Endovascular management of acute complicated type B aortic dissection: adjunct procedures

ARDAL, Hasan; ARBATLI, Harun; NUMAN, Fürüzan; YILMAZ, OĞUZ; YAĞAN, Naci Erciyes; SÖNMEZ, Bingür; GÜLŞEN, Fatih

Endovascular management of acute complicated type B aortic dissection: adjunct procedures

Oğuz YILMAZ, (Şişli Memorial Hastanesi, Kalp ve Damar Cerrahisi Anabilim Dalı, İstanbul, Türkiye)

Harun ARBATLI, (Şişli Memorial Hastanesi, Kalp ve Damar Cerrahisi Anabilim Dalı, İstanbul, Türkiye)

Fürüzan NUMAN, (Şişli Memorial Hastanesi, İnvaziv Radyoloji, İstanbul, Türkiye)

Hasan ARDAL, (Şişli Memorial Hastanesi, Kalp ve Damar Cerrahisi Anabilim Dalı, İstanbul, Türkiye)

Naci Erciyes YAĞAN, (Şişli Memorial Hastanesi, Kalp ve Damar Cerrahisi Anabilim Dalı, İstanbul, Türkiye)

Fatih GÜLŞEN, (İstanbul Üniversitesi, Cerrahpaşa Tıp Fakültesi, Radyoloji Anabilim Dalı, İstanbul, Türkiye)

Bingür SÖNMEZ (Şişli Memorial Hastanesi, Kalp ve Damar Cerrahisi Anabilim Dalı, İstanbul, Türkiye)

Türk Göğüs Kalp Damar Cerrahisi Dergisi

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Yıl: 2014 Cilt: 22 Sayı: 2 Sayfa Aralığı: 312 - 319 Metin Dili: Türkçe İndeks Tarihi: 29-07-2022

Endovascular management of acute complicated type B aortic dissection: adjunct procedures

Öz:

Amaç: Bu çalışmada akut komplike tip B aort diseksiyonlarında endovasküler tedavinin (TEVAR) sonuçları ve ilave girişimsel işlemlerin katkıları değerlendirildi.Çalışma planı: Akut komplike tip B aort diseksiyonlu 30 hastaya (26 erkek, 4 kadın; ort. yaş 55.2±14.7 yıl; dağılım 24-86 yıl) endovasküler tedavi uygulandı. Hastaların sekizinde malperfüzyon (%26.7), dördünde rüptür riski (%13.3), 12'sinde kontrol edilemeyen hipertansiyon (%40) ve altısında tedaviye dirençli şiddetli ağrı (%20) vardı. Kendiliğinden genişleyen stent-greftler (Talent® and Valiant®, Medtronic Inc.) kullanıldı. Hastaların 19'unda (%63.3) sol subklaviyan arter ağzı bilerek kapatıldı. Sekiz hastada (%26.7) ilave stentleme gerekli oldu. Bu hastalarda toplam 12 adet çıplak metal stent kullanılmış olup, hastaların altısında (%20) renal arterlere, üçünde (%10) iliyak arterlere ve ikisinde de (%6.7) çölyak artere uygulandı. Ortalama takip süresi 55 ay (dağılım 25-99 ay) idi.Bul gu lar: İmplant edilen ortalama aortik stent-greft sayısı 1.42 idi. Bir hastada stent-greftin proksimale migrasyonu neticesinde sol ana karotis arter ağzı kısmen kapandı, ancak bu herhangi bir erken nörolojik komplikasyona neden olmadı. Aynı hastanın 15 ay sonra kendiliğinden antikoagülan tedavisini kesmesi sonucunda sağ hemipleji gelişti. Viseral malperfüzyonlu diğer bir hastada, çölyak ve sol renal arterlerin stentlenmesinden sonra yapılan erken laparoskopik eksplorasyonda bağırsak iskemisi olmadığı görüldü. İşlem sonrası anjina pektoris gelişen bir hastada ise, sağ koroner arterin stentlenmesi gerekti. Hiçbir hastada inme gözlenmezken, parapleji ile gelen bir hastada işlemin hemen ardından paraplejinin düzeldiği görüldü. Ortalama yoğun bakım ve hastane kalış süreleri sırasıyla 3.2±3.4 ve 9.8±7.1 gündü. Otuz gün içerisinde hiçbir hasta kaybedilmedi. Bir yıllık sağkalım oranı %96.7 idi.So nuç: Komplike tip B aort diseksiyonlarında endovasküler tedavinin başarı oranları yüksek olmasına rağmen, TEVAR tek başına bir çözüm olmayabilir. İşlemden hemen sonra malperfüzyon bulguları dikkatle gözlenmelidir. Viseral arterlerin stentlenmesi veya açık cerrahi revaskülarizasyon gibi ilave girişimler özellikle genç hastalarda göz önünde bulundurulmalıdır.

Anahtar Kelime:

Konular: Kalp ve Kalp Damar Sistemi Cerrahi

Akut komplike tip B aort diseksiyonlarında endovasküler tedavi: İlave işlemler

Öz:

Background: This study aims to evaluate the results of endovascular treatment (TEVAR) and the contribution of adjunct procedures in acute complicated type B aortic dissections. Methods: Thirty patients (26 males, 4 females; mean age 55.2±14.7 years, range 24 to 86 years) with acute complicated type B dissection underwent endovascular treatment. The dissection was complicated by malperfusion in eight patients (26.7%), impending rupture in four (13.3%), uncontrollable hypertension in 12 (40%), and severe treatment- resistant pain in six (20%). Self-expanding stent-grafts (Talent® and Valiant®, Medtronic Inc.) were used. Ostium of the left subclavian artery was covered intentionally in 19 patients (63.3%). Additional stenting was necessary in eight patients (26.7%). Of a total of 12 bare metal stents used in these patients, stents were inserted in the renal arteries in six (20%), iliac arteries in three (10%), and celiac arteries in two (6.7%) patients. Median follow-up was 55 months (range, 25 to 99 months). Results: The mean number of stent-grafts implanted was 1.42 (range, 1 to 3). One patient had inadvertent partial closure of the left common carotid artery ostium due to proximal migration of the stent-graft which caused no early neurological complications. Right hemiplegia occurred 15 months later due to his discontinuation of the anticoagulant therapy in the same patient. In another patient with visceral malperfusion, early laparoscopic exploration following the stenting of the celiac and the left renal arteries revealed no ischemia of the bowels. One patient with postoperative angina pectoris required stenting of the right coronary artery. There was no stroke in any patients, while reversal of paraplegia was observed in one patient early after the procedure. The mean lengths of intensive care unit and hospital stays were 3.2±3.4 and 9.8±7.1 days, respectively. There was no 30-day mortality. The one-year survival rate was 96.7%. Conclusion: Although endovascular treatment of complicated type B aortic dissections has a high success rate, TEVAR may not be the sole solution. Findings of malperfusion should be carefully sought in the early postoperative period. The adjunct procedures such as stenting of the visceral arteries or open surgical revascularization should always be considered particularly in young patients.

Anahtar Kelime:

Konular: Kalp ve Kalp Damar Sistemi Cerrahi

Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık

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APA	YILMAZ O, ARBATLI H, NUMAN F, ARDAL H, YAĞAN N, GÜLŞEN F, SÖNMEZ B (2014). Endovascular management of acute complicated type B aortic dissection: adjunct procedures. , 312 - 319.
Chicago	YILMAZ OĞUZ,ARBATLI Harun,NUMAN Fürüzan,ARDAL Hasan,YAĞAN Naci Erciyes,GÜLŞEN Fatih,SÖNMEZ Bingür Endovascular management of acute complicated type B aortic dissection: adjunct procedures. (2014): 312 - 319.
MLA	YILMAZ OĞUZ,ARBATLI Harun,NUMAN Fürüzan,ARDAL Hasan,YAĞAN Naci Erciyes,GÜLŞEN Fatih,SÖNMEZ Bingür Endovascular management of acute complicated type B aortic dissection: adjunct procedures. , 2014, ss.312 - 319.
AMA	YILMAZ O,ARBATLI H,NUMAN F,ARDAL H,YAĞAN N,GÜLŞEN F,SÖNMEZ B Endovascular management of acute complicated type B aortic dissection: adjunct procedures. . 2014; 312 - 319.
Vancouver	YILMAZ O,ARBATLI H,NUMAN F,ARDAL H,YAĞAN N,GÜLŞEN F,SÖNMEZ B Endovascular management of acute complicated type B aortic dissection: adjunct procedures. . 2014; 312 - 319.
IEEE	YILMAZ O,ARBATLI H,NUMAN F,ARDAL H,YAĞAN N,GÜLŞEN F,SÖNMEZ B "Endovascular management of acute complicated type B aortic dissection: adjunct procedures." , ss.312 - 319, 2014.
ISNAD	YILMAZ, OĞUZ vd. "Endovascular management of acute complicated type B aortic dissection: adjunct procedures". (2014), 312-319.

APA	YILMAZ O, ARBATLI H, NUMAN F, ARDAL H, YAĞAN N, GÜLŞEN F, SÖNMEZ B (2014). Endovascular management of acute complicated type B aortic dissection: adjunct procedures. Türk Göğüs Kalp Damar Cerrahisi Dergisi, 22(2), 312 - 319.
Chicago	YILMAZ OĞUZ,ARBATLI Harun,NUMAN Fürüzan,ARDAL Hasan,YAĞAN Naci Erciyes,GÜLŞEN Fatih,SÖNMEZ Bingür Endovascular management of acute complicated type B aortic dissection: adjunct procedures. Türk Göğüs Kalp Damar Cerrahisi Dergisi 22, no.2 (2014): 312 - 319.
MLA	YILMAZ OĞUZ,ARBATLI Harun,NUMAN Fürüzan,ARDAL Hasan,YAĞAN Naci Erciyes,GÜLŞEN Fatih,SÖNMEZ Bingür Endovascular management of acute complicated type B aortic dissection: adjunct procedures. Türk Göğüs Kalp Damar Cerrahisi Dergisi, vol.22, no.2, 2014, ss.312 - 319.
AMA	YILMAZ O,ARBATLI H,NUMAN F,ARDAL H,YAĞAN N,GÜLŞEN F,SÖNMEZ B Endovascular management of acute complicated type B aortic dissection: adjunct procedures. Türk Göğüs Kalp Damar Cerrahisi Dergisi. 2014; 22(2): 312 - 319.
Vancouver	YILMAZ O,ARBATLI H,NUMAN F,ARDAL H,YAĞAN N,GÜLŞEN F,SÖNMEZ B Endovascular management of acute complicated type B aortic dissection: adjunct procedures. Türk Göğüs Kalp Damar Cerrahisi Dergisi. 2014; 22(2): 312 - 319.
IEEE	YILMAZ O,ARBATLI H,NUMAN F,ARDAL H,YAĞAN N,GÜLŞEN F,SÖNMEZ B "Endovascular management of acute complicated type B aortic dissection: adjunct procedures." Türk Göğüs Kalp Damar Cerrahisi Dergisi, 22, ss.312 - 319, 2014.
ISNAD	YILMAZ, OĞUZ vd. "Endovascular management of acute complicated type B aortic dissection: adjunct procedures". Türk Göğüs Kalp Damar Cerrahisi Dergisi 22/2 (2014), 312-319.