Periferik Arter Anevrizmaları (Fırat Deneyimi)

Amaç: Periferik arter anevrizmalarına gerek arteriyoskleroz insidansında artış, gerekse tanı ve tedavi amaçlı invaziv metodların yaygın kullanımı nedeniyle sıklıkla rastlanılmaktadır. Bu çalışmamızın amacı kliniğimizde periferik arter anevrizması nedeniyle opere edilen olguların preoperatif özelliklerini, cerrahi tedavi sonuçlarını retrospektif olarak değerlendirmektir. Gereç ve Yöntem: Kliniğimizde 1994-2004 yılları arasında periferik arter anevrizma saptanan 23 olgu retrospektif olarak incelendi. Bulgular: Akut ve kronik olmak üzere toplam 12 (%52.1) olguda ekstremite iskemisi mevcuttu. Gerçek anevrizma 12 (%52.2) (3 olguda birden fazla anevrizma), psödo-anevrizma ise 11 (%47.8) olguda tesbit edildi. Etiyolojide gerçek anevrizmalarda en sık olarak arteriyoskleroz, psödoanevrizmalarda ise iyatrojenik nedenler saptandı. Toplam 26 anevrizmanın en sık yerleşim bölgeleri femoral ve popliteal arterler olup en sık uygulanan cerrahi yöntemin anevrizmektomi ile birlikte safen ven veya vasküler greft ile interpozisyon olduğu saptandı. Sonuç: Toplam 3 (%13) olguda amputasyon (2 alt ekstremite parmak ve 1 diz üstü) gerekti. Bir hastamız ise postoperatif akciğer ödemi sonucu kaybedildi. Komplikasyon gelişimi, yapılacak müdahalelerin başarı şansını azaltacağı için asemptomatik bile olsa periferik anevrizmalar mutlaka cerrahi olarak tedavi edilmelidir kanaatindeyiz. ©2007, Fırat Üniversitesi, Tıp Fakültesi

Anahtar Kelimeler:

Periferik arter, anevrizma

Peripheral Arterial Aneurysms (Firat Experience)

Objective: Peripheral arterial aneurysms are frequently encountered due to increased incidence of arteriosclerosis and common use of invasive methods for diagnostic and therapeutic purposes. The aim of this report is to retrospectively evaluate preoperative features of peripheral arterial aneurism cases operated at our clinic and their results of surgical treatment. Materials and Methods: A total of 23 peripheral arterial aneurysm cases diagnosed and operated at our clinic between the years of 1994 and 2004 were retrospectively evaluated. Results: Acute and chronic ischemias of extremities were determined in 12 cases (52.1%). True aneurysm and pseudo-aneurysm were seen in 12 (52.2%; more than one aneurysms in three cases) and 11 (47.8%) cases. In etiology, most frequent causes for true and pseudo-aneurysms were recorded to be arteriosclerosis and iatrogenic factors, respectively. Most frequent localization of 26 aneurysms was in the femoral and popliteal arteries. It was noted that aneurysmectomy combined with interposition of sapheneous vein or synthetic graftl was the most commonly applied surgical method. Conclusions: In a total of three cases (13%) amputation (two lower extremity toes and 1 upper-knee) was performed. One patient deceased as a result of post-operative pulmonary edema. It is suggested that peripheral aneurysms (even asymptomatic cases) must be surgically treated since they may cause complications and reduce the success rate of operations to be performed. ©2007, Firat University, Medical Faculty

Keywords:

-,

PDF

___

Trubel W, Staudacher M, Wolner E. Aneurysm spurium after iatrogenic arterial puncture-incidence, risk factors and surgical therapy. Wien Clin Wochenschr 1993; 105: 139-143.
Anthony S, Charles MM, Steven FH, Lois S, Julius HJ, Jonathan LH. Femoral Pseudoaneurysm following Nonpenetrating Trauma in a Patient with Aortic Insufficiency. The American Journal of Medicine 1985; 78: 719-720.
Messina LM, Brothers TE, Wakefield TW, et al. Clinical characteristics and surgical management of vascular complications in patients undergoing cardiac catheterization: Interventional versus diagnostic procedures. J Vasc Surg 1991; 13: 593-600.
Kurtoglu M, Aksoy M, Karaaslan C, Zilan A. Renkli doppler ultrasonografi, psödoanevrizmaların tanısında olduğu kadar tedavisinde de etkin bir seçenektir. Ulus Travma Dergisi 2003; 9: 300-303
Roggo A, Brunner U, Ottinger LW, Largiader F. The continuing challenge of aneurysms of the popliteal artery. Surg Gynecol Obstet 1993; 177: 565-572.
Ouriel K, Shortell CK. Popliteal and Femoral Aneursyms. In: Rutherford RB, editor. Vascular Surgery. 4. Edition. New-York: W.B. Saunders. 1995: 1103-1112.
Keçeligil HT, Kolbakır F, Keyik T, Erk MK. Periferik arter psödoanevrizmaları. Türk Göğüs Kalp damar Cerrahisi Dergisi 1994; 2: 323-325.
Ting ACW, Cheng SWK. Femoral pseudoaneurysms in drug addicts. World J Surg 1997; 21: 783-787.
Kronzon I. Diagnosis and treatment of iatrogenic femoral artery pseudoaneurysm: A review. J Am Soc Echocardiogr 1997; 10: 236-245.
Ylonen K, Biancari F, Leo E, et al Predictors of development of anastomotic femoral pseudoaneurysms after aortobifemoral reconstruction for abdominal aortic aneurysm. Am J Surg 2004; 187: 83-87.
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: 586-593.
Davidovic LB, Markovic DM, Pejkic SD, Kovacevic NS, Colic MM, Doric PM. Subclavian artery aneurysms. Asian J Surg 2003; 26: 7-11; discussion 12.
Kırali K, Güler M, Mansuroğlu D, Ömeroğlu SN, Özen Y, Dağlar B, İpek G, Yakut C. Ekstremite arterlerinin psödoanevrizmaları ve tedavisi .Türk Göğüs Kalp Damar Cerrahisi Dergisi 2000; 8: 802-804
Whitehouse WM Jr, Wakefield TW, Graham LM, et al Limb- threatening potential of arteriosclerotic popliteal artery aneurysms. Surgery. 1983; 93: 694-699.
Kabul Tarihi: 04.07.2006