Akut Komplike Tip B Aort Diseksiyonu Olan Hastalara Ait Endovasüler Tedavi Sonuçları

Yıl 2015, Cilt: 17 Sayı: 2, 9 - 15, 05.01.2016

Cengiz Ovalı , Behçet Sevin

Öz

Aort diseksiyonu göreceli olarak nadir görülen, fakat katastrofik seyreden bir acil kardiyovasküler hastalıktır. Aort diseksiyonu, herhangi bir nedene bağlı aortanın intima tabakasında oluşan bir yırtık sonucu intima ile mediya tabakasında ikinci yalancı bir lümenin oluşması olarak tanımlanır. Aort diseksiyonu Stanford sınıflandırmasına göre Tip A ve Tip B olarak 2 sınıfa ayrılır. Tip A diseksiyon çıkan aortanın tutulduğu diseksiyon tipi, Tip B diseksiyon ise sol subklavien arterin distalinden başlayan torakoabdominal aortaya uzanım gösteren diseksiyon tiplerini ifade eder. Tip A aort diseksiyonun standart tedavisi cerrahi iken, komplike olmuş Tip B diseksiyonlarda endovasküler tedavi öncelikli olarak düşünülmelidir. Bu yazıda merkezimizde akut komplike tip B aort diseksiyonu nedeniyle endovasküler yaklaşımla tedavisi yapılan hastalara ait sonuçlar bildirildi. Endovasküler yaklaşımla tedavisi yapılan toplam 3 hastanın tamamında endovasküler greft ile kapama işlemi başarılı bir şekilde tamamlandı ve 6 aylık takipleri sorunsuzdu. Komplike olmuş tip B aort diseksiyonu olguları için endovasküler tedavi yöntemi hasta seçiminin titizlikle yapılması koşuluyla etkin bir tedavi şeklidir.

Anahtar Kelimeler

Tip B aort diseksiyonu, endovasküler tedavi, klinik sonuçlar

Kaynakça

• Nienaber CA, Eagle KA. Aortic dissection: new frontiers in diagnosis and management: Part I: from etiology to diagnostic strategies. Circulation. 2003; 108(5): 628-35.
• Bickerstaff LK, Pairolero PC, Hollier LH, Melton LJ, Van Peenen HJ, Cherry KJ, Joyce JW, Lie JT. Thoracic aortic aneurysms: a population-based study. Surgery. 1982; 92(6): 1103-8.
• Meszaros I, Morocz J, Szlavi J, Schmidt J, Tornoci L, Nagy L, Szep L. Epidemiology and clinicopathology of aortic dissection. Chest. 2000; 117(5): 1271-8.
• Clouse WD, Hallett JW Jr, Schaff HV, Spittell PC, Rowland CM, Ilstrup DM, Melton LJ 3rd. Acute aortic dissection: population-based incidence compared with degenerative aortic aneurysm rupture. Mayo Clin Proc. 2004; 79(2): 176-80.
• Spittell PC, Spittell JA Jr, Joyce JW, Tajik AJ, Edwards WD, Schaff HV, Stanson AW. Clinical features and differential diagnosis of aortic dissection: experience with 236 cases (1980 through 1990). Mayo Clin Proc. 1993; 68(7): 642-51.
• Hagan PG, Nienaber CA, Isselbacher EM, Bruckman D, Karavite DJ, Russman PL, Evangelista A, Fattori R, Suzuki T, Oh JK, Moore AG, Malouf JF, Pape LA, Gaca C, Sechtem U, Lenferink S, Deutsch HJ, Diedrichs H, Marcos y Robles J, Llovet A, Gilon D, Das SK, Armstrong WF, Deeb GM, Eagle KA. The International Registry of Acute Aortic Dissection (IRAD): new insights into an old disease. JAMA. 2000; 283(7): 897-903.
• Duebener LF, Lorenzen P, Richardt G, Misfeld M, Nötzold A, Hartmann F, Sievers HH, Geist V. Emergency endovascular stent-grafting for life-threatening acute type B aortic dissections. Ann Thorac Surg. 2004; 78(4): 1261-6.
• Eggebrecht H, Nienaber CA, Neuhäuser M, Baumgart D, Kische S, Schmermund A, Herold U, Rehders TC, Jakob HG, Erbel R. Endovascular stent-graft placement in aortic dissection: a meta-analysis. Eur Heart J. 2006; 27(4): 489-98.
• Erbel R, Alfonso F, Boileau C, Dirsch O, Eber B, Haverich A, Rakowski H, Struyven J, Radegran K, Sechtem U, Taylor J, Zollikofer C, Klein WW, Mulder B. Diagnosis and management of aortic dissection. Eur Heart J. 2001; 22(18): 1642-81.
• Spittell PC, Spittell JA Jr, Joyce JW, Tajik AJ, Edwards WD, Schaff HV, Stanson AW. Clinical features and differential diagnosis of aortic dissection: experience with 236 cases (1980 through 1990). Mayo Clin Proc. 1993; 68(7): 642-51.
• Januzzi JL, Isselbacher EM, Fattori R, Cooper JV, Smith DE, Fang J, Eagle KA, Mehta RH, Nienaber CA, Pape LA. Characterizing the young patient with aortic dissection: results from the International Registry of Aortic Dissection (IRAD). J Am Coll Cardiol. 2004; 43(4): 665-9.
• Kaya A, Heijmen RH, Overtoom TT, Vos JA, Morshuis WJ, Schepens MA. Thoracic stent grafting for acute aortic pathology. Ann Thorac Surg. 2006; 82(2): 560-5.
• Duebener LF, Lorenzen P, Richardt G, Misfeld M, Nötzold A, Hartmann F, Sievers HH, Geist V. Emergency endovascular stent-grafting for life-threatening acute type B aortic dissections. Ann Thorac Surg. 2004; 78(4): 1261-6.
• Nienaber CA, Kische S, Rousseau H, Eggebrecht H, Rehders TC, Kundt G, Glass A, Scheinert D, Czerny M, Kleinfeldt T, Zipfel B, Labrousse L, Fattori R, Ince H. Endovascular repair of type B aortic dissection: long-term results of the randomized investigation of stent grafts in aortic dissection trial. Circ Cardiovasc Interv. 2013; 6(4): 407-16.
• Nienaber CA, Zannetti S, Barbieri B, Kische S, Schareck W. INvestigation of STEnt grafts in patients with type B Aortic Dissection: design of the INSTEAD trial--a prospective, multicenter, European randomized trial. Am Heart J. 2005; 149(4): 592-9.
• Grabenwöger M, Alfonso F, Bachet J, Bonser R, Czerny M, Eggebrecht H, Evangelista A, Fattori R, Jakob H, Lönn L, Nienaber CA, Rocchi G, Rousseau H,Thompson M, Weigang E, Erbel R. Thoracic Endovascular Aortic Repair (TEVAR) for the treatment of aortic diseases: a position statement from the European Association for Cardio-Thoracic Surgery (EACTS) and the European Society of Cardiology (ESC), in collaboration with the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur J Cardiothorac Surg. 2012; 42(1): 17-24.
• Coady MA, Ikonomidis JS, Cheung AT, Matsumoto AH, Dake MD, Chaikof EL, Cambria RP, Mora-Mangano CT, Sundt TM, Sellke FW; Surgical management of descending thoracic aortic disease: open and endovascular approaches: a scientific statement from the American Heart Association. Circulation. 2010; 121(25): 2780-84.
• White SB, Stavropoulos SW. Management of endoleaks following endovascular aneurysm repair. Semin Intervent Radiol. 2009; 26(1): 33-38.
• Parmer SS, Carpenter JP, Stavropoulos SW, Fairman RM, Pochettino A, Woo EY, Moser GW, Bavaria JE. Endoleaks after endovascular repair of thoracic aortic aneurysms. J Vasc Surg. 2006; 44(3): 447-52.
• Cheung AT, Weiss SJ, McGarvey ML, Stecker MM, Hogan MS, Escherich A, Bavaria JE. Interventions for reversing delayed-onset postoperative paraplegia after thoracic aortic reconstruction. Ann Thorac Surg. 2002; 74(2): 413-9.
• Maniar HS, Sundt TM 3rd, Prasad SM, Chu CM, Camillo CJ, Moon MR, Rubin BG, Sicard GA. Delayed paraplegia after thoracic and thoracoabdominal aneurysm repair: a continuing risk. Ann Thorac Surg. 2003; 75(1): 113-9.