Sinan DEMİRTAŞ, Osman TİRYAKİOĞLU, Ahmet ÇALIŞKAN, ORKUT GÜÇLÜ, Gündüz YÜMÜN, Celal YAVUZ, Orhan TEZCAN, OĞUZ KARAHAN

Endovasküler aortik onarımda tek merkez deneyimi: Teknik ve klinik yönlerin incelenmesi

Amaç: Bu çalışmanın amacı; cerrahisi yüksek riskli aortik patolojiye sahip hastalarda uyguladığımız Endovasküler Aortik Onarım tecrübelerimizin paylaşılması ve önceki raporlarla; gelişen mortalite, komplikasyonlar, ek girişimler açısından kıyaslanarak literatüre katkı sağlanmasıdır. Yöntemler: Retrospektif olarak endovasküler aortik onarım uygulanan hastalar değerlendirildi. Perioperatif 1 aylık mortalite, prosedür esnasındaki ek girişimler, gelişen komplikasyonlar, endoleak tipleri, uygulanan anestezi yöntemi, hastalığın tanısı, komorbid faktörleri ve demografik veriler kaydedildi. Sonuçlar literatürdeki veriler ile karşılaştırıldı. Bulgular: Abdominal endovasküler aortik onarım (EVAR) 19 hastaya uygulandı. Torasik endovasküler aortik onarım (TEVAR) 11 hastaya uygulandı. EVAR hastaları abdominal aort anevrizma tanısı ile işleme alındı. Bu hastaların 9 u rüptür nedeniyle acil olarak opere edildi. TEVAR uygulanan 8 hasta Tip 3 aort diseksiyonu, 1 hasta ise transeksiyon nedeniyle işleme alındı. Tüm vakaların 1 aylık mortalitesi % 10 ( 3 hasta) olarak bulundu. Endoleak gelişen 6 hastadan, 3 tanesi Tip1a, 2 tanesi Tip1 b ve 1 tanesi de Tip 2 idi. İki hastaya Tip1a ve 1 hastaya daTip1b endoleak nedeniyle balon anjioplasti yapıldı. Bir hastada postoperatif kontrast nefropatisine bağlı kronik böbrek yetmezliği(% 3,3) gelişti. Postoperatif dönemde hematom nedeniyle 2 (%6,7) hastada reeksplorasyon uygulandı. Sonuç: Endovasküler yöntemler aort patolojilerinde teknolojinin de ilerlemesiyle sıkça tercih edilen bir tedavi yöntemi haline gelmiştir. Bizim serimizde olduğu gibi cerrahi açıdan ciddi risk taşıyan hasta grubunda endovasküler yöntemlerin güvenle tercih edilebilecek bir alternatif olduğu kanaatindeyiz.

Single center experience in endovascular aortic repair: review of technical and clinical aspects

Objective: The aim of this study is sharing of our endovascular aortic repair experiments in patients with high risk for surgery and contributing to literature with comparing previous report according to mortality complications and additional operations. Methods: Patients with endovascular aortic repair application were evaluated retrospectively. Perioperative one month mortality, additional applications during procedure, occurred complications, endoleak types, approaching anesthetical technique, diagnosis of disease, comorbid factors and demographical data registered. Results were compared with data in the literature Results: Abdominal endovascular aortic repair (EVAR) applicated into 19 patients. Thoracic endovascular aortic repair (TEVAR) applicated into 11 patients. EVAR patients were operated with diagnosis of abdominal aortic aneurysm. Nine of these patients were emergely operated due to rupture. TEVAR applicated 8 patients were operated due to Type 3 Aortic Dissection and 1 patient was operated due to transsection. One month mortality of all patients were found as 10% (three patients). Endoleaks were occurred 6 patients: Three of them were Type 1a, two of them were Type1b and one of them was Type2. Balloon angioplasty applicated in two patients due to Type 1a endoleak and, in one patient due to Type 1b endoleak. Chronic renal failure was developed in one patient (3.3%) due to contrast nephropathy. Reexploration was applicated in two patients (6.7%) due to hematoma. Conclusion: Endovascular techniques are become frequently preferred treatment modality with the developing technology. We believed that endovascular approaches are safely preferable alternative in patients with high surgical risk as our series.

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