Kritik uzuv iskemisi olan hastalarda dizaltı kronik total tıkanıklıklarının rekanalizasyonunda geçiş kateterlerinin kullanımı

Amaç: Bu çalışmada kritik uzuv iskemisi olan hastaların diz altı arterlerin kronik total tıkanıklıkların açılmasında hidrofilik geçiş kateterinin akut işlem başarısındaki yeri araştırıldı. Çalışma planı: Mart 2013 - Temmuz 2017 tarihleri arasında, merkezimizde diz altı arterlerde kronik total tıkanıklığı olan ve girişimsel tedavide geçiş kateteri kullanılmış 30 hasta retrospektif olarak tanımlandı. Kabul edilme kriterleri, kritik uzuv iskemisi (Rutherford Sınıf 4 veya üstü semptom) ile birlikte hastalarda en az bir dizaltı arterde tıkanıklık olması ve revaskülarizasyonunda geçiş kateterinin kullanılması idi. Primer teknik başarı, klavuz telin tıkanıklık sonrası gerçek lümene yerleştirilmesi olarak tanımlandı. Bulgular: Otuz hastada 34 işlem uygulandı, bunlardan 41 lezyon geçiş kateteri kullanılarak tedavi edildi. On dokuz anterior tibial arter, 18 posterior tibial arter ve dört peroneal artere girişimde bulunuldu. Ortalama lezyon uzunluğu 110.2±36.0 mm ve 20 lezyon (%48.8) ciddi kalsifik idi. Primer teknik başarı oranı %80.5 idi. Lezyonların açılması 25 olguda (%76) kılavuz tel ve geçiş kateteri ile sağlanırken sekiz olguda (%24) yalnız geçiş kateteri ile sağlandı. Sonuç: Geçiş kateterinin kullanılması, infrapopliteal arter kronik total tıkanıklıklarının açılmasında önemli bir komplikasyona neden olmadan yüksek işlem başarı oranı göstermiştir.

The use of crossing catheters in the recanalization of below-the-knee chronic total occlusions in patients with critical limb ischemia

Background: This study investigates the procedural success of the use of a hydrophilic crossing catheter in the recanalization of below-the-knee artery chronic total occlusions in patients with critical limb ischemia.Methods: We retrospectively identified below-the knee chronic total occlusion interventions in 30 patients performed between March 2013 and July 2017 in our institute. The inclusion criteria were critical limb ischemia (Rutherford Class 4 or greater) and occlusion of at least one tibial vessel with revascularization performed with the use of a crossing catheter. Primary technical success was defined as placement of a guide wire in the true lumen, past the distal chronic total occlusions cap.Results: Thirty patients underwent 34 procedures, in which 41 lesions were treated with the use of crossing catheters. Nineteen anterior tibial arteries, 18 posterior tibial arteries, and four peroneal arteries were treated. Mean length was 110.2±36 mm and 20 lesions (48.8%) were severely calcified. The primary technical success rate was 80.5%. Recanalization was achieved with a guide wire and crossing catheter in 25 lesions (76%) and with the crossing catheter alone in eight cases (24%).Conclusion: The use of a crossing catheter showed a high rate of technical and procedural success in infrapopliteal chronic total occlusions without significant complications.

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