Üst Ekstremitede İyatrojenik Psödoanevrizma Gelişen Hastaların Demografik Özelliklerinin ve Tedavilerinin Değerlendirilmesi: Tek Merkez Deneyimi

Abstract

Amaç: Üst ekstremite arterlerinden perkütan girişimler sonrası psödoanevrizma nadiren görülür. Bu çalışmada üst ekstremitede iatrojenik psödoanevrizması olan hastaların demografik özelliklerini ve psödoanevrizma tedavi yöntemlerini değerlendirmeyi amaçladık. Yöntem ve Gereçler: 2012-2022 yılları arasında kliniğimizde psödoanevrizma nedeniyle takip edilen 17 hasta retrospektif olarak incelendi. Son nokta sinir hasarı, kompartman sendromu, tromboembolik olay, fistül ve cerrahi ihtiyacı olarak belirlendi. Sinir hasarı, elektromiyografi ve semptomlarla görüldüğü gibi aksonal dejenerasyon olarak belirlendi. Bulgular: Çalışmaya alınan 17 hastanın 8'inde radial arter psödoanevrizması, 5'inde ulnar arter psödoanevrizması ve 4'ünde brakiyal arter psödoanevrizması gelişti. 15'i konservatif yöntemlerle tedavi edilirken, 2'si cerrahi olarak tedavi edildi. İkisinden biri geç dönemde teşhis edilen 9X9 mm çapındaki psödoanevrizma nedeniyle, diğeri ise ağrı ve 36x26 mm çapındaki psödoanevrizma nedeniyle ameliyat edildi. Bir hastada ulnar sinir hasarı tespit edildi. Bir hastaya fistül teşhisi konuldu. Ulnar sinir yaralanması ve brakial arterovenöz fistül konservatif yöntemlerle ameliyatsız tedavi edildi. Sonuç: Üst ekstremite arterlerinde perkütan girişim sonrası gelişen psödoanevrizmaların çoğu konservatif yöntemler ile tedavi edilebilmektedir. Girişimsel kardiyologlar psödoanevrizmalar için farklı tedavi yöntemlerinin olduğunu bilmeli ve güncel veriler ışığında başarılı bir şekilde tedavi edebilmelidir. Erken tanı ve tedavi, geç tanı daha kötü komplikasyonlara ve cerrahi müdahale gereksinimine yol açtığı için hayati önem taşımaktadır.

Keywords

• Psödoanevrizma
• perkutan girişim
• tedavi yöntemi

Evaluation of Demographic Characteristics and Treatment of Upper Extremity Iatrogenic Pseudoaneurysm Patients: A Single Center Experience

Abstract

Objective: Pseudoaneurysm is rarely seen after percutaneous interventions from upper extremity arteries. In this study, we aimed to evaluate the demographic characteristics of patients with iatrogenic pseudoaneurysms in the upper extremities and the treatment methods for pseudoaneurysms. Material and Methods: We retrospectively reviewed the cases seventeen patients who were followed up in our clinic for pseudoaneurysm between 2012 and 2022. The endpoint was determined as nerve damage, compartment syndrome, thromboembolic event, fistula and the need for surgery. Nerve damage was determined as axonal degeneration, as seen by electromyography and symptoms. Results: Of the 17 patients included in the study, 8 developed radial artery pseudoaneurysms, 5 developed ulnar artery pseudoaneurysms, and 4 developed brachial artery pseudoaneurysms. While 15 were treated with conservative methods, 2 were treated surgically. One of the two underwent surgery due to a pseudoaneurysm with a diameter of 9X9 mm diagnosed in the late period, and the other underwent surgery due to pain and a pseudoaneurysm with a diameter of 36x26 mm. Ulnar nerve damage was detected in one patient. One patient was diagnosed with fistula. Ulnar nerve injury and brachial arterovenous fistula were treated with conservative methods without surgery. Conclusion: Most of the pseudoaneurysms developing after percutaneous intervention in the upper extremity arteries can be treated with conservative methods. Interventional cardiologists should know that different treatment methods are available for pseudoaneurysms and should be able to treat them successfully in light of the current data. Early diagnosis and treatment are of vital importance since late diagnosis leads to worse complications and the need for surgical intervention.

Keywords

• Pseudoaneurysm
• percutaneous intervention
• treatment method

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