Hüseyin Tuğsan BALLI, Erol AKGÜL, Kairgeldy AİKİMBAEV

Subklavyen arter tıkayıcı hastalıklarında endovasküler tedavinin etkinliği

Amaç: Bu retrospektif çalışmanın amacı, subklavyen arter tıkayıcı hastalıklarında endovasküler tedavinin başarısını ve klinik sonuçlarını değerlendirmek ve bu sonuçları cerrahi tedavi yöntemleri ile karşılaştırmaktır. Gereç ve Yöntem: 1994-2009 yılları arasında mevcut klinik semptomları ile görüntüleme yöntemleri renkli Doppler ultrasonografi (RDUS), Dijital Subtraksiyon Anjiyografi (DSA) sonrasında subklavyen arter stenozu ve/veya oklüzyonu saptanan 14’ü (%37,8) kadın, 23’ü (%62,2) erkek olan ve yaşları ortalama 56,4 (22 ile 82 yıl arasında değişen) 37 hastada mevcut 38 lezyona balon anjiyoplasti ve/veya stent implantasyonu ile endovasküler tedavi uygulandı. Tedavi sonrasında hastaların kontrolleri önceden planlanmış sürelerde klinik ve RDUS ile takipleri yapıldı. Bulgular: Lezyonların 32’si sol (%84,2), 6’sı sağ (%15,8) yerleşimliydi. Olguların 7’si (%18,4) oklüzyon, 31’i (%81,6) stenoz idi. Stenoz oranı RDUS’de %50’den fazla, DSA’da ise ortalama %83,2 idi. Stenotik lezyonlar için teknik başarı %100 idi. Oklüde olan 3 lezyon geçilemediği için bu hastalara endovasküler tedavi yapılamadı. Bu nedenle oklüzyonlar için teknik başarı %57 idi. Komplikasyon olarak işlem sırasında bir hastada ekstravazasyon ve subklavyen arter proksimalinde trombotik oklüzyon gelişmesi üzerine ekstravazasyon mevcut segmente stent greft ve proksimaldeki oklüzyona ayrı bir stent implantasyonu yapıldı. Bir hastada ise distal embolizasyon gelişmesi üzerine 1,5 saat boyunca 5 mg t-PA infüzyonu yapıldı ve rekanalizasyon sağlandı. Takibi yapılabilen hastalarda erken (0-3 ay) ve orta (3-6 ay) dönem için primer ve sekonder patensi oranı %100 iken geç (6-12 ay) dönem için primer patensi %95,5, sekonder patensi ise %100 olarak bulundu. Sonuç: Subklavyen arter tıkayıcı hastalıklarında endovasküler tedavi teknik ve klinik olarak cerrahi tedaviye alternatif etkin ve güvenli bir yöntemdir.

Anahtar Kelimeler:

Subklavyen arter, Endovasküler Tedavi, Stent, Balon Anjiyoplasti, Stenoz

Efficacy of endovascular treatment of subclavian artery occlusive diseases

Purpose: The purpose of this retrospective study was to evaluate the technical success and clinical outcomes of endovascular procedures and to compare them with the surgical procedures of subclavian artery occlusive diseases.Material and Methods: Between 1994 and 2009, 37 patients with clinical symptoms secondary to subclavian artery stenoses and/or occlusion were diagnosed by color Doppler ultrasound (CDUS) or Digital Subtraction Angiography (DSA). 14 (37.8%) of these patients were female and 23 (62.2%) were male; mean age was 56.4 (arange 22-82). 38 lesions were treated with balon anjioplasty and/or stent placement. After treatment, patients’ follow-ups were performed by CDUS and clinically.Results: 32 (84.2%) of lesions were found on the left and 6 (15.8%) were on the right side. Technical success rate for stenotic lesions was 100%. We couldn’t achieve to pass through 3 occlusions and so the technical success rate for occlusions was 57%. As a complication, in one patient during the procedure thrombotic occlusion in the proximal segment of subclavian artery and extravasation in the mid segment were encountered. Another stent and a stent graft were used to treat these complications. In another patient, because of distal thromboembolic occlusions, 5 mg t-PA infusion for 1.5 hour was applied and recanalisation was obtained. For early (0-3 months) and mid (3-6 months) terms primary and secondary patency rate was 100%. We found primary patency rate 95.5% and secondary patency rate 100% for late term (6-12 months).Conclusion: Endovascular treatment of subclavian artery occlusive diseases is technically and clinically effective and safe procedure and alternative to surgery.

Keywords:

Subclavian artery, Endovascular treatment, Stent, Balloon Angioplasty, Stenosis,

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