disease. Eur J Vasc Endovasc Surg 2016; 51(3):395-403.
• 12) Subherwal S, Patel M.R, Kober L, Peterson E.D, Bhatt D.L, Gislason G.H, et al. Peripheral artery disease is a coronary heart disease risk equivalent among both men and women: results from a nationwide study. Eur J Prev Cardiol 2015; 22(3): 317-325
• 13) Shiraki T, Iida O, Takahara M, Okamoto S, Kitano I, Tsuji Y, et al. Predictive scoring model of mortality after surgical or endovascular revascularization in patients with critical limb ischemia. J Vasc Surg 2014;60(2):383–389.
• 14) Lee MS, Rha SW, Han SK, Choi BG, Choi SY, Park Y, et al. Clinical outcomes of patients with critical limb ischemia who undergo routine coronary angiography and subsequent percutaneous coronary intervention. J Invasive Cardiol. 2015;27(4):213-7.
• 15) Price JF, Stewart MC, Douglas AF, Murray GD, Fowkes GF. Frequency of a low ankle brachial index in the general population by age, sex and deprivation: cross-sectional survey of 28,980 men and women. Eur J Cardiovasc Prev Rehabil 2008;15(3):370–5.
• 16) Bozkurt AK, Tasci I, Tabak O, Gumus M, Kaplan Y. Peripheral artery disease assessed by ankle-brachial index in patients with established cardiovascular disease or at least one risk factor for atherothrombosis--CAREFUL study: a national, multi-center, cross-sectional observational study. BMC Cardiovasc Disord 2011; 19;11:4.
• 17) Urbano L, Portilla E, Muñoz W, Hofman A, Sierra-Torres CH. Prevalence and risk factors associated to peripheral arterial disease in an adult population from Colombia. Arch Cardiol Mex. 2017; S1405-9940(17)30011-3.
• 18) Sur G, Sur M, Kudor-Szabadi L, Sur L, Sporis D, Sur D. Arterial hypertension - prevalence of risk factors and morbide associations that increase cardiovascular risk. Maedica (Buchar) 2010; 5(1):34-40.
• 19) Korhonen PE, Syvänen KT, Vesalainen RK, Kantola IM, Kautiainen H, Järvenpää S, et al. Ankle-brachial index is lower in hypertensive than in normotensive individuals in a cardiovascular risk population. J Hypertens 2009; 27(10):2036-43.
• 20) Carratala A, Martinez-Hervas S, Rodriguez-Borja E, Benito E, Real JT, Saez GT, et al. PAI-1 levels are related to insulin resistance and carotid atherosclerosis in subjects with familial combined hyperlipidemia. J Investig Med 2017; jim-2017-000468.
• 21) Tünel HA, Manduz Ş, Katrancıoğlu N, Karahan O, Berkan Ö. Periferik tıkayıcı arter hastalığı olan vasküler cerrahi uygulanacak hastalarda koroner arter hastalığı riskinin ve sıklığının belirlenmesi. Turkish J Thorac Cardiovasc Surg 2009; 17(4): 261-6.
• 22) Yunke Z, Guoping L, Zhenyue C. Triglyceride-to-HDL cholesterol ratio. Predictive value for CHD severity and new-onset heart failure. Herz 2014;39(1):105-10.
• 23) Luz PL, Favarato D, Faria-Neto Junior JR, Lemos P, Chagas AC. High ratio of triglycerides to HDL-cholesterol predicts extensive coronary disease. Clinics 2008;63(4):427-32.