İliyak arter ve infrainguinal arter tıkayıcı hastalığında hybrid strateji

Abstract

Amaç: Periferik arter hastalığının tedavisi farklı tedavi seçeneklerine sahiptir. Son zamanlarda hibrid tedavi yöntemi (endovasküler tedavi artı cerrahi) alt ekstremite arter hastalığı tedavisinde kullanılmaktadır.  Bu çalışmada iliyak arter ve infrainguinal periferik arter hastalığında hibrid tedavi incelenmiştir.

Gereç ve Yöntemler: Bu çalışma Ocak 2010 ile Ağustos 2015 yılları arasında tıkayıcı iliyak arter hastalığı olan ve endovasküler tedavi yapılan 76 hastayı içermektedir. 56 hastaya sadece iliyak arter endovasküler tedavi uygulanırken, 20 hastaya iliyak arter endovasküler tedaviye ilave infrainguinal vasküler cerrahi uygulanmıştır.  

Bulgular: Yirmi hibrid tedavi kolunda, iliyak arter lezyon uzunluğu 31,0 ± 7,6 mm idi. Yedi hasta TASC-II A iliyak arter sınıfında iken, 13 hasta TASC-II B iliyak sınıfında idi.  Femoropopliteal lezyonlara göre 8 hasta TASC-II C, 12 hasta TASC-II D. Bir hasta postoperatif dönem öldü, bir hastada greft tıkanıklığı gelişti ve kateter yöntemi ile tedavi edildi. Takipte bir hastada iliyak arter stent tıkanıklığı gelişti. Bir yıllık takipte ayak bileği/ kol sistolik basınç oranı 0,91 ± 0,20 idi.

Sonuçlar: Hibrid tedavi iliyak arter ve infrainguinal arter hastalığını içeren çoklu alt ekstremite arter hastalığında uygun bir tekniktir. Bu teknik daha az komplikasyon oranlı açıklık oranına sahiptir. 

Keywords

• İliyak arter hastalığı,infrainguinal arter hastalığı,hibrid tedavi

Hybrid strategy in iliac artery disease and infrainguinal arterial occlusive disease

Abstract

Aim: The treatment of peripheral arterial disease has encompassed different therapy options. Hybrid therapy method (endovascular treatment plus surgery) has recently been used in lower extremity arterial disease. This study has examined hybrid therapy practice in iliac and infrainguinal arterial disease.   

    

Materials and Methods: This study included 76 patients with occlusive iliac artery disease and performed iliac artery endovascular treatment from January 2010 to August 2015. While 56 patients underwent only iliac artery stenting, 20 of 76 patients underwent additionally infrainguinal vascular surgery (hybrid therapy). 

 

Results: In 20 hybrid patients group, iliac artery lesion length was 31.0 ± 7.6 mm. Seven patients had TASC-II A iliac artery class, while 13 patients had TASC-II B class. According to femoropopliteal lesions, eight patients had TASC-II C, while 12 patients had TASC-II D.  One patient died in postoperative period. Graft stenosis developed in one patient, which was resolved through catheter therapy. In the one-year follow-up, in one patient, iliac stent restenosis developed. ABI was 0.91 ± 0.20. 

Conclusion: Hybrid therapy is a feasible option for multilevel lower extremity artery disease, including iliac artery disease and TASC-II C or D femoropopliteal disease. This technique has favorable patency with lower complication rates.

Keywords

• Iliac arterial disease,infrainguinal arterial disease,hybrid therapy

References

1. 1-Dosluoglu HH, O'Brien-Irr MS, Lukan J, Harris LM, Dryjski ML, Cherr GS. Does preferential use of endovascular interventions by vascular surgeons improve limb salvage, control of symptoms, and survival of patients with critical limb ischemia? Am J Surg 2006; 192: 572-6.
2. 2-Lam C, Gandhi RT, Vatakencherry G, Katzen BT. Iliac artery revascularization: overview of current interventional therapies. Interv Cardiol 2010; 2: 851-9.
3. 3-Norgren L, Hiatt WR, Dormandy JA, et al. Inter-society consensus for the management of peripheral arterial disease (TASC II). J Vasc Surg 2007; 45(Suppl.S): S5
4. 4-Faries P, Morrissey NJ, Teodorescu V, et al. Recent advances in peripheral angioplasty and stenting. Angiology 2002; 59: 617-26.
5. 5-Rosanio S, Tocchi M, Uretsky BF, Stouffer GA. Use of intraluminal stents in the treatment of carotid, renal and peripheral arterial disease. Am J Med Sci 2000; 319: 575-96.
6. 6-Spijkerboer AM, Nass PC, de Valois JC, et al. Iliac artery stenoses after percutaneous transluminal angioplasty: follow-up with duplex ultrasonography J Vasc Surg 1996; 23: 691-7
7. 7-Selvin E, Erlinger TR. Prevalence of and risk factors for peripheral arterial disease in the United States: results from the National Health and Nutrition Examination Survey, 1999-2000. Circulation 2004; 110: 738-43.
8. 8-Klein WM, Graaf YVD, Seegers J, et al. Dutch Iliac stent trial: Long- term results in patients randomized for primary or selective stent placement Radiology 2006; 238: 734-44.

9. 9-Molnar RG, Gray WA; ACTIVE Trial Investigators. Sustained patency and clinical improvement following treatment of atherosclerotic iliac artery disease using the Assurant cobalt iliac balloon-expandable stent system. J Endovasc Ther 2013; 20: 94-103.
10. 10-Ponec D, Jaff MR, Swischuk J, Feiring A, Laird J, Mehra M. The Nitinol SMART stent vs Wallstent for suboptimal iliac artery angioplasty: CRISP-US Trial results. J Vasc Interv Radiol 2004; 15: 911-8.
11. 11-Dieter RS, Laird JR. Overview of restenosis in peripheral arterial interventions. Endovascular Today 2004: 10: 36-8. 12-Siracuse JJ, Giles KA, Pomposelli FB, et al. Results for primary bypass versus primary angioplasty/stent for intermittent claudication due to superficial femoral artery occlusive disease. J Vasc Surg 2012; 55: 1001-7.
12. 13- Twine CP, McLain AD. Graft type for femoro-popliteal bypass surgery. Cochrane Database Syst Rev 2010; 12: CD001487. doi: 10.1002/14651858.CD001487.pub2.
13. 14- Miura T, Soga Y, Aihara H, Yokoi H, Iwabuchi M. Prevalence and clinical outcome of polyvascular atherosclerotic disease in patients undergoing coronary intervention. Circ J 2013; 77: 89-95.
14. 15-Aihara H, Soga Y, Mii S, et al. RECANALISE Registry Investigators. Comparison of long-term outcome after endovascular therapy versus bypass surgery in claudication patients with Trans-Atlantic Inter-Society Consensus-II C and D femoropopliteal disease. Circ J 2014; 78: 457-64.
15. 16-Dosluoglu HH, Lall P, Cherr GS, Harris LM, Dryjski ML. Role of simple and complex hybrid revascularization procedures for symptomatic lower extremity occlusive disease. J Vasc Surg 2010; 51: 1425-1435.e1.
16. 17-Chang RW1, Goodney PP, Baek JH, Nolan BW, Rzucidlo EM, Powell RJ. Long-term results of combined common femoral endarterectomy and iliac stenting/stent grafting for occlusive disease. J Vasc Surg 2008; 48: 362-7. 18-Aho PS1, Venermo M. Hybrid procedures as a novel technique in the treatment of critical limb ischemia. Scand J Surg 2012; 101: 107-13.
17. 19-Slovut DP1, Lipsitz EC. Surgical technique and peripheral artery disease. Circulation 2012; 126: 1127-38.
18. 20-Pereira CE, Albers M, Romiti M, Brochado-Neto FC, Pereira CA. Meta-analysis of femoropopliteal bypass grafts for lower extremity arterial insufficiency. J Vasc Surg 2006; 44: 510-7.