AKUT PERİFERİK ARTERYEL EMBOLİ VAKALARINDA GİRİŞİM ZAMANLAMASININ MÜDAHALE SONUÇLARI ÜZERİNE ETKİSİ

Amaç: Akut periferik arteriyel emboli, anevrizma rüptürü ve arteriyel yaralanmalardan sonra damar cerrahisinin üçüncü sıklıkta görülen acil durumudur. Bu çalışmanın amacı akut periferik arteriyel emboli vakalarında şikayetlerin başlaması ile cerrahi yapılması arasında geçen sürenin sonuçlara ve mortalite üzerine olan etkilerini değerlendirmektir. Materyal ve Metod: Mayıs 1993 ile Şubat 2012 tarihleri arasında kliniğimize müracaat eden ve akut periferik arteriyel emboli tanısı konan 726 hastaya uygulanan 870 cerrahi müdahalenin erken dönem sonuçları retrospektif olarak değerlendirildi. Hastaların ortalama yaşı 65,2 ± 13,9 idi. 419 hasta (%58) erkek, 307 hasta (%42) kadın idi. Şikayetlerinin başlaması ile hastaneye başvuru zamanı arasında geçen süre ortalama 23,8 ± 6 saat idi. Hastalar başvuru zamanına göre 24 saatden önce ve sonra olmak üzere 2 gruba ayrıldı. Bulgular: 595 hastada (%81) başvuru zamanı 24 saatden önce, 131 hastada (%19) 24 saatden sonra idi (p< 0.001). Geç başvuran hasta grubunda, başvuru anında ekstremitede motor fonksiyon kaybı %86, erken başvuran hasta grubunda %51 oranında tespit edildi (p<0.001). 24 saat içinde başvuran hasta grubunda%89, 24 saatden sonra başvuran hasta grubunda %60 oranında başarılı revaskülarizasyon sağlandı (p< 0.001). 24 saat içinde başvuran hasta grubunda amputasyon oranı %1, mortalite oranı %5 iken 24 saatden sonra başvuran hasta grubunda bu oranlar sırasıyla %27, %28 bulundu ve anlamlı fark tespit edildi (p< 0.001). Geç başvuran hastaların %64 ‘ne, erken başvuran hastaların %10’ nuna re-embolektomi gerekti (p< 0.001). Erken başvuran hastaların %5’ ne, geç başvuran hastaların %42’sine fasiyotomi yapıldı (p< 0.001). İki grup arasında, ek işlem ihtiyacı %6 ya %36 oranıyla 24 saatden sonra başvuran hasta grubunda anlamlı yüksek bulundu (p< 0.001). Sonuç: Akut periferik arteriyel embolide iskemi süresi, cerrahi sonuçları etkileyen önemli bir faktördür. Yüksek mortalite ve morbiditeyi önlemek için erken tanı ve tedavi gerektiren ciddi bir klinik tablodur.

Anahtar Kelimeler:

Emboli, iskemi süresi, başvuru zamanı, amputasyon, mortalite.

THE EFFECT OF TIMING ON THE RESULTS OF THE INTERVENTION OF ACUTE PERIPHERAL ARTERIAL EMBOLY

SUMMARY Objective: Acute peripheral arterial embolism is the third most common emergency case in the vascular surgery following aneurysm ruptures and arterial injuries. The aim of this study is to determine the effects of the time between the onset of complaints and surgery on outcomes and mortality in cases of acute peripheral arterial embolism. Material and Method: We retrospectively examined the surgical outcomes in the early period of 726 patients who underwent a total of 870 operations for acute peripheral arterial embolism at our clinic between May 1993 and February 2012. The mean age of the patients was 65.2 ± 13.9 years.There were 419 (58 %) men, 307 (42 %) women patients The mean time between the onset of symptoms and the time of admission to the hospital was 23.8 ± 6 hours.The patients divided into two groups according to admission time before or after 24 hours. Results: Among the patients; 595 (81 %) were admitted less than 24 hours and 131 (19 %) were admitted more than 24 hours (p< 0.001). The rate of motion functional loss was determined in the 86 %of the patients with late admission time and in the 51 %of the patients with early admission time (p< 0.001). The rate of succesfull revascularization was 89 %in the patients who were admitted within 24 hours and 60 %in the patients who were admitted more than 24 hours (p<0.001). The rate of amputation was 1 %and mortality rate was 5 %in the patients who were admitted within 24 hours whereas these rates were found in the patients who were admitted more than 24 hours as 27 %and 28 %, respectively. There was the significantly difference between the groups (p<0.001). Re-embolectomy required in the 64 %of the patients with late admission time and the 10 %of the patients with early admission time (p<0.001). Faciotomy was performed in the 5 %of the patients who were admitted within 24 hours and in the 42 %of the patients who were admitted more than 24 hours (p<0.001). Among the two groups, the necessary of additional surgical interventions was found higher by the rate 6 %versus 36 %in the patients who were admitted more than 24 hours (p<0.001). Conclusion: Duration of ischemia is an important factor affecting surgical results in the patients with acute peripheral arterial embolism. Peripheral embolism is a serious clinical situation which required early diagnosis and interventions for preventing hig mortality and morbidity.

Keywords:

Emboli, iskemi süresi, başvuru zamanı, amputasyon,

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