Evaluation of Early and Mid-term Results of TEVAR Procedures with Various Etiology.

Yıl 2019, , 283 - 288, 31.12.2019

Dilşad Amanvermez Şenarslan , Funda Yıldırım , Ömer Tetik

https://doi.org/10.34087/cbusbed.641171

Cited By: 1

Öz

Amaç:

Torasik
endovasküler aort anevrizması tamiri (TEVAR), günümüzde dejeneratif
anevrizmalar, sakküler anevrizmalar ve akut torasik aortik sendromların
tedavisinde öncelikli tercih edilmektedir. Bu çalışmanın amacı son 3 yılda
kliniğimizde uygulanan TEVAR girişimlerinin erken ve orta dönem sonuçlarını
değerlendirmektir.

 Gereç ve Yöntem:

Otuz hastaya
(25 erkek, 5 kadın) Ocak 2015- Aralık 2018 arasında TEVAR işlemi uygulandı. Tüm
hastalarda Valiant ™ Torasik Stent Greft Sistemi (Medtronic®) kullanıldı.

Bulgular:

Hastaların yaş ortalaması 60,4±18 idi. Hastaların %53,3'ünde
dejeneratif anevrizma, %36,7'sinde akut aortik sendrom, %10'unda aort
koarktasyonu ve eşlik eden poststenotik anevrizma mevcuttu. Hastaların %63,3'ü
semptomatikti ve sırt veya göğüs ağrısı vardı.

İşlemlerin teknik başarısı %100 idi. Yoğun bakım
ünitesinde ortalama kalış süresi 1 ± 2 gün, hastanede kalış süresi ortalama 3,2
± 2 gündü. Hastane mortalitesi olmadı ve ilk 30 günlük dönemde bir hasta tip 2
diseksiyon nedeniyle öldü. İki hastada tip II endoleak görüldü ve endoleak'ler
kendiliğinden düzeldiği için ikincil bir müdahaleye ihtiyacımız olmadı.
Subklaviyan arterin 3 hastada kapatılması gerekti ve hastalarda sol üst
ekstremitede iskemisi gelişmedi. Yeterli hidrasyona rağmen, postoperatif erken
dönemde 2 hastanın kreatinin düzeylerinde artış vardı ve izlemde normal
değerlere geriledi. Ortalama takip süresi 6 ± 9 aydı ve uzun vadede 2 mortalite
vardı. Bir hasta akciğer kanserinden öldü, ikincisi ise anevrizmal hastalıktan
bağımsız olarak mezenterik iskemi nedeniyle öldü.

Sonuç:

TEVAR, torasik aort anevrizmaları veya akut aortik
sendromların tedavisinde, anatomik olarak uygun hastalarda ilk tedavi
seçeneğidir. TEVAR, konvansiyonel cerrahiye kıyasla düşük morbidite ve
mortalite oranlarıyla, güvenle uygulanabilir.

Anahtar Kelimeler

Aortic aneurysm, dissecting aneurysm, endovascular procedure

Kaynakça

• 1. Roselli EE, Thoracic endovascular aortic repair versus open surgery for type-B chronic dissection, The Journal of Thoracic and Cardiovascular Surgery, 2015, 149(2), S163-167.
• 2. Medical Advisory Secretariat, Endovascular repair of descending thoracic aortic aneurysm: an evidence-based analysis, Ontario Health Technology Assessment Series, 2005, 5(18): 1–59.
• 3. Riambau V, Böckler D, Brunkwall J, Cao P, Chiesa R, Coppi G, et al, Editor’s Choice- Management of Descending Thoracic Aorta Diseases: Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS), European Journal of Vascular and Endovascular Surgery, 2017, 53(1), 4–52.
• 4. Eggebrecht H, Nienaber CA, Neuhäuser M, Baumgart D, Kische S, Schmermund A, et al, Endovascular stent-graft placement in aortic dissection: a meta-analysis, European Heart Journal, 2006, 27(4), 489–98.
• 5. Walsh SR, Tang TY, Sadat U, Naik J, Gaunt ME, Boyle JR, et al, Endovascular stenting versus open surgery for thoracic aortic disease: systematic review and meta-analysis of perioperative results, Journal of Vascular Surgery, 2008, 47(5), 1094–8.
• 6. Li QG, Yu WD, Ma WG, Large clinical registries for acute aortic dissection: interpretation and comparison of latest results, Zhonghua Wai Ke Za Zhi [Chinese Journal of Surgery], 2019, 57(5), 326–30.
• 7. Erben Y, Oderich GS, Verhagen HJM, Witsenburg M, van den Hoven AT, Debus ES, et al, Multicenter experience with endovascular treatment of aortic coarctation in adults, Journal of Vascular Surgery, 2019, 69(3), 671-679.e1.
• 8. Hagan PG, Nienaber CA, Isselbacher EM, Bruckman D, Karavite DJ, Russman PL, et al, The International Registry of Acute Aortic Dissection (IRAD): new insights into an old disease, JAMA, 2000, 283(7), 897–903.
• 9. Nienaber CA, Kische S, Ince H, Fattori R, Thoracic endovascular aneurysm repair for complicated type B aortic dissection, Journal of Vascular Surgery, 2011, 54(5), 1529–33.
• 10. Tsai TT, Trimarchi S, Nienaber CA, Acute aortic dissection: perspectives from the International Registry of Acute Aortic Dissection (IRAD), European Journal of Vascular and Endovascular Surgery, 2009, 37(2): 149–59.
• 11. Nienaber CA. Influence and critique of the INSTEAD Trial (TEVAR versus medical treatment for uncomplicated type B aortic dissection), Seminars in Vascular Surgery, 2011, 24(3), 167–71.
• 12. Nienaber CA, Kische S, Rousseau H, Eggebrecht H, Rehders TC, Kundt G, et al, Endovascular repair of type B aortic dissection: long-term results of the randomized investigation of stent grafts in aortic dissection trial, Circulation. Cardiovascular Interventions, 2013, 6(4), 407–16.
• 13. Brunkwall J, Kasprzak P, Verhoeven E, Heijmen R, Taylor P, ADSORB Trialists, et al, Endovascular repair of acute uncomplicated aortic type B dissection promotes aortic remodelling: 1 year results of the ADSORB trial, European Journal of Vascular and Endovascular Surgery, 2014, 48(3), 285–91.
• 14. Laquian L, Scali ST, Beaver TM, Kubilis P, Beck AW, Giles K, et al, Outcomes of Thoracic Endovascular Aortic Repair for Acute Type B Dissection in Patients With Intractable Pain or Refractory Hypertension, Journal of Endovascular Therapy, 2018, 25(2), 220–9.
• 15. Canaud L, Ozdemir BA, Patterson BO, Holt PJE, Loftus IM, Thompson MM, Retrograde aortic dissection after thoracic endovascular aortic repair, Annals of Surgery, 2014, 260(2), 389–95.
• 16. Chen Y, Zhang S, Liu L, Lu Q, Zhang T, Jing Z, Retrograde Type A Aortic Dissection After Thoracic Endovascular Aortic Repair: A Systematic Review and Meta-Analysis, Journal of the American Heart Association, 2017, 6(9).
• 17. An Z, Song Z, Tang H, Han L, Xu Z, Retrograde Type A Dissection after Thoracic Endovascular Aortic Repair: Surgical Strategy and Literature Review, Heart, Lung & Circulation, 2018, 27(5), 629–34.
• 18. Ma T, Dong ZH, Fu WG, Guo DQ, Xu X, Chen B, et al, Incidence and risk factors for retrograde type A dissection and stent graft-induced new entry after thoracic endovascular aortic repair, Journal of Vascular Surgery, 2018, 67(4), 1026-1033.e2.
• 19. Lee WA, Matsumura JS, Mitchell RS, Farber MA, Greenberg RK, Azizzadeh A, et al, Endovascular repair of traumatic thoracic aortic injury: clinical practice guidelines of the Society for Vascular Surgery, Journal of Vascular Surgery, 2011, 53(1), 187–92.
• 20. Cowley RA, Turney SZ, Hankins JR, Rodriguez A, Attar S, Shankar BS, Rupture of thoracic aorta caused by blunt trauma. A fifteen-year experience, The Journal of Thoracic and Cardiovascular Surgery, 1990, 100(5), 652–60; discussion 660-661.
• 21. Murad MH, Rizvi AZ, Malgor R, Carey J, Alkatib AA, Erwin PJ, et al, Comparative effectiveness of the treatments for thoracic aortic transection, Journal of Vascular Surgery, 2011, 53(1), 193-199.e1-21.
• 22. Fox N, Schwartz D, Salazar JH, Haut ER, Dahm P, Black JH, et al, Evaluation and management of blunt traumatic aortic injury: a practice management guideline from the Eastern Association for the Surgery of Trauma, The Journal of Trauma and Acute Care Surgery, 2015, 78(1), 136–46.
• 23. Chung J, Kasirajan K, Veeraswamy RK, Dodson TF, Salam AA, Chaikof EL, et al, Left subclavian artery coverage during thoracic endovascular aortic repair and risk of perioperative stroke or death, Journal of Vascular Surgery, 2011, 54(4), 979–84.
• 24. Zamor KC, Eskandari MK, Rodriguez HE, Ho KJ, Morasch MD, Hoel AW, Outcomes of Thoracic Endovascular Aortic Repair and Subclavian Revascularization Techniques, Journal of the American College of Surgeons, 2015, 221(1), 93–100.
• 25. Waterford SD, Chou D, Bombien R, Uzun I, Shah A, Khoynezhad A, Left Subclavian Arterial Coverage and Stroke During Thoracic Aortic Endografting: A Systematic Review, The Annals of Thoracic Surgery, 2016, 101(1), 381–9.
• 26. Patterson BO, Holt PJ, Nienaber C, Fairman RM, Heijmen RH, Thompson MM, Management of the left subclavian artery and neurologic complications after thoracic endovascular aortic repair, Journal of Vascular Surgery, 2014, 60(6), 1491-1497.e1.
• 27. Hajibandeh S, Hajibandeh S, Antoniou SA, Torella F, Antoniou GA, Meta-analysis of Left Subclavian Artery Coverage With and Without Revascularization in Thoracic Endovascular Aortic Repair, Journal of Endovascular Therapy, 2016, 23(4), 634–41.
• 28. Delafontaine J-L, Hu B, Tan T-W, Tang GL, Starnes BW, Virk C, et al, Outcome Comparison of TEVAR with and without Left Subclavian Artery Revascularization from Analysis of Nationwide Inpatient Sample Database, Annals of Vascular Surgery, 2019 (Epub, doi: 10.1016/j.avsg.2019.01.005.)