Nuri ERDOĞAN, Serap DOĞAN, Aydın TUNÇAY, Hakan İMAMOĞLU

ACİL KOŞULLARDA ALT EKSTREMİTE ARTER HASTALIĞININ DEĞERLENDİRİLMESİNDE YENİ BİR YAKLAŞIM

Amaç: Alt ekstremitenin periferik arter hastalığı tanısı olan hastalarda Doppler US ile anterior ve posteriortibial arter distalindeki dalga formlarına bakarak proksimalde bulunabilecek stenozu ve/veya oklüzyonutahmin etme konusundaki etkinliğini değerlendirmek.Gereç ve Yöntem: Çalışma periferik arteryel hastalığına ait klinik bulguları olan 131 hastaya ait 261 ekstremiteüzerinde gerçekleştirildi. Her bir extremitede iki tip Doppler ultrason incelemesi yapıldı: 1. Pelvik arterlerdenbaşlayarak anterior ve posterior tibial arterlerin distal kısımlarını içine alan eksiksiz inceleme; ve2. yalnızca anterior ve posterior tibial arterlerin distal kısımlarını içine alan hızlı inceleme. Hızlı incelemedekidalga formları üç başlık altında kategorize edildi: 1. Normal trifazik akım; 2. pulsus parvus et tardus (sistolikakselerasyon zamanı>200 ms); ve 3. ve önceki kategorilere uymayan arada kalan akım formları. Dalgaformlarının okluzyon ve/veya ciddi stenozla ilişkisini araştırmak için Pearson ki-kare analizi ve Bonferronidüzeltmeli z testi kullanıldıBulgular: Hızlı incelemede pulsus parvus et tardus saptanan hastaların hepsinde (n=38), arada kalan dalgaformları saptanan hastaların ise (n=192) %43.2’sinde ciddi stenoz ve/veya oklüzyon saptandı. Normal trifazikakım saptanan hastaların (n=31) hiç birinde ciddi stenoz ve/veya oklüzyon yoktu. Ciddi stenoz ve/veyaoklüzyon ile pulsus parvus et tardus ve trifazik dalga formları arasındaki ilişki istatistiksel olarak anlamlıydı(p

A Novel Approach For Evaluation of the Lower Extremity Arterial Disease in Emergency Setting

Objective: To investigate the efficacy of distal anterior and posterior tibial arterial waveforms in predicting the proximal stenosis and/or occlusion in patients with peripheral arterial disease of lower extremities. Material and Methods: The study was conducted on 261 lower extremities in 131 patients with clinical signs of peripheral arterial disease. Two types of Doppler examination were performed in each extremity: 1. A complete examination starting from pelvic arteries to anterior plus posterior tibial arterial arteries; and 2. a rapid examination which involved distal sections of anterior plus posterior tibial arterial arteries only. The waveforms in the rapid examination were categorized under three headings: 1. triphasic normal flow; 3. pulsusparvus et tardus (with systolic acceleration time>200 ms); and 3. intermediary forms which do not fit the previous categories. The relation between occlusion or severe stenosis and the waveforms were investigated by Pearson’s Chi-square analysis and Bonferroni correction z test. Results: Rapid examination revealed proximally located severe stenosis and/or occlusion in all (n=38) extremities with pulsus parvus et tardus and 43.2% of extremities with intermediary waveforms (n=192), whereas no severe stenosis and/or occlusion was detected in extremities with a normal triphasic flow (n=31). The relation between stenosis and/or occlusion and parvus et tardus waveform, triphasic flow was significant (p

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1. Sampson UK, Fowkes FG, McDermott MM, Criqui MH, Aboyans V, Norman PE, et al. Global and regional burden of death and disability from peripheral artery disease: 21 world regions, 1990 to 2010. Glob Heart 2014;9(1):145–158.
2. GBD 2015 Disease and Injury Incidence and Prevalence Collaborators Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: A systematic analysis for the Global Burden of Disease Study 2015. Lancet 2016;388(10053):1545–1602.
3. Ranke C, Creutzig A, Alexander K. Duplex scanning of the peripheral arteries: correlation of the peak velocity ratio with angiographic diameter reduction. Ultrasound Med Biol 1992;18(5):433–40.
4. Styczynski G, Szmigielski C, Kaczynska A, Leszczynski J, Rosinski G, Kuch-Wocial A. Echocardiographic evaluation of aorto-iliac occlusive disease. Int J Cardiovasc Imaging 2012;28(6):1351-6.
5. Eiberg JP, Jensen F, Gronval Rasmussen JB, Schroeder TV. Sreening for aortoiliac lesions by visual interpretation of the common femoral Doppler waveform. Eur J Vasc Endovasc Surg 2001;22(4):331– 336.
6. Shaalan W, French-Sherry E, Castilla M, Lozanski L, Bassiouny H. Reliability of common femoral artery hemodynamics in assessing the severity of aortoiliac inflow disease. J Vasc Surg 2003;37(5):960–969.
7. Spronk S, den Hoed P, de Jonge L, vanDijk L, Pattynama P. Value of the duplex waveform at the common femoral artery for diagnosing obstructive aortoiliac disease. J Vasc Surg 2005;42(2):236–242.
8. O‘Neill S, George R, Wallace W, Blair P, McKinley A. Do Doppler waveforms at the common femoral artery accurately predict iliac stenosis? Ir J Med Sci 2011;180(1):247–249.
9. Hingorani AP, Ascher E, Marks N. Duplex arteriography for lower extremity revascularization. Perspect Vasc Surg Endovasc Ther 2007;19(1):6-20.
10. Sung CK, Lee KH, Kim SH. Evaluation of factors influencing arterial Doppler waveforms in an in vitro flow phantom. Ultrasonography 2017;36(1):39-52.