Diyabetin alt ekstremite kronik total oklüzyonlarında rotasyonel aterektomi ve ilaç kaplı balon sonuçlarına etkisi

Yıl 2025, Cilt: 8 Sayı: 4, 674 - 679, 30.07.2025

Ufuk Türkmen

https://doi.org/10.32322/jhsm.1701502

Öz

Amaç: Bu çalışmanın amacı, rotasyonel aterektomi (RA) ile ilaç kaplı balon (DCB) kombinasyonunun, alt ekstremite arterlerinde kronik total oklüzyon (CTO) bulunan diyabetik ve non-diyabetik hastalardaki teknik başarı, damar açıklığı ve reoklüzyon oranları üzerindeki etkisini değerlendirmektir.
Yöntemler: Ekim 2018–Ekim 2022 tarihleri arasında RA + DCB uygulanan 151 hasta retrospektif olarak incelendi. Hastalar, diyabetik (n=77) ve non-diyabetik (n=74) olmak üzere iki gruba ayrıldı. Teknik başarı, reoklüzyon oranı, primer açıklık ve ayak bileği-kol indeksi (ABI) gibi klinik sonuçlar karşılaştırıldı. Reoklüzyonsuz sağkalım oranları Kaplan-Meier yöntemiyle analiz edildi; gruplar arası fark log-rank testi ile değerlendirildi.
Bulgular: Her iki grupta da teknik başarı oranı %100, stent kullanım oranı <%8 olarak saptandı. Diyabetik hastalarda 12 aylık reoklüzyon oranı %13.0, non-diyabetik hastalarda %5.4 idi (p=0.160). ABI değerlerinde her iki grupta da anlamlı artış gözlendi (p<0.001). Diyabetik grupta medyan ABI 0.60’tan 1.10’a, non-diyabetik grupta 0.60’tan 1.20’ye yükseldi. Gruplar arasında ABI değişim farkı istatistiksel olarak anlamlı değildi (p=0.143). Reoklüzyonsuz sağkalım oranı diyabetik grupta %87.0, non-diyabetik grupta %94.6 idi (p=0.48).
Sonuç: RA + DCB kombinasyonu, hem diyabetik hem de non-diyabetik hastalarda yüksek teknik başarı ve düşük reoklüzyon oranları ile etkili bir tedavi yaklaşımıdır. Özellikle diyabetik grupta reoklüzyon oranları daha yüksek seyretse de, elde edilen ABI artışı tedavinin fonksiyonel etkinliğini göstermektedir. Bu çalışma, RA + DCB stratejisinin yüksek riskli popülasyonda güvenle uygulanabileceğini ve daha ileri prospektif çalışmalar için güçlü bir temel oluşturduğunu ortaya koymaktadır.

Anahtar Kelimeler

Rotasyonel aterektomi , İlaç kaplı balon , Kronik total oklüzyon , Periferik arter hastalığı , Diyabet , Ayak bileği-kol indeksi

The impact of diabetes on rotational atherectomy and drug-coated balloon outcomes in lower extremity chronic total occlusions

Öz

Aims: This study aimed to evaluate the effect of combining rotational atherectomy (RA) and drug-coated balloon (DCB) angioplasty on clinical outcomes in diabetic (DMG) and non-diabetic (NDMG) patients with chronic total occlusions (CTOs) in the lower extremity arteries (LEAs).
Methods: A total of 151 patients treated between 2018 and 2022 were retrospectively analyzed. Patients were categorized as DMG (n=77) and NDMG (n=74). Outcomes such as technical success, vessel patency, re-occlusion, and ankle-brachial index (ABI) were compared between the groups.
Results: Technical success was achieved in all patients, with a stent usage rate below 8%. At 12 months, re-occlusion occurred in 13.0% of DMG and 5.4% of NDMG patients. Both groups showed a significant increase in ABI: from 0.60 to 1.10 in DMG and from 0.60 to 1.20 in NDMG. The 12-month re-occlusion-free survival rate was 87.0% in DMG and 94.6% in NDMG.
Conclusion: RA combined with DCB angioplasty appears to be a safe and effective treatment strategy for CTOs in LEAs. The approach offers high technical success and favorable mid-term outcomes in both diabetic and non-diabetic patients, supporting its use in high-risk populations.

Anahtar Kelimeler

Ankle-Brachial Index , chronic total occlusion , diabetes , drug-coated balloon , peripheral artery disease , rotational atherectomy

Kaynakça

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