İLİYAK ARTER TOTAL OKLÜZYONLARINDA ENDOVASKÜLER TEDAVİ: TEK MERKEZ DENEYİMİ

Yıl 2019, Cilt: 21 Sayı: 1, 44 - 51, 30.04.2019

Hasanali Durmaz

https://doi.org/10.24938/kutfd.490136

Öz

Amaç: Bu çalışmada, klinik ve radyolojik olarak
ana iliyak ve eksternal iliyak arterlerde total oklüzyon tanısı konulduktan sonra
endovasküler yöntemler ile tedavi edilen hastalardaki deneyimin ve tedavi etkinliğinin
sunulması; böylece özellikle iliyak arterlerde total oklüzyonlara yaklaşım konusunda
literatüre katkı sağlanması amaçlandı.

Gereç ve Yöntem: Aralık 2012 ve Eylül 2018 tarihleri
arasında hastanemiz girişimsel radyoloji ünitesine ana iliyak ve eksternal iliyak
arter total oklüzyonu tanısı ile başvuran 21 hastanın (3 kadın, 18 erkek) kayıtları
retrospektif olarak incelendi. Endovasküler tedavi kararı alınan ve iliyak lezyonun
geçilebildiği 20 hastada primer stentleme ve ihtiyaç halinde perkütan translüminal
anjiyoplasti işlemi uygulandı. İşlem sonrası hastalar 1., 3., 6., 12. aylarda ve
sonrasında yıllık olarak klinik bulguların değerlendirilmesi ve renkli Doppler ultrasonografi
ile, ileri tetkik gereken durumlarda ise BT anjiyografi veya dijital subtraksiyon
anjiyografi ile takip edildi.

Bulgular: Çalışmaya dahil edilen ve ana iliyak
(%57, n=12), eksternal iliyak (%14, n=3) ve hem ana iliyak hem de eksternal iliyak
(%29, n=6) arterlerde total oklüzyonu olan toplam 21 hasta TASC (TransAtlantic InterSociety Consensus) II sınıflamasına
göre değerlendirilmiş olup %66.7’si (n=14) tip B, %4.8’i (n=1) tip C ve %28.6’sı
(n=6) tip D olarak sınıflandırıldı. Ortalama oklüde segment uzunluğu 8.19 mm ölçüldü
(3−17 mm). Yirmi hastada toplam 35 stent (32 balonla açılan, 3 kendiliğinden açılan)
kullanıldı ve 12 hastada rezidü darlık nedeniyle perkütan translüminal anjiyoplasti
uygulandı. Endovasküler tedavinin teknik başarı oranı %95.2 (n=20) olarak hesaplandı.
İşlem yapılan 20 hastanın ortalama takip süresi 60.6 ay (aralık: 1-68 ay) olarak
bulundu. 1, 3 ve 5 yıllık primer patensi oranları sırasıyla %91.6, %71.4 ve %50
olarak hesaplandı.

Sonuç: İliyak
bölgede stent ve perkütan translüminal anjiyoplasti işleminin teknik başarı ve patensi
oranları yüksek olup mevcut malzeme ve yaklaşım tekniklerinin gelişmesi, uygulayan
merkezlerin deneyiminin artması ile bu oranların daha da yükselmesi beklenmektedir.

Anahtar Kelimeler

balon anjiyoplasti, endovasküler prosedürler, iliyak arter, oklüzyon, stentler, Anjiyografi, stentler

Endovascular Treatment of Iliac Artery Total Occlusions: A Single Center Experience

Öz

Objective: The purpose of
the study is to present our experience and treatment efficacy in patients with total
occlusion in common and external iliac arteries who were treated by endovascular
methods after clinical and radiological diagnosis, and therefore to contribute to
the relevant literature especially about the approach to the total occlusions in
the iliac arteries by means of radiological intervention.

Material and Method: We retrospectively reviewed the medical records of 21 patients
(3 females, 18 males) with total occlusion of common and external iliac arteries
who were admitted to our interventional radiology unit between December 2012 and
September 2018. Primary stenting and percutaneous transluminal angioplasty in case
of need, were performed in 20 patients in whom endovascular treatment was decided
and the iliac lesions could be passed. Patients were followed up by the evaluation
of clinical findings and utilizing color Doppler ultrasound on the 1st, 3rd, 6th
and 12th months, and by CT angiography or digital subtraction angiography when further
examinations were required.

Results: A total of 21
patients with total occlusion of common iliac (57%, n=12), external iliac (14%,
n=3), both common and iliac (29%, n=6) arteries were evaluated according to the
TASC (TransAtlantic InterSociety Consensus) II classification, and 66.7% (n=14)
of the patients were classified as type B, 4.8%(n=1) as type C and 28.6%(n=6) as
type D. The mean occluded segment length was measured as 8.19 mm (range: 3-17 mm).
A total of 35 stents (32 balloon expandables, 3 self expandables) were used in 20
patients and percutaneous transluminal angioplasty was performed in 12 patients
due to residual stenosis. Technical success rate in endovascular treatment was calculated
as 95.2% (n=20). The mean follow-up period for 20 patients was 60.6 months (range:
1-68 ay). Primary patency rates for 1, 3 and 5 years were calculated as 91.6%, 71.4%and
50%, respectively.

Conclusion: The technical
success and patency rates of stent placement and percutaneous transluminal angioplasty
in the iliac region are high and it is expected that these rates will increase with
the development of existing materials, approach techniques and the experience of
the centers applying them.

Anahtar Kelimeler

Angiopraphy, balloon angioplasty, endovascular procedures, iliac artery, occlusion, stents

Kaynakça

• 1. Müller AM, Langwieser N, Bradaric C, Haller B, Fusaro M, Ott Ilka et al. Endovascular treatment for steno-occlusive iliac artery disease: safety and long-term outcome. Angiology. 2018;69(4):308-15.
• 2. Neisen MJ. Endovascular management of aortoiliac occlusive disease. Semin Intervent Radiol. 2009;26(4):296-302.
• 3. Norgren L, Hiatt WR, Dormandy JA, Nehler MR, Harris KA, Fowkes FG. Inter-society consensus for the management of peripheral arterial disease (TASC II). J Vasc Surg. 2007;45:5-67.
• 4. Clair DG, Beach JM. Strategies for managing aortoiliac occlusions: access, treatment and outcomes. Expert Rev Cardiovasc Ther. 2015;13(5):551-63.
• 5. Jaff MR, Christopher JW, William RH, Gerry RF, John D, Mahmood R et al. An update on methods for revascularization and expansion of the TASC lesion classification to include below-the-knee arteries: a supplement to the inter-society consensus for the management of peripheral arterial disease (TASC II). Ann Vasc Dis. 2015;20(5):465-78.
• 6. Adili F, Balzer K, Betz T, Billing A, Böckler D, Brixner D et al. A current practice of first-line treatment strategies in patients with critical limb ischemia. J Vasc Surg. 2015; 62:965-73.
• 7. Hans SS, DeSantis D, Siddiqui R, KhouryM. Results of endovascular therapy and aortobifemoral grafting for Transatlantic Inter-Society type C and D aortoiliac occlusive disease. Surgery. 2008;144(4):583-9.
• 8. Jongkind V, Akkersdijk GJ, Yeung KK, Wisselink W. A systematic review of endovascular treatment of extensive aortoiliac occlusive disease. J Vasc Surg. 2010;52:1376-83.
• 9. Ye W, Liu CW, Ricco JB, Mani K, Zeng R, Jiang J. Early and late outcomes of percutaneous treatment of Transatlantic Inter-Society Consensus class C and D aorto-iliac lesions. J Vasc Surg. 2011;53:1728-37.
• 10. LeVille CD, Kashyap VS, Clair DG, Bena JF, Leyden SP, Greenberg RK et al. Endovascular management of iliac artery occlusion: extending treatment to transatlantic inter-society consensus class C and D patients. J Vasc Surg. 2006;43(1):32-9.
• 11. Indes JE, Mandawat A, Tuggle CT, Muhs B, Sosa JA. Endovascular pro¬cedures for aorto-iliac occlusive disease are associated with superior short-term clinical and economic outcomes com¬pared with open surgery in the inpatient population. J Vasc Surg. 2010;52:1173-9.
• 12. Indes JE, Pfaff MJ, Farrokhyar F, Brown H, Hashim P, Cheung K et al. Clinical outcomes of 5358 patients undergoing direct open bypass or endovascu¬lar treatment for aortoiliac occlusive disease: a systematic review and meta-analysis. J Endovasc Ther. 2013;20:443-55.
• 13. Clair DG, Adams J, Reen B, Feldman R, Starr J, Diaz-Cartelle J et al. The EPIC nitinol stent system in the treatment of iliac artery lesions: one-year results from the ORION clinical trial. J Endovasc Ther. 2014;21:213-22.
• 14. Mousa AY, Beauford RB, Flores L, Faries P, Patel P, Fogler R. Endovascular treatment of iliac occlusive disease: review and update. Vascular. 2007;15(1):5-11.
• 15. Gardiner GA Jr, Sullivan KL, Halpern EJ, Parker L, Beck M, Bonn J et al. Angiographic assessment of initial balloon angioplasty results. J Vasc Interv Radiol. 2004;15:1081-7.