Mehmet ÖZÜLKÜ, Enes DUMAN, Cevahir HABERAL, Tonguç SABA, Ali TÜNEL

İnfrarenal abdominal aort anevrizmalarında iliyak arter morfolojisi kaynaklı ameliyat sırası destekleyici işlem gereksinimi ve komplikasyonlar

Amaç: Bu çalışmada infrarenal abdominal aort anevrizmalarında girişim ve başlıca endovasküler aort tamiri işlemi sırasında teknik zorluklara ve komplikasyonlara yol açabilecek iliyak arter morfolojisine bağlı sorunlar değerlendirildi. Çalışma planı: Bu çalışmaya Ocak 2007 - Haziran 2014 tarihleri arasında endovasküler aort tamiri uygulanmış 119 hasta (100 erkek, 9 kadın; ort. yaş 69.4 yıl; dağılım 52-93 yıl) alındı. İliyak arter morfolojisi sorunları değerlendirildi. Morfoloji normal, anevrizmatik lezyon, darlık, tortuosite ve diseksiyon olarak sınıflandırıldı. Stent greftin ana gövdesinin ve karşı taraf bacağın yerleştirilmesi, ana işlem olarak tanımlandı. İşlem sırasında ek işlemler, iliyak arter morfolojisine bağlı lezyonların gerektirdiği ameliyat sırası destekleyici işlemlerdi. İliyak arter morfolojisine bağlı işlemler, zorluklar ve çözümler retrospektif olarak değerlendirildi. Bulgular: Yirmi iki hastada iliyak arter morfolojisi normaldi. Altmış iki hastada anevrizmatik lezyon, 28 hastada darlık, 45 hastada tortuosite ve iki hastada diseksiyon mevcuttu. Ana işlem 27 hastada yeterli oldu. Ameliyat sırasında destekleyici işlemler 92 hastada gerekti. Ameliyat sırası destekleyici işlemlerin neden olduğu komplikasyonlar için 17 hastaya ek işlem uygulandı. Komplikasyonun ek işlemlerle çözülemediği üç hastaya ise cerrahi girişim gerekti. Sonuç: İliyak arter morfolojisinin bilinmesi, komplikasyonların olması durumunda sorun çözmeye yönelik becerilerin kazanılması ve ameliyat sırası destekleyici işlemlerin uygulanabilmesi amacıyla damar cerrahları için gittikçe artan bir gerekliliktir.

Requirement of intraoperative supportive procedures and complications in infrarenal abdominal aortic aneurysms due to iliac artery morphology

Background: This study aims to evaluate the problems due to the iliac artery morphology which can lead to technical difficulties and complications during the access and the main procedure of the endovascular aortic repair applied in infrarenal abdominal aortic aneurysms.Methods: This study included a total of 119 patients (100 males, 9 females; mean age 69.4 years; range 52 to 93 years) who underwent endovascular aortic repair between January 2007 and June 2014. The iliac artery morphology problems were evaluated. Morphologies were classified as normal, aneurysmal lesions, stenosis, tortuosity, and dissection. The placement of the main body of the stent graft and the contralateral limb was defined as the main procedure. Additional procedures included intraoperative supportive procedures which were performed due to iliac artery lesions during the procedure. Procedures, challenges, and solutions due to the iliac artery morphology were retrospectively analyzed.Results: Iliac artery morphology was normal in 22 patients. Sixty-two patients had an aneurysmal lesion, 28 patients had stenosis, 45 patients had tortuosity, and two patients had dissection. The main procedure was sufficient in 27 patients. Intraoperative supportive procedures were required in 92 patients. Additional procedures were applied to 17 patients for complications due to the intraoperative supportive procedures. A surgical intervention was required in three patients, since the complication was unable to be solved by additional procedures.Conclusion: Being aware of iliac artery morphology has increasingly become a prerequisite for vascular surgeons to gain problem-solving skills in case of complications and to be able to apply intraoperative supportive procedures.

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