Sinan ŞAHİN, Ahmet MEMİŞ, Mustafa PARILDAR, Bayer ÇINAR, Ahmet Müfid OKBAY, Şule Nurdan BİLGİN, Abdullah Kemal TUYGUN, Cüneyt KONURALP

Travmatik vasküler yaralanmalarda endovasküler ve kısa dönem sonuçları

Amaç: Tedavileri endovasküler yolla yapılan travmatik vasküler yaralanmaların kısa dönem sonuçları değerlendirildi. Çalışma planı: Travmatik vasküler yaralanma sonucu, renkli Doppler ultrasonografi ve/veya dijital subtraksiyon anjiografi ile arteriyovenöz fistül ve/veya pödoanevrizma saptanan dokuz olgu (7 erkek, 2 kadın; ort. yaş 39.8; dağılım 14-75) kaplı stentler ile tedavi edildi. Ekstravazasyon izlenen durumlarda balon kateterle fiksasyon veya ikinci bir stent uygulaması yapıldı. Olgular 72 saat içinde taburcu edildi. İşlem sonrası klinik muayene, renkli Doppler ultrasonografi ve dijital subtraksiyon anjiyografi incelemeleriyle stend açıklıkları değerlendirildi. Bulgular: Üç olguda psödoanevrizma, dört olguda arteriyovenöz fistül, iki olguda ise psödoanevrizmanın eşlik ettiği arteriyovenöz fistül vardı. Arteriyovenöz fistül bulunan hastalarda, fistüllerin ikisi yüzeyel femoral arter, biri anterior tibial arter, biri ana iliyak arter, biri eksternal iliyak arter, biri de popliteal arter ile ven arasındaydı. Psödoanevrizmalar brakiyal arter, aksiller arter ve anterior tibial arterden kaynaklanıyordu. Tedavide dört olguda balon ekspandable, beş olguda self ekspandable kaplı stentler kullanıldı. Teknik başarı %100 olarak değerlendirildi. Ortalama 14.7 ay takip edilen olgularda stent açıklıkları %100 olarak saptandı. Sonuç: Travmatik vasküler yaralanmaların tedavisinde uygun lezyonlarda, başarı ve açıklık oranları yüksek olan endovasküler yaklaşım, cerrahi tedaviye alternatif bir seçenek olarak düşünülebilir.

Endovascular therapeutic approaches and short term results in traumatic vascular injuries

Background: Short term results of endovascular therapy in traumatic vascular injuries were evaluated. Methods: Nine patients (7 men, 2 women; mean age 39.8 years; range 14 to 75 years) who had traumatic vascular injuries and in whom pseudoaneurysm and/or arteriovenous fistulas were demonstrated by color Doppler ultrasonography and/or digital subtraction angiography, were treated with stent-grafts. In case of contrast leakage balloon fixation was performed or another cover stent was deployed. Patients were discharged in 72 hours. Following the procedures, stent patencies were evaluated by clinical examination, color Doppler ultrasonography and digital subtraction angiography. Results: Three cases had a pseudoaneurysm, four cases had arteriovenous fistulas and two cases had pseudoaneurysms associated with arterivenous fistulas. Two of the arteriovenous fistulas were between superficial femoral artery and vein, one was between anterior tibial artery and vein, one was between common iliac artery and vein, and one was between external iliac artery and vein. Pseudoaneurysms were originating from brachial, axillary and anterior tibial arteries, respectively. Balloon expandable cover stents were used in 4 patients and self-expandable cover stents were used in 5 patients. Technical success was 100%, and patency rate was 100% during a mean follow up of 14.7 months. Conclusion: Endovascular approach which has a high success and patency rate, may be an alternative to surgical therapy in suitable lesions in the treatment of traumatic vascular injuries.

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1. Parodi JC, Schonholz C, Ferreira LM, Bergan J. Endovascular stent-graft treatment of traumatic arterial lesions. Ann Vase Surg 1999;13:121-9.
2. Marin ML, Veith FJ, Cynamon J, Sanchez LA, Lyon RT, Levine BA, eUal. Initial experience with transluminally placed endovascular grafts for the treatment of complex vascular lesions. Ann. Surg 1995;222:449 65.
3. Blum U, Voshage G, Lammer J, Beyersdorf F, Tollner D, Kretschmer G, et al. Endoluminal stent-grâfts for infrarenal abdominal aortic aneurysms. N Engl J Med 1997;336:13-20.
4. Ruebben A, Tettoni S, Muratore P, Rossato D, Savio D, Rabbia C. Arteriovenous fistulas induced by femoral arterial catheterization: percutaneous treatment. Radiology 1998;209:729-34.
5. Thalhammer C, Kirchherr AS, Uhlich F, Waigand J, Gross CM. Postcatheterization pseudoaneurysms and arteriovenous fistulas: repair with percutaneous implantation of endovascular covered stents. Radiology 2000 ;214:127-31.
6. McArthur CS, Marin ML. Endovascular therapy for the treatment of arterial trauma. Mt Sinai J Med 2004;71:4-ll.
7. Marin ML, Veith FJ, Panetta TF, Cynamon J, Barone H, Schonholz C, Parodi JC. Percutaneous transfemoral insertion of a stented graft to repair a traumatic femoral arteriovenous fistula. J Vase Surg 1993; 18:299-302.
8. Fellmeth BD, Roberts AC, Bookstein JJ, Freischlag JA, Forsythe JR, Buckner NK, et al. Postangiographic femoral artery injuries: nonsurgical repair with US-guided compression. Radiology 1991;178:671-5.
9. Cox GS, Young JR, Gray BR, Grubb MW, Hertzer NR. Ultrasound-guided compression repair of postcatheterization pseudoaneurysms: results of treatment in one hundred cases. J Vase Surg 1994; 19:683-6.
10. Dean SM, Olin JW, Piedmonte M, Grubb M, Young JR. Ultrasound-guided compression closure of postcatheterization pseudoaneurysms during concurrent anticoagulation: a review of seventy-seven patients. J Vase Surg 1996;23:28-34.
11. Kramer S, Pamler R, Seifarth H, Brambs HJ, SunderPlassmann L, Gorich J. Endovascular grafting of traumatic aortic aneurysms in contaminated fields. J Endovasc Ther 2001;8:262-7.
12. Baltacioglu F, Cimsit NC, Cil B, Çekirge S, Ispir S. Endovascular stent-graft applications in latrogenic vascular injuries. Cardiovasc Intervent Radiol 2003;26:434-9.
13. Parodi JC. Endovascular repair of abdominal aortic aneurysms and other arterial lesions. J Vase Surg 1995;21:549-55.
14. Dolmatch BL, Dong YH, Brennecke LH. Healing response to vascular stent-grafts. In: Dolmatch BL, Blum U, editors. Stent-grafts: current clinical practice. Kaçıncı Baskı. New York: Thieme; 2000. p. 31-42.