Ahmet Fatih ÖZYAZICIOĞLU, Burak ERDOLU, Ahmet Hakan VURAL, Gündüz YÜMÜN, Engin AKGÜL

Periferik arteriyel lezyonların tedavisinde biyoeriyebilen stentlerin restenoz üzerine etkisinin değerlendirilmesi

Amaç: Bu çalışmada biyoeriyebilen stent takılan hastalarda restenoz riskini artıran muhtemel faktörler araştırıldı.Çalış-ma- planı: Ocak 2010 - Aralık 2012 tarihleri arasında femoral arter tıkanıklığı biyoeriyebilen stent ile tedavi edilen toplam 45 hasta (39 erkek, 6 kadın; ort. yaş 58±7.2 yıl; dağılım 41-71 yıl) retrospektif olarak incelendi. Ayak Bileği-Kol İndeks skorları başlangıçta ve ameliyat sonrasında birinci hafta, birinci ay, altıncı ay ve birinci yılda kaydedildi. Hastalar ameliyat sonrası altıncı ay arteriyel Doppler ultrasonografi bulgularına göre iki gruba ayrıldı: grup 1 (n=10) akım yok-monofazik akım ve grup 2 (n=35) bifazik-trifazik akım paternine sahipti. Grup 1’de ameliyat sonrası altıncı aydan sonraki ilave tedaviler de kaydedildi.Bul-gu-lar: Hastaların 10’unda (%22) ilk altı ay içinde restenoz gelişti. Sigara içenlerin sayısı grup 1’de anlamlı düzeyde yüksek olmakla birlikte (p=0.048), diyabet ile restenoz arasında bir ilişki bulunmadı. Koroner arter hastalığı varlığı (p=0.049) ve trigliserit yüksekliği (p=0.035) restenozun risk faktörleri olarak bulundu. Birden fazla stent uygulaması, restenoza yatkınlaştırıcı bir faktördü (p=0.033).Sonuç:- Çalışma bulgularımız periferik arter hastalığı olanlarda 60 yaş altında olmak, trigliserit düzeylerinde artış ve sigara içiciliğinin restenozun risk faktörleri olduğunu göstermektedir. Ayrıca, koroner arter hastalığı varlığı da restenoz riskini artırmaktadır. Ancak, uzun segment darlığı ve ileri evre hastalığı olanlarda biyoeriyebilen uygulaması ile tatmin edici sonuçlar elde edilememiştir; bu nedenle, işleme bağlı sonuçları iyileştirmek için geniş ölçekli çalışmalar gerekmektedir.

ABSTRACT Background: This study aims to investigate possible factors which increase the risk of restenosis in patients undergoing biodegradable stenting. Methods: A total of 45 patients (39 males, 6 females; mean age 58±7.2 years; range 41 to 71 years) in whom femoral artery occlusion was treated by biodegradable stents between January 2010 and December 2012 were retrospectively analyzed. The Ankle Brachial Index scores were recorded at baseline and at one week, one month, sixth month, and one year, postoperatively. The patients were divided into two groups according to the postoperative six-month arterial Doppler ultrasonography findings: group 1 (n=10) had no flow or monophasic flow, and group 2 (n=35) had biphasic or triphasic flow pattern. Additional treatments after postoperative sixth month in group 1 were also noted. Results: Restenosis developed in 10 patients (22%) within postoperative six months. Although the number of smokers was significantly higher in group 1 (p=0.048), no relationship was found between diabetes and restenosis. The presence of coronary artery disease (p=0.049) and elevated triglycerides (p=0.035) were found to be risk factors of restenosis. More than one stenting was a predisposing factor of restenosis (p=0.033). Conclusion: Our study results show that being under the age of 60 years, elevated triglyceride levels, and smoking are the risk factors for restenosis in those with peripheral arterial disease. In addition, the presence of coronary artery disease increases the risk of restenosis. However, biodegradable stent implantation yielded unsatisfactory results in those with long-segment stenosis and advanced disease; therefore, we recommend further large- scale studies to improve the procedural outcomes.

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