Supraaortik multiple stenozlarda eş zamanlı balon anjiyoplasti ve stent implantasyonu

Year 2020, Volume: 45 Issue: 1, 9 - 13, 31.03.2020

Aylin Güneşli , Erol Akgül

https://doi.org/10.17826/cumj.626386

Abstract

Amaç: Bu çalışmanın amacı supraaortik çoklu stenotik lezyonlarda yapılan, eş zamanlı endovasküler tedavinin başarısı ile komplikasyonlarını değerlendirmektir.
Gereç ve Yöntem: 1 Ocak-2004 ile 31 Aralık 2009 tarihler arasında supraaortik damar yatağında çoklu darlık nedeni ile perkütan girişimsel işlem uygulanan hastaların kayıtları geriye dönük incelendi. Doppler ultrasonografi, manyetik rezonans inceleme, bilgisayarlı tomografi veya dijital subtraksiyon anjiyografi ile supraaortik damarlarda %50 nin üzerinde darlık saptanması koşuluyla perkütan endovasküler girişim uygulanması kararı alındı. Klinik olarak en az 2 tane ciddi darlığı olan ve aynı seansta çoklu girişimsel işlem kararı verilen hastalar çalışmaya dahil edildi.
Bulgular: Çalışmaya 6’sı kadın (%17,4) toplam 34 hasta (ortalama yaş 60,4±12,5) dahil edildi. Otuzdört hastada toplam 74 lezyona girişim uygulandı. Girişimlerin tamamında stent kullanıldı. Mortalite veya ciddi morbidite görülmedi. İşlemin teknik olarak akut başarısı %100’dü. Ortalama 29,5±18,3 aylık takipte, 4 hastada (%11,7) restenoz geliştiği görüldü. Bu hastalardan 3’üne tekrar girişim uygulandı.
Sonuç: Çalışmamızın sonuçlarına göre supraaortik dallarda tıkayıcı aterosklerotik damar hastalığı gelişmesi durumunda endovasküler girişim güvenle uygulanabilir. Bu tedavinin mortalitesive morbiditesi oldukça düşüktür. Takiplerinde restenoz gelişen hastalara tekrar girişim güvenle uygulanabilir. Aynı hasta grubunda çoklu lezyon var ise aynı seansta çoklu girişim güvenle uygulanabilen bir tedavi seçeneğidir.

Keywords

Supraaortik ark, endovasküler tedavi, tıkanıklık

Simultaneous balloon angioplasty and stent ımplantation in supraaortic multiple stenosis

Abstract

Purpose: The aim of this study was to evaluate the success and complications of endovascular treatment in supraaortic multiple stenotic lesions
Materials and Methods: The study was planned as a retrospectively. The records of patients who underwent percutaneous interventional treatment for multiple stenosis in the supraaortic vessels between January 1, 2004 and December 31, 2009 were reviewed. Percutaneous endovascular intervention was decided with doppler ultrasonography, magnetic resonance imaging, computed tomography or digital subtraction angiography provided that more than 50% stenosis was detected in the supraaortic vessels. Patients with at least 2 severe stenosis who underwent multiple interventional procedures in one session were included in the study.
Results: A total of 34 patients (mean age 60.4 ± 12.5 years and 6 female (17.4%)) were included in the study. A total of 74 lesions were treated in 34 patients. Stents were used in all procedures. No mortality or serious morbidity was observed during follow-up. The technical success of the procedure was 100%. Restenosis was observed in 4 patients (11.7%) at a mean follow-up of 29.5 ± 18.3 months. Three of these patients were re-treated.
Conclusion: According to the results of our study, endovascular intervention can be safely performed in occlusive atherosclerotic vascular disease of the supraaortic branches. Mortality and morbidity of this treatment is very low. In patients with restenosis during follow-up, re-intervention can be performed safely. If multiple lesions are present in the same patient group, multiple interventions are a safe treatment option.

Keywords

Endovascular treatment, occlusion, supraaortic arch

References

• 1. Writing Group Members, Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, et al. American Heart Association Statistics Committee; Stroke Statistics Subcommittee. Executive Summary: Heart Disease and Stroke Statistics--2016 Update: A Report From the American Heart Association. Circulation. 2016;133:447-54.
• 2. Ernemann U, Bender B, Melms A, Brechtel K, Kobba J, Balletshofer B. Current concepts of the interventional treatment of proximal supraaortic vessel stenosis. Vasa. 2012;41:313-8.
• 3. Mirzaie M, Fatehpur S, Friedrich M, Sossalla S, Sohns C, Schoendube FA, et al. Complex Reconstruction of Supraaortic Branches. Ann Thorac Cardiovasc Surg. 2011;17:347-51.
• 4. Müller-Hülsbeck S, Both M, Charalambous N, Schäfer PJ, Heller M, Jahnke T. [Endovascular treatment of atherosclerotic arterial stenoses and occlusions of the supraaortic arteries: mid-term results from a single center analysis]. Rontgenpraxis. 2007;56:119-28.
• 5. Sfyroeras GS, Karathanos C, Antoniou GA, Saleptsis V, Giannoukas AD. A meta-analysis of combined endarterectomy and proximal balloon angioplasty for tandem disease of the arch vessels and carotid bifurcation. J Vasc Surg. 2011;54:534-40.
• 6. Samaniego EA, Katzen BT, Kreusch AS, Uthoff H. Endovascular Treatment of Proximal Aortic Arch Lesions through a Retrograde Approach. Interv Neurol. 2015;3:41-7.
• 7. Brunkwall J, Berggvist D, Bergentz SE. Long-term results of arterial reconstruction of the upper extremity. Eur J Vasc Surg 1994;8:47e51.
• 8. Berguer R, Morasch MD, Kline RA, Kazmers A, Friedland MS. Cervical reconstruction of the supra-aortic trunks: a 16-year experience. J Vasc Surg 1999;29:239e46. discussion 246e8
• 9. van de Weijer MA, Vonken EJ, de Vries JP, Moll FL, Vos JA, de Borst GJ. Technical and Clinical Success and Long-Term Durability of Endovascular Treatment for Atherosclerotic Aortic Arch Branch Origin Obstruction: Evaluation of 144 Procedures. Eur J Vasc Endovasc Surg. 2015;50:13-20.
• 10. Peterson BG, Resnick SA, Morasch MD, Hassoun HT, Eskandari MK. Aortic arch vessel stenting: a single-center experience using cerebral protection. Arch Surg 2006;141: 560e3. discussion 563e4.
• 11. Sullivan TM, Gray BH, Bacharach JM, Perl 2nd J, Childs MB, Modzelewski L, et al. Angioplasty and primary stenting of the subclavian, innominate, and common carotid arteries in 83 patients. J Vasc Surg 1998;28:1059e65.