Hakan AKBAYRAK, Ünal AYDIN, Melike KARADAĞ, Halil BAŞEL, Abdussamet HAZAR, Ayşenur DOSTBİL

Periferik arterlerin yalancı ve gerçek anevrizmalarındaki deneyimlerimiz

Amaç. Son yıllarda tanı ve tedavi amaçlı invaziv metotların yaygın kullanımı nedeniyle pseudo anevrizma olguları artmıştır. Bu çalışmamızın amacı, kliniğimizde opere edilen periferik arter gerçek ve pseudo anevrizma olgularının preoperatif özelliklerinin, cerrahi tedavi sonuçlarının retrospektif olarak değerlendirilmesidir. Yöntem. Kliniğimizde 1999-2008 yılları arasında periferik arter anevrizması saptanan 35 olgu retrospektif olarak incelendi. Bulgular. Akut ve kronik olmak üzere toplam 12 (%34,3) olguda ekstremite iskemisi mevcuttu. Gerçek anevrizma 12 (%34,3) (1 olguda birden fazla anevrizma), psödoanevrizma ise 23 (%65,7) olguda tespit edildi. Etiyolojide gerçek anevrizmalarda en sık ateroskleroz, psödoanevrizmalarda ise iyatrojenik nedenler saptandı. 26 (%74,2) olguda anevrizmanın en sık yerleştiği bölge femoral ve popliteal arterler olup en sık uygulanan cerrahi yöntemin psödo anevrizmada primer tamir, gerçek anevrizmada ise anevrizmektomi ile birlikte safen ven veya sentetik greft interpozisyonu idi. Sonuçlar. Toplam 1 (%2,9) gerçek anevrizmada 8 saatlik bir iskemi nedeniyle alt ekstremite parmaklarında ampütasyon gerekti. Elektif cerrahi onarımın, bu komplikasyonun tedavisini kolaylaştırdığı görülmüştür. Komplikasyon gelişimi, yapılacak müdahalelerin başarı şansını azaltacağı için asemptomatik bile olsa periferik anevrizmalar mutlaka cerrahi olarak tedavi edilmelidir.

Our experience of the pseudoaneurism and true aneurisms in periferic arteries

Aim. Peripheral arterial aneurysms are frequently encountered due to increased incidence of arteriosclerosis and common use of invasive methods for the diagnostic and therapeutic purposes. The aim of this report is to evaluate preoperative features of peripheral arterial aneurisms operated at our clinic and their surgical results retrospectively. Methods. 35 peripheral arterial aneurysm cases diagnosed and operated at our clinic between the years of 1999-2008 and they were retrospectively evaluated. Results. Acute and chronic ischemia of the extremities were determined in 12 cases (34.3%). True aneurysms were seen in 12 (34.3%) cases (more than one aneurysm in one case). Pseudo-aneurysms were seen in 23 (65.7%) cases. Frequent causes for true and pseudo-aneurysms were arteriosclerosis and iatrogenic factors. Frequent localization of the 26 (74.2%) aneurysms were the femoral and popliteal arteries. It was noted that, aneurysmectomy combined with interposition of sapheneous vein or synthetic graft was the most commonly applied surgical method in patients with true anevrisms. Conclusions. In one true anevrism (2.9%), amputation of the lower extremity toes was required due to ischemia more than eight hours. It is suggested that peripheral aneurysms (even asymptomatic cases) must be surgically treated since they may cause serious complications.

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1. Keçeligil HT, Kolbakır F, Keyik T, Erk MK. Periferik arter psödoanevrizmaları. Türk Göğüs Kalp Damar Cerrahisi Dergisi 1994; 2: 323-5.
2. Trubel W, Staudacher M, Wolner E. Aneurysm spurium after iatrogenic arterial puncture-incidence, risk factors and surgical therapy. Wien Clin Wochenschr 1993; 105: 139-43.
3. Anthony S, Charles MM, Steven FH, Lois S, Julius HJ, Jonathan LH. Femoral Pseudoaneurysm following Nonpenetrating Trauma in a Patient with Aortic Insufficiency. Am. J. Med 1985; 78: 719-20.
4. Messina LM, Brothers TE, Wakefield TW, Zelenock GB, Lindenauer SM, Greenfield LJ, Jacobs LA, Fellows EP, Grube SV, Stanley JC. Clinical characteristics and surgical management of vascular complications in patients undergoing cardiac catheterization: Interventional versus diagnostic procedures. J Vasc Surg 1991; 13: 593-600.
5. Kurtoglu M, Aksoy M, Karaaslan C, Zilan A. Renkli Doppler ultrasonografi, psödoanevrizmaların tanısında olduğu kadar tedavisinde de etkin bir seçenektir. Ulusal Travma Dergisi 2003; 9: 300-3
6. Kang SS, Labropoulos N, Mansour MA, Baker WH. Percutaneous ultrasound guided thrombin injection: A new method for treating postcatheterization femoral pseudoaneurysms. J Vasc Surg 1998; 27:1032-8.
7. Thalhammer C, Kirchherr AS, Uhlich F, Waigand J, Gross CM. Postcatheterization pseudoaneurysms and arteriovenous fistulas: Repair with percutaneous implantation of endovascular covered stents. Radiology 2000; 214:127-31.
8. Clark ET, Gewertz BL. Pseudoaneurysms. In: Rutherford RB (Ed). Vascular Surgery. 4th edition. Philadelphia (USA): W.B. Saunders Company, 1995: pp1153-61.
9. Johns JP, Pupa LE, Bailey SR. Spontaneous thrombosis of iatrogenic femoral artery pseudoaneurysms:Documentation with color Doppler and two dimensional ultrasonography. J Vasc Surg 1991; 14: 24-9.
10. Zahn R, Thoma S, Fromm E, Lotter R, Zander M, Seidl K, Senges J. Do 5-F-catheters reduce the incidence of a pseudoaneurysm. Int Angiol 1996; 15: 257-60.
11. Rudolphi D. An update on the peripheral pseudoaneurysm. J Vasc Nurs 1993; 11: 67-70.
12. Roggo A, Brunner U, Ottinger LW, Largiader F. The continuing challenge of aneurysms of the popliteal artery. Surg GynecolObstet 1993; 177: 565-72.
13. Ouriel K, Shortell CK. Popliteal and Femoral Aneursyms. In: Rutherford RB (Ed). Vascular Surgery. 4. Edition. New-York (USA): W.B. Saunders. 1995: pp1103-112.
14. Ting ACW, Cheng SWK. Femoral pseudoaneurysms in drug addicts. World J Surg 1997; 21: 783-87.
15. Ylönen K, Biancari F, Leo E, Rainio P, Salmela E, Lahtinen J, Satta J, Pokela R, Lepojärvi M, Juvonen T. Predictors of development of anastomotic femoral pseudoaneurysms after aortobifemoral reconstruction for abdominal aortic aneurysm. Am J Surg 2004; 187: 83-7.
16. Mahmood A, Salaman R, Sintler M, Smith SR, Simms MH, Vohra RK. Surgery of popliteal artery aneurysms: a 12-year experience. J Vasc Surg 2003; 37: 586-93.