Treatment of Iatrogenic and Traumatic Vascular Lesions With Stent-Grafts

Yıl 2025, Cilt: 35 Sayı: 5, 943 - 953, 28.10.2025

Fatih Öncü , Burak Mert Akhan , Abdullah Ozer , Koray Akkan , Baran Önal , Erhan T. Ilgit

https://doi.org/10.54005/geneltip.1682481

Öz

Purpose of this study is to report our experience with stent-graft applications in iatrogenic and traumatic vascular injuries.
We report endovascular treatment of 65 patients (45 men, 20 women; age range 17 - 91 years-old, mean 60 years), 65 iatrogenic and traumatic vascular lesions with stent-grafts. The localisations of the vascular lesions are as follows: 43 lower extremity, eight upper extremity, seven supra aortic, seven visceral. Early Doppler ultrasound imaging was performed before patient discharge.
Immediate technical success was achieved in 59 lesions (%91). In the remaining six lesions pathology continued and these cases were treated with accompanying embolisation (four with glue embolisation, one with vascular plug, one with concomitant stent-graft). Complications such as deformation or migration were not observed in any case. Follow-up was available for 53 lesions (mean follow-up 13 months, range 4-19 months). During the follow-up period, 13 cases of in-stent restenosis were observed. Seven cases of incomplete restenosis and two stent-graft occlusions were treated with balloon angioplasty, while one stent-graft occlusion was managed with the placement of an additional stent-graft. Three cases of in-stent restenosis were left untreated due to the absence of significant clinical symptoms. The primary patency rate was 76%, the primary assisted patency rate was 88%, and the secondary patency rate was 94%.
Endovascular treatment of iatrogenic and traumatic vascular lesions with stent-grafts is a safe, effective and less invasive procedure.

Anahtar Kelimeler

iatrogenic , trauma , arteriovenous fistula , pseudoaneurysm , extravasation , dissection , stent-graft , covered stent , endovascular treatment

İyatrojenik ve Travmatik Vasküler Lezyonların Stent-Greft ile Tedavisi

Öz

Bu çalışmanın amacı, iyatrojenik ve travmatik vasküler yaralanmaların stent-greft ile tedavisinde elde ettiğimiz deneyimleri paylaşmaktır.
İyatrojenik ve travmatik vasküler yaralanması olan toplam 65 hastada (45 erkek, 20 kadın; yaş aralığı 17-91, ortalama yaş 60) 65 lezyon stent-greft kullanılarak endovasküler yöntemle tedavi edildi. Vasküler lezyonların lokalizasyonları şu şekildedir: 43 alt ekstremite, sekiz üst ekstremite, yedi supra-aortik ve yedi visseral. Hastalar taburculuk öncesinde erken dönem Doppler ultrasonografi ile değerlendirildi.
59 lezyonda (%91) teknik başarı sağlandı. Kalan altı lezyonda patolojinin devam etmesi nedeniyle bu olgular ek embolizasyon teknikleriyle tedavi edildi (dört olguda yapıştırıcı (glue) embolizasyonu, bir olguda vasküler tıkaç, bir olguda ek stent-greft yerleştirilmesi uygulandı). Hastaların hiçbirinde deformasyon veya migrasyon gibi komplikasyonlar görülmedi. Toplam 53 lezyonun takibi yapıldı (ortalama takip süresi 13 ay, takip aralığı 4-19 ay). Takip süreci boyunca 13 stent-greft içi restenoz vakası gözlendi. Yedi inkomplet restenoz ve iki stent-greft oklüzyonu balon anjiyoplasti ile tedavi edilirken, bir stent-greft oklüzyonu ek bir stent-greft yerleştirilerek yönetildi. Üç stent-greft içi restenoz vakası ise belirgin klinik semptom bulunmaması nedeniyle tedavi edilmedi. Primer açıklık oranı %76, primer yardımcı açıklık oranı %88 ve sekonder açıklık oranı %94 olarak belirlendi.
İyatrojenik ve travmatik vasküler yaralanmaların stent-greft ile endovasküler tedavisi güvenli, etkin ve minimal invaziv bir yöntemdir.

Anahtar Kelimeler

iyatrojenik , travma , arteriyovenöz fistül , psödoanevrizma , ekstravazasyon , diseksiyon , stent-greft , kaplı stent , endovasküler tedavi

Kaynakça

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