Ali FIRAT, Behlül İGÜS, Hüseyin Yüce BİRCAN

SANTRAL VENÖZ STENOZ VE OKLÜZYONLARDA ENDOVASKÜLER TEDAVİ SEÇENEKLERİ; ANJİOPLASTİ Mİ, STENT Mİ?

Amaç: Bu çalışmada santral ven darlığı veya tıkanıklığı olan hemodiyaliz hastalarının perkütan transluminal anjiyoplasti (PTA) ve perkütan transluminal stentleme (PTS) ile tedavinin etkinliğini ve patensi oranlarının sonuçları karşılaştırılması amaçlanmıştır. Materyal ve Metot: Yüz kırk iki santral venöz darlığı veya tıkanması olan 71 kronik hemodiyaliz hasta grubunda (36 erkek, 35 kadın) Mart 2013 ile Haziran 2018 arasında 109 endovasküler girişim uygulandı. Hastaların klinik takibi kontrol venografi ile 1, 3 ve 6. aylarda yapıldı ve asemptomatik hastalarda 6 ay intervallerle kontrollere devam edildi. Bulgular: Tedavi süresince 45 hastada PTA, 26 hastada PTS işlemi yapıldı. Primer açıklık oranları sırasıyla 3., 6., 12. ve 24. aylarda PTA grubunda; % 97,74, %88,23, % 73,76, % 50,76 ve PTS grubunda; % 96,23, %92,34, %65,96, %47 olarak saptandı. Yardımcı primer açıklık oranları sırasıyla 3., 6. ve12. aylarda PTA grubunda; % 97,73, %90,76, %75,92 ve PTS grubunda; %96,25 %84,38, %79,87 olarak saptandı. Primer ve yardımcı açıklık oranları açısından gruplar arasında istatistiksel olarak anlamlı bir fark bulunmadı (p=0,216, p=0,121). PTS grubundaki ortalama müdahale sayısı (2,62 ± 1,23), PTA grubundan (1,43 ± 0,62) anlamlı derecede yüksekti. Sonuç: Endovasküler tedavi, santral ven tıkanıklığı tedavisinde güvenli ve etkili bir yöntemdir. PTS, tedavide daha uzun açıklık sağlamamakla birlikte aksine tedaviye daha yüksek ek maliyetler ve damar açıklığını sağlamak için daha fazla girişimler getirmektedir. PTS, anjioplasti dirençli veya sık tekrarlayan lezyonlarda tercih edilmelidir.

ENDOVASCULAR TREATMENT OPTIONS IN CENTRAL VENOUS STENOSIS AND OCCLUSION: ANGIOPLASTY OR STENT?

Objectives: The purpose of this study was to compare the patency rate outcomes and efficacy of percutaneoustransluminal angioplasty (PTA) versus percutaneous transluminal stenting (PTS) for the treatment of centralvein stenosis and occlusion in hemodialysis patients.Materials and Methods: A total of 71 chronic hemodialysis patients (36 males, 35 females) with 142 eventsof central venous stenosis or occlusion underwent 109 endovascular interventions between March 2013 andJune 2018. The clinical follow-up of the patients was performed with control venography at 1, 3, and 6 months,and then at 6-month intervals for asymptomatic patients.Results: PTA was applied to 45 patients and PTS to 26 patients during the study period. At 3, 6,12 and 24months, primary patency rates were 97.74%, 88.23%, 73.76% and 50.76% respectively in the PTA group and96.23%, 92.34%, 65.96% and 47% in the PTS group. Assisted primary patency at 3, 6, and 12 months was97.73%, 90.76%, and 75.92% respectively in the PTA group and 96.25%, 84.38%, and 79.87% in the PTS group.No statistically significant difference was determined between the groups in respect of primary and assistedpatency rates (p=0.216, p=0.121). The average number of interventions in the PTS group (2.62± 1.23) wassignificantly higher than that in the PTA group (1.43±0.62).Conclusion: Endovascular treatment is a safe and effective method in the management of central veinocclusion. PTS does not result in longer patency in the treatment, but conversely incurs greater costs andnecessitates more interventions to provide patency. Therefore, PTS should only be preferred for PTA-resistantlesions or concurrent lesions.

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