Management of endovascular treatment in spontaneous iliac artery dissections: Applications enabling classical surgery

Background:This study aims to investigate the effectiveness of endovascular applications for the treatment of spontaneous iliac artery dissections.Methods: The medical records of 13 patients (12 males, 1 female; mean age 67.9±5.7 years; range, 58 to 75 years) with spontaneous iliac artery dissection between January 2017 and December 2019 were retrospectively reviewed. The diagnosis of spontaneous iliac artery dissection was made based on contrast-enhanced computed tomography. Demographic and clinical characteristics of the patients, physical examination and imaging findings, and hybrid treatments applied during endovascular treatment were analyzed.Results:The mean follow-up was 12.5±1.1 (range, 6 to 16) months. Five patients received hybrid treatment during endovascular treatment. The re-entry site was closed by a patch plasty over the common femoral artery in one of these patients. Embolectomy was performed in the remaining four patients for the treatment of acute ischemia of the extremities. Since no patency could be achieved in two of the patients undergoing embolectomy, a femoropopliteal bypass was performed. The technical success and primary patency rates were 100%. No new false lumen formation, intra-stent occlusion or arterial occlusion was observed during the hospital stay and follow-up.Conclusion:Endovascular methods can be safely used in the treatment of spontaneous iliac artery dissections; however, hybrid treatments may be also required in selected cases. We believe that it is effective and safe to apply endovascular and hybrid treatments without preventing possible surgical treatments which may be required in the future.Keywords:Dissection, endovascular treatment, hybrid treatment, iliac artery.

Spontan iliyak arter diseksiyonlarında endovasküler tedavi yönetimi: Klasik cerrahiye olanak sağlayan uygulamalar

Amaç: Bu çalışmada spontan iliyak arter diseksiyonlarının tedavisinde endovasküler uygulamaların etkinliği araştırıldı.Ç a l ı ş m a p l a n ı : Ocak 2017 - Aralık 2019 tarihleri arasında spontan iliyak arter diseksiyonlu 13 hastanın (12 erkek, 1 kadın; ort. yaş 67.9±5.7 yıl; dağılım, 58-75 yıl) tıbbi kayıtları retrospektif olarak incelendi. Spontan iliyak arter diseksiyonunun tanısı, kontrastlı bilgisayarlı tomografi ile konuldu. Hastaların demografik ve klinik özellikleri, fizik muayene ve görüntüleme bulguları ve endovasküler tedavi sırasında uygulanan hibrit tedaviler incelendi.Bul gu lar: Ortalama takip süresi, 12.5±1.1 (dağılım, 6-16) ay idi. Endovasküler tedavi sırasında beş hastaya hibrit tedavi uygulandı. Bu hastalardan birinde ana femoral artere yama plasti yapılarak, yeniden giriş bölgesi kapatıldı. Geri kalan dört hastada akut ekstremite iskemisinin tedavisi amacıyla embolektomi uygulandı. Embolektomi uygulanan hastalardan ikisinde açıklık sağlanamaması nedeniyle, femoropopliteal baypas uygulandı. Teknik başarı ve primer açıklık oranları %100 idi. Hastanede yatış ve takip süresince yeni yalancı lümen oluşumu, stent içi oklüzyon veya arteriyel oklüzyon izlenmedi.S o n u ç :Spontan iliyak arter diseksiyonlarının tedavisinde endovasküler yöntemler güvenli bir şekilde kullanılabilir; ancak belirli olgularda hibrit tedaviler de gerekebilmektedir. Yapılacak endovasküler ve hibrit tedavilerin ileride gerekebilecek muhtemel cerrahi tedavileri engellemeyecek şekilde uygulanmasının etkili ve güvenilir olduğu kanaatindeyiz.A n a h t a r s ö z c ü k l e r :Diseksiyon, endovasküler tedavi, hybrid tedavi, iliyak arter.

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