Ali Ahmet ARIKAN, Şadan YAVUZ, Ersan ÖZBUDAK, Sevtap GÜMÜŞTAŞ, Ercüment ÇİFTÇİ, Turan BERKİ, Muhip KANKO

İzole iliyak arter anevrizmaları: Cerrahi yöntem ile endovasküler girişimlerin karşılaştırılması

Amaç: Bu çalışmada izole iliyak arter anevrizmalarının (İİAA) tedavisinde açık cerrahi yöntem ile endovasküler yaklaşımlar karşılaştırıldı ve tartışıldı. Çalışma planı: Kliniğimizde Ocak 2004 - Temmuz 2012 tarihleri arasında, çapı 3.5 cm ve üzerinde olan İİAA’lı 23 hastanın tıbbi kaydı retrospektif olarak incelendi. Hastanede kalış ve takip sırasındaki hasta kayıtları değerlendirildi. Hastaların demografik verileri, anevrizma yerleşim yerleri, yapılan işlem tipi, yoğun bakım ünitesinde (YBÜ) ve hastanede kalış süreleri gibi parametreler kaydedildi. Hastaların 13’ü (12 erkek, 1 kadın; ort. yaş 69.3±11 yıl; dağılım 57-80 yıl) endovasküler stent greft onarım (EVAR) yöntemi ile 10’u (9 erkek, 1 kadın; ort. yaş 71.4±9 yıl; dağılım 63-82 yıl) açık cerrahi yöntem ile tedavi edildi. EVAR grubunda 13 hastanın altısı, cerrahi grupta ise 10 hastanın üçü rüptüre İİAA olarak acil ameliyata alındı.Bulgular: Ortalama hastanede ve YBÜ’de kalış süreleri EVAR grubunda sırasıyla 1.9 gün ve 0.7 gün iken, cerrahi grupta sırasıyla 10.9 gün ve 7.2 gün idi. Her iki grupta da teknik başarı ve erken dönem açıklık oranı %100 idi. Endovasküler stent greft yöntemi grubunda işlem ve hastane içi mortalite oranı %0 iken, cerrahi grupta bir hasta (%10) ameliyat sonrası 56. günde YBÜ’de solunum yetmezliği nedeni ile kaybedildi.Sonuç: Çalışmamızın sonucunda literatüre uygun olarak, iliyak arter anevrizmalarının tedavisinde EVAR’ın cerrahiye göre daha düşük morbidite ve mortalite ile uygulanabilir bir yöntem olduğunu düşünmekteyiz.

Isolated iliac artery aneurysms: a comparison of surgical method and endovascular approaches

Background: This study aims to compare and discuss open surgical method and endovascular approaches in the management of isolated iliac artery aneurysms (IIAA). Methods: Medical records of 23 patients with IIAA with an aneurysm diameter greater than 3.5 cm who underwent treatment between January 2004 and July 2012 in our clinic were retrospectively analyzed. The patient records during hospital stay and follow-up were evaluated. Parameters including demographic data of the patients, localization of the aneurysms, the type of procedure, the length of intensive care unit (ICU) and hospital stay were recorded. Thirteen patients (12 males, 1 female; mean age 69.3±11 years; range 57 to 80 years) were treated with endovascular stent grafts repair (EVAR), whereas 10 patients (9 males, 1 female; mean age 71.4±9 years; range 63 to 82 years) underwent open surgery. Six out of 13 EVAR patients and three out of 10 open surgery patients underwent emergent operation due to ruptured IIAA.Results: The mean length of hospital stay and ICU stay in EVAR group were 1.9 and 0.7 days, respectively, while in surgery group these were 10.9 and 7.2 days, respectively. Technical success and postoperative early patency rates were 100% in both groups. Perioperative and in-hospital mortality rate were 0% in EVAR group; however one patient (10%) died due to respiratory failure on postoperative 56th day in ICU.Conclusion: According to our study results, we conclude that EVAR can be performed with a lower morbidity and mortality rate compared to open surgery in the management of iliac artery aneurysms, which is consistent with the literature.

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