Periferik Arter Hastalıklarında Tedavi Modellerinin Geleceği: Cerrahi ve Endovasküler Yaklaşımlar

Yıl 2025, Cilt: 34 Sayı: 2, 129 - 140, 30.06.2025

Burak Toprak , Mehmet Erin Tüysüz

https://doi.org/10.17827/aktd.1667049

Öz

Periferik arter hastalığı (PAH), dünya çapında 200 milyondan fazla insanı etkileyen, morbidite ve mortaliteye neden olan önemli bir vasküler hastalıktır. Tedavi yaklaşımları, geleneksel cerrahi revaskülarizasyondan minimal invaziv endovasküler tekniklere evrilmiştir. Son yıllarda, cerrahi ve endovasküler yöntemleri birleştiren hibrit prosedürler, hasta sonuçlarını optimize etmek için yeni bir seçenek olarak ortaya çıkmıştır. Bu derlemede, PAH tedavisinde cerrahi, endovasküler ve hibrit yaklaşımların etkinliği, avantajları ve sınırlamaları karşılaştırılmaktadır.
Çalışmada PubMed, Scopus ve Web of Science veritabanlarında yapılan güncel randomize kontrollü çalışmalar, kohort analizleri ve sistematik derlemeler incelenmiştir. Tedavi yaklaşımlarının etkinliğini değerlendirmek için açıklık oranları, komplikasyon profilleri, ampütasyonsuz sağkalım ve hasta bildirimli sonuçlar gibi temel metrikler analiz edilmiştir. Bulgular, kompleks PAH vakalarında cerrahi revaskülarizasyonun uzun dönem açıklık açısından üstün olduğunu ancak daha yüksek perioperatif riskler taşıdığını göstermektedir. Endovasküler girişimler, anjiyoplasti ve stentleme gibi yöntemlerle düşük kısa dönem komplikasyonları ve hızlı iyileşme sağlarken, restenoz oranları önemli bir sorun olmaya devam etmektedir. Hibrit prosedürler ise yüksek riskli hastalar ve kompleks lezyonlar için umut vadeden bir alternatif olarak öne çıkmaktadır.
PAH tedavisinde en uygun yaklaşım, lezyonun kompleksliği, hastanın ek hastalıkları ve uzun vadeli dayanıklılık gereksinimleri göz önünde bulundurularak belirlenmelidir. Cerrahi girişimler kalıcı sonuçlar sunarken, endovasküler teknikler düşük riskli minimal invaziv seçenekler sağlamaktadır. Hibrit stratejiler, uygun hastalarda her iki yöntemin avantajlarını birleştirerek sonuçları iyileştirebilir. Gelecekte, uzun dönem karşılaştırmalı çalışmalar ve kişiselleştirilmiş tedavi modelleri, PAH yönetiminde klinik karar alma süreçlerini daha da geliştirebilir.

Anahtar Kelimeler

Periferik arter hastalığı , kritik ekstremite iskemisi , cerrahi revaskülarizasyon , endovasküler tedavi , hibrit prosedürler , multidisipliner yaklaşımlar

The Future of Treatment Models in Peripheral Artery Disease: Surgical and Endovascular Approaches

Öz

Peripheral artery disease (PAD) affects over 200 million people worldwide, leading to significant morbidity and mortality. Treatment strategies have evolved from traditional surgical revascularization to minimally invasive endovascular techniques. Recently, hybrid procedures combining surgical and endovascular approaches have emerged as a promising alternative to optimize patient outcomes. This review compares the efficacy, benefits, and limitations of these treatment modalities in PAD management.
A comprehensive analysis of recent randomized controlled trials, cohort studies, and systematic reviews was conducted using PubMed, Scopus, and Web of Science. Key metrics, including patency rates, complication profiles, amputation-free survival, and patient-reported outcomes, were evaluated. Findings suggest that surgical revascularization remains the gold standard for complex PAD cases due to superior long-term patency, despite higher perioperative risks. Endovascular interventions, such as angioplasty and stenting, offer lower short-term complications and faster recovery but are associated with higher restenosis rates. Hybrid procedures provide an alternative for high-risk patients and complex lesions, integrating the advantages of both techniques. Technological advancements, including drug-coated devices and precision imaging, continue to refine treatment outcomes.
The choice of optimal PAD treatment depends on lesion complexity, patient comorbidities, and durability requirements. While surgical approaches provide long-lasting results, endovascular techniques offer less invasive solutions with lower immediate risks. Hybrid strategies bridge these approaches, improving outcomes in select cases. Future research should focus on long-term comparative studies and personalized treatment models to enhance clinical decision-making in PAD management.

Anahtar Kelimeler

Peripheral artery disease , critical limb ischemia , surgical revascularization , endovascular treatment , hybrid procedures , multidisciplinary approaches.

Etik Beyan

N/A

Destekleyen Kurum

No external funding was received for the preparation of this manuscript.

Teşekkür

N/A

Kaynakça

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