Kürşat BOZKURT, Hasan TÜZÜN, Gökçe ŞİRİN, Ayla Gürel SAYIN, Cengiz KÖKSAL, Kazım BEŞİRLİ

İnfraninguinal periferik aterosklerotik arter hastalıklarında akım değerlendirmesinde anjiyografi ve renkli doppler ultrasonografinin karşılaştırılması

Amaç: Çalışmamızda infrainguinal periferik aterosklerotik arter hastalıklarında distal akım (runn off) değerlendirilmesinde anjiyografi ve renkli Doppler ultrasonografiyi (RDUSG) karşılatırdık. Materyal ve Metod: İnfrainguinal periferik aterosklerotik arter hastalığı tanısı konan ve alt ekstremitede kritik iskemi nedeni ile kliniğimize müracaat eden 10 hasta çalışmaya dahil edildi. Hastaların ortalama yaşları 60 ± 6.4 yıl idi. Bu hastaların ikisi bayan, sekiz hasta ise erkek idi. Hastaların yedisinde istirahat ağrısı, üçünde iskemik yara saptandı ve fizik muayenede olguların hiçbirinde popliteal ve distal nabızlar yoktu. Preoperatif ankle-brakiyal indeks (ABI) ölçümleri 0.26 ± 0.07 idi. Anjiyografik incelemelerde, süperfisyel femoral arter dört olguda bifurkasyon düzeyinde ve diğer dört olguda ise Hunter kanalı seviyesinde tam tıkalı idi. Bir olguda ana femoral arter inguinal ligament seviyesinde ve diğer bir olguda da popliteal arter (PA) diz seviyesinde tam tıkalı idi. Olguların hiçbirinde distal akım saptanmadı. Diz altı vasküler yapıları değerlendirmek ve cerrahi rekonstriksiyon için uygun bir segment bulmak amacıyla RDUSG işlemi gerçekleştirildi. Bulgular: Renkli Doppler ultrasonografi uygulanan hastaların üçünde tibialis anterior arterde (ATA) düşük hızda ve monofazik akım kaydedildi. Bu üç olgu da erkek idi ve primer yakınmaları istirahat ağrısı olup, hiçbirinde iskemik yara yoktu. Ameliyatta doppler sonuçları ile uyumlu olarak ATA’da açık lümen saptandı. İki vakaya ana femoral arterden ATA’ya reverse safen ven bypass, diğer vakaya proksimal PA’dan ATA’ya reverse safen ven bypass operasyonu uygulandı. Postop ABI değerleri 0.66 ± 0.06 idi. Postoperatif cerrahi komplikasyon gelişmedi. Sonuç: Renkli Doppler ultrasonografik inceleme, infrainguinal rekonstriksiyon stratejisinin saptanmasında güvenilir şekilde kullanılabilir.

Comparison of the angiography and coloured doppler ultrasonography to evaluate outflow in infrainguinal peripheric atherosclerotic arterial disease

Background: In current study we compared the results of the angiography and coloured Doppler ultrasonography (CDU) for the investigation of the outflow in the infrainguinal peripheral atherosclerotic arterial disease. Methods:Ten patients who were presented with critical lower limb ischemia due to atherosclerotic peripheral arterial disease were included in the study. The average age was 60 ± 6.4 years. Two of the patients were female and eight were male. The patients did not have diabetes mellitus. Seven patients had rest pain and three patients had ischemic ulcer and neither popliteal nor distal pulses were palpated on physical examination. Preoperative mean ankle-brachial index (ABI) was 0.26 ± 0.07. Digital subtraction angiography revealed total occlusion of superficial femoral artery in four cases at the bifurcation level and in four cases at the level of Hunter cannel. The common femoral artery was detected to be totally occluded in one patient at the level of inguinal ligament and in one patient popliteal artery (PA) was totally occluded just at the knee level. No outflow was detected in all cases. We used CDU in order to examine vascular structures below the knee and to find if there is a suitable segment for surgical reconstruction. Results: By using CDU a monophasic flow at the tibialis anterior artery (ATA) were detected in three patients. They were male with primarily complained of rest pain and without ischemic ulcer. Operative exploration showed patent lumen at the ATA level just in accordance with the CDU results. In two cases common femoro-ATA reversed saphenous vein bypass and in one case proximal PAATA reversed saphenous vein bypass were performed. Postoperative ABI measurements were 0.66 ± 0.06. There were no postoperative surgical complications. Conclusions: CDU imaging can be used reliably for planning infrainguinal reconstruction strategies.

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