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Endovasküler Yöntemlerle Tedavi Ettiğimiz Akut Alt Ekstremite Emboli Deneyimlerimiz

Year 2022, Volume: 32 Issue: 1, 39 - 44, 28.02.2022
https://doi.org/10.54005/geneltip.1022548

Abstract

Amaç: Çalışmada akut femoro-popliteal baypas greft oklüzyonunda reolitik trombektomi veya kateter aracılı trombolitik infüzyon tedavisi ile endovasküler tedavinin 1 yıllık sonuçlarını retrospektif olarak değerlendirmeyi amaçladık.
Yöntem: 2016-2018 yılları arasında daha önceden femoropopliteal baypas operasyonu geçiren ve takipleri sırasında ipsilateral akut ekstremite iskemisi tanısı alan 13 hasta çalışmaya dahil edildi. Hastalar tedavi yöntemlerine göre iki ayrı gruba ayrıldı.
Bulgular: İki grup arasında demografik veriler ve Rutherford emboli sınıflaması açısından anlamlı fark yoktu. Reolitik trombektomi ve kateter aracılı trombolitik infüzyon tedavi gruplarında primer patensi 6 ay için sırasıyla %87,5 ve %80, 12 ay için %75 ve %60 idi. Sekonder patensi her iki grupta 6 ay için %100, 12 ay için sırasıyla %87,5 ve %80 bulundu. Primer ve sekonder patensi açısından iki grup arasında anlamlı fark saptanmadı.
Sonuçlar :Akut femoropopliteal greft oklüzyonu tedavisinde cerrahiye göre daha invaziv olması ve erken mobilizasyon, düşük mortalite ve morbidite oranları nedeniyle seçilmiş hasta grubunda endovasküler tedavi tercih edilebilir.

References

  • 1. Norgren L, Hiatt WR, Dormandy JA, et al. Inter-Society consensus for the management of peripheral arterial disease (TASC II). J Vasc Surg 2007;45(Suppl S):S5–67
  • 2. Hage AN, McDevitt JL, Chick JFB, Vadlamudi V. Acute Limb Ischemia Therapies: When and How to Treat Endovascularly. Semin Intervent Radiol. 2018;35(5):453-460. doi: 10.1055/s-0038-1676321.
  • 3. Atay M, Gürsoy M, Bakuy V, et al. Akut üst ekstremite arteryel embolileri: 2 yıllık klinik deneyimimiz. Bakırköy Tıp Dergisi 2016;12(4):202-206
  • 4. T.J. Fogarty, J.J. Cranley, R.J. Krause, et al. A method for extraction of arterial emboli and thrombi Surg Gynecol Obstet, 116 (1963), pp. 241-244
  • 5. Umemoto T, Hirasawa K, Matsuda Y, Ashikaga T. A novel fully percutaneous thrombectomy technique with balloon occlusion guiding catheter and over-the-wire Fogarty catheter for acute limb ischemia. Journal Of The Amerıcan College Of Cardıology 2017;70(18): Suppl B, pp:8149
  • 6. Olinic DM, Stanek A, Tătaru DA, et al. Acute Limb Ischemia: An Update on Diagnosis and Management. J Clin Med. 2019;8(8):1215. Published 2019 Aug 14. doi:10.3390/jcm8081215
  • 7. McNally MM, Univers J. Acute Limb Ischemia. Surg Clin North Am. 2018 Oct;98(5):1081-1096. doi: 10.1016/j.suc.2018.05.002. PMID: 30243449.
  • 8. Bayır A, Ak A. Acil olgularda trombolitik tedavi. Genel Tıp Derg 2003; 13: 81-8
  • 9. Working Party on Thrombolysis in the Management of Limb Ischemia. Thrombolysis in the management of lower limb peripheral arterial occlusion--a consensus document. J Vasc Interv Radiol. 2003;14(9 Pt 2):S337-49. doi: 10.1016/s1051-0443(07)61244-5. PMID: 14514841.
  • 10. Poursina O, Elizondo-Adamchik H, et al. Safety and efficacy of an endovascular-first approach to acute limb ischemia. J Vasc Surg. 2021 May;73(5):1741-1749. doi: 10.1016/j.jvs.2020.10,002. Epub 2020 Oct 15. PMID: 33068768.
  • 11. Koraen L, Kuoppala M, Acosta S, Wahlgren CM. Thrombolysis for lower extremity bypass graft occlusion. Journal Of Vascular Surgery 2011;54(5): 1339-1444
  • 12. Vesely TM, Idso MC, Audrain J, et al. Thrombolysis versus Surgical Thrombectomy for the Treatment of Dialysis Graft Thrombosis: Pilot Study Com - paring Costs. Journal of Vascular and Interventional Radiology 1996;7(4):507-512
  • 13. Yılmaz G, Sincer İ, Erdal E. Catheter-directed intra-arterial thrombolysis for lower extremity arterial occlusions. ol J Cardiol 2019; 22: 54-9. DOI: 10.14744/ AnatolJCardiol. 2019. 63296
  • 14. Lian WS, Das SK, Hu XX, et al. Efficacy of intra-arterial catheter-directed thrombolysis for popliteal and infrapopliteal acute limb ischemia. J Vasc Surg 2020;71(1):141-148
  • 15. Vakhitov D, Suominen V, Korhonen J, et al. Independent factors predicting early lower limb intra-arterial thrombolysis failure. Ann Vasc Surg 2014; 28: 164-9.
  • 16. Ouriel K, Shortell CK, Azodo MW, et al. Acute peripheral arterial occlusion: predictors of success in catheter-directed thrombolytic therapy. Radiology 1994; 93:561–566
  • 17. Braithwaite BD, Buckenham TM, Galland RB, et al. Prospective randomized trial of high-dose bolus versus low-dose tissue plasminogen activator infusion in the management of acute limb ischemia. Thrombolysis Study Group. Br J Surg. 1997 May;84(5):646-50. PMID: 9171752.
  • 18. Gürsoy M, Bakuy V, Atay M, et al. Hybrid approach in patients with recurrent brachial artery embolism. Ulus Travma Acil Cerr Derg 2014;20(1):56-58
  • 19. . Saraç A, Akan H, Demirağ MK, et al. Akut Atardamar Tıkanıklıklarında Lokal Trombolitik Tedavi. J. Exp. Clin. Med.. 2004; 21(2):78-83
  • 20. Yetkin U, Gürbüz A. Akut Arter Tıkanmalarına Genel Bakış. Van Tıp Dergisi 2002;9(1)
  • 21. Odeh K, Ullah R, Hashim H, et al. Comparative Study on Catheter-Directed Thrombolysis – Continuous Tissue Plasminogen Activator Versus Angiojet Catheter Power Pulse Spray Rheolytic Thrombectomy Outcome Study: Single-Center Experience. Journal of the American College of Cardiology. 2017;69(11):2016. doi:10.1016/s0735-1097(17)35405-0
  • 22. Shen Y, Wang X, Jin S, et al. Increased risk of acute kidney injury with percutaneous mechanical thrombectomy using AngioJet compared with catheter-directed thrombolysis. Journal of Vascular Surgery: Venous and Lymphatic Disorders 2019;7(1):29-37
  • 23. Plate G, Oredsson S, Lanke J. When is thrombolysis for acute lower limb ischemia worthwhile? Eur J Vasc Endovasc Surg 2009; 37: 206-12
  • 24. Çolak N, Aksoy ÖN. Periferik arter hastalığı ve postoperatif takibi. In: Çağlı K, Diken Aİ, Yalçınkaya A, Diken ÖE, Erişkin Kalp ve Damar Cerrahisinde Yoğunbakım. Güneş Tıp Yayınevi 2016. P:199-209
  • 25. Darwood R, Berridge DC, Kessel DO, et al. Surgery versus thrombolysis for initial management of acute limb ischemia. Cochrane Database Syst Rev. 2018 ;10;8(8):CD002784

Our Experiences in Acute Arterial Embolism Treatment with Endovascular Techniques in Lower Extremity

Year 2022, Volume: 32 Issue: 1, 39 - 44, 28.02.2022
https://doi.org/10.54005/geneltip.1022548

Abstract

Objectives: The study aims to retrospectively evaluate the 1-year results of endovascular treatment with rheolytic thrombectomy(TR) or catheter-directed thrombolytic(CDT) infusion therapy in acute femoro-popliteal bypass graft occlusion.
Methods: The patients who had a history of femoro-popliteal by-pass operation and during their follow-up diagnosed with ipsilateral acute limb ischemia between 2016 and 2018 were included. The total of 13 patients were included and they were divided into two groups according to their treatment methods (RT, n=8 vs CDT, n=5).
Results: There was no statistically significant difference between the two groups in terms of demographic data and Rutherford embolism classification. Reolitic thrombectomy and catheter-directed thromolytic infusion primary patency values were 87.5% and 80% for 6 months, 75% and 60% for 12 months, respectively. Secondary patency values were found to be 100% in both groups for 6 months, and 87.5% and 80% for 12 months, respectively. There was no significant difference between the two groups in terms of primer and sekonder patency.
Conclusion:Endovascular therapy can be preferred in the treatment of acute femoro-popliteal by-pass graft occlusion in selected patient groups due to its less invasiveness, early mobilization, and low mortality and morbidity rates compared to surgery,

References

  • 1. Norgren L, Hiatt WR, Dormandy JA, et al. Inter-Society consensus for the management of peripheral arterial disease (TASC II). J Vasc Surg 2007;45(Suppl S):S5–67
  • 2. Hage AN, McDevitt JL, Chick JFB, Vadlamudi V. Acute Limb Ischemia Therapies: When and How to Treat Endovascularly. Semin Intervent Radiol. 2018;35(5):453-460. doi: 10.1055/s-0038-1676321.
  • 3. Atay M, Gürsoy M, Bakuy V, et al. Akut üst ekstremite arteryel embolileri: 2 yıllık klinik deneyimimiz. Bakırköy Tıp Dergisi 2016;12(4):202-206
  • 4. T.J. Fogarty, J.J. Cranley, R.J. Krause, et al. A method for extraction of arterial emboli and thrombi Surg Gynecol Obstet, 116 (1963), pp. 241-244
  • 5. Umemoto T, Hirasawa K, Matsuda Y, Ashikaga T. A novel fully percutaneous thrombectomy technique with balloon occlusion guiding catheter and over-the-wire Fogarty catheter for acute limb ischemia. Journal Of The Amerıcan College Of Cardıology 2017;70(18): Suppl B, pp:8149
  • 6. Olinic DM, Stanek A, Tătaru DA, et al. Acute Limb Ischemia: An Update on Diagnosis and Management. J Clin Med. 2019;8(8):1215. Published 2019 Aug 14. doi:10.3390/jcm8081215
  • 7. McNally MM, Univers J. Acute Limb Ischemia. Surg Clin North Am. 2018 Oct;98(5):1081-1096. doi: 10.1016/j.suc.2018.05.002. PMID: 30243449.
  • 8. Bayır A, Ak A. Acil olgularda trombolitik tedavi. Genel Tıp Derg 2003; 13: 81-8
  • 9. Working Party on Thrombolysis in the Management of Limb Ischemia. Thrombolysis in the management of lower limb peripheral arterial occlusion--a consensus document. J Vasc Interv Radiol. 2003;14(9 Pt 2):S337-49. doi: 10.1016/s1051-0443(07)61244-5. PMID: 14514841.
  • 10. Poursina O, Elizondo-Adamchik H, et al. Safety and efficacy of an endovascular-first approach to acute limb ischemia. J Vasc Surg. 2021 May;73(5):1741-1749. doi: 10.1016/j.jvs.2020.10,002. Epub 2020 Oct 15. PMID: 33068768.
  • 11. Koraen L, Kuoppala M, Acosta S, Wahlgren CM. Thrombolysis for lower extremity bypass graft occlusion. Journal Of Vascular Surgery 2011;54(5): 1339-1444
  • 12. Vesely TM, Idso MC, Audrain J, et al. Thrombolysis versus Surgical Thrombectomy for the Treatment of Dialysis Graft Thrombosis: Pilot Study Com - paring Costs. Journal of Vascular and Interventional Radiology 1996;7(4):507-512
  • 13. Yılmaz G, Sincer İ, Erdal E. Catheter-directed intra-arterial thrombolysis for lower extremity arterial occlusions. ol J Cardiol 2019; 22: 54-9. DOI: 10.14744/ AnatolJCardiol. 2019. 63296
  • 14. Lian WS, Das SK, Hu XX, et al. Efficacy of intra-arterial catheter-directed thrombolysis for popliteal and infrapopliteal acute limb ischemia. J Vasc Surg 2020;71(1):141-148
  • 15. Vakhitov D, Suominen V, Korhonen J, et al. Independent factors predicting early lower limb intra-arterial thrombolysis failure. Ann Vasc Surg 2014; 28: 164-9.
  • 16. Ouriel K, Shortell CK, Azodo MW, et al. Acute peripheral arterial occlusion: predictors of success in catheter-directed thrombolytic therapy. Radiology 1994; 93:561–566
  • 17. Braithwaite BD, Buckenham TM, Galland RB, et al. Prospective randomized trial of high-dose bolus versus low-dose tissue plasminogen activator infusion in the management of acute limb ischemia. Thrombolysis Study Group. Br J Surg. 1997 May;84(5):646-50. PMID: 9171752.
  • 18. Gürsoy M, Bakuy V, Atay M, et al. Hybrid approach in patients with recurrent brachial artery embolism. Ulus Travma Acil Cerr Derg 2014;20(1):56-58
  • 19. . Saraç A, Akan H, Demirağ MK, et al. Akut Atardamar Tıkanıklıklarında Lokal Trombolitik Tedavi. J. Exp. Clin. Med.. 2004; 21(2):78-83
  • 20. Yetkin U, Gürbüz A. Akut Arter Tıkanmalarına Genel Bakış. Van Tıp Dergisi 2002;9(1)
  • 21. Odeh K, Ullah R, Hashim H, et al. Comparative Study on Catheter-Directed Thrombolysis – Continuous Tissue Plasminogen Activator Versus Angiojet Catheter Power Pulse Spray Rheolytic Thrombectomy Outcome Study: Single-Center Experience. Journal of the American College of Cardiology. 2017;69(11):2016. doi:10.1016/s0735-1097(17)35405-0
  • 22. Shen Y, Wang X, Jin S, et al. Increased risk of acute kidney injury with percutaneous mechanical thrombectomy using AngioJet compared with catheter-directed thrombolysis. Journal of Vascular Surgery: Venous and Lymphatic Disorders 2019;7(1):29-37
  • 23. Plate G, Oredsson S, Lanke J. When is thrombolysis for acute lower limb ischemia worthwhile? Eur J Vasc Endovasc Surg 2009; 37: 206-12
  • 24. Çolak N, Aksoy ÖN. Periferik arter hastalığı ve postoperatif takibi. In: Çağlı K, Diken Aİ, Yalçınkaya A, Diken ÖE, Erişkin Kalp ve Damar Cerrahisinde Yoğunbakım. Güneş Tıp Yayınevi 2016. P:199-209
  • 25. Darwood R, Berridge DC, Kessel DO, et al. Surgery versus thrombolysis for initial management of acute limb ischemia. Cochrane Database Syst Rev. 2018 ;10;8(8):CD002784
There are 25 citations in total.

Details

Primary Language English
Subjects Clinical Sciences
Journal Section Original Article
Authors

Mehmet Atay 0000-0003-0011-190X

Onur Saydam 0000-0002-8968-6672

Publication Date February 28, 2022
Submission Date November 12, 2021
Published in Issue Year 2022 Volume: 32 Issue: 1

Cite

Vancouver Atay M, Saydam O. Our Experiences in Acute Arterial Embolism Treatment with Endovascular Techniques in Lower Extremity. Genel Tıp Derg. 2022;32(1):39-44.

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