Evaluation of Early and Mid-term Results of TEVAR Procedures with Various Etiology.

Year 2019, Volume: 6 Issue: 4, 283 - 288, 31.12.2019

Dilşad Amanvermez Şenarslan , Funda Yıldırım , Ömer Tetik

https://doi.org/10.34087/cbusbed.641171

Cited By: 1

Abstract

Amaç:

Torasik
endovasküler aort anevrizması tamiri (TEVAR), günümüzde dejeneratif
anevrizmalar, sakküler anevrizmalar ve akut torasik aortik sendromların
tedavisinde öncelikli tercih edilmektedir. Bu çalışmanın amacı son 3 yılda
kliniğimizde uygulanan TEVAR girişimlerinin erken ve orta dönem sonuçlarını
değerlendirmektir.

 Gereç ve Yöntem:

Otuz hastaya
(25 erkek, 5 kadın) Ocak 2015- Aralık 2018 arasında TEVAR işlemi uygulandı. Tüm
hastalarda Valiant ™ Torasik Stent Greft Sistemi (Medtronic®) kullanıldı.

Bulgular:

Hastaların yaş ortalaması 60,4±18 idi. Hastaların %53,3'ünde
dejeneratif anevrizma, %36,7'sinde akut aortik sendrom, %10'unda aort
koarktasyonu ve eşlik eden poststenotik anevrizma mevcuttu. Hastaların %63,3'ü
semptomatikti ve sırt veya göğüs ağrısı vardı.

İşlemlerin teknik başarısı %100 idi. Yoğun bakım
ünitesinde ortalama kalış süresi 1 ± 2 gün, hastanede kalış süresi ortalama 3,2
± 2 gündü. Hastane mortalitesi olmadı ve ilk 30 günlük dönemde bir hasta tip 2
diseksiyon nedeniyle öldü. İki hastada tip II endoleak görüldü ve endoleak'ler
kendiliğinden düzeldiği için ikincil bir müdahaleye ihtiyacımız olmadı.
Subklaviyan arterin 3 hastada kapatılması gerekti ve hastalarda sol üst
ekstremitede iskemisi gelişmedi. Yeterli hidrasyona rağmen, postoperatif erken
dönemde 2 hastanın kreatinin düzeylerinde artış vardı ve izlemde normal
değerlere geriledi. Ortalama takip süresi 6 ± 9 aydı ve uzun vadede 2 mortalite
vardı. Bir hasta akciğer kanserinden öldü, ikincisi ise anevrizmal hastalıktan
bağımsız olarak mezenterik iskemi nedeniyle öldü.

Sonuç:

TEVAR, torasik aort anevrizmaları veya akut aortik
sendromların tedavisinde, anatomik olarak uygun hastalarda ilk tedavi
seçeneğidir. TEVAR, konvansiyonel cerrahiye kıyasla düşük morbidite ve
mortalite oranlarıyla, güvenle uygulanabilir.

Keywords

Aortic aneurysm, dissecting aneurysm, endovascular procedure

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