Öz
Aim. Peripheral arterial aneurysms are frequently encountered due to increased incidence of
arteriosclerosis and common use of invasive methods for the diagnostic and therapeutic purposes.
The aim of this report is to evaluate preoperative features of peripheral arterial aneurisms operated
at our clinic and their surgical results retrospectively. Methods. 35 peripheral arterial aneurysm
cases diagnosed and operated at our clinic between the years of 1999-2008 and they were
retrospectively evaluated. Results. Acute and chronic ischemia of the extremities were determined
in 12 cases (34.3%). True aneurysms were seen in 12 (34.3%) cases (more than one aneurysm in
one case). Pseudo-aneurysms were seen in 23 (65.7%) cases. Frequent causes for true and pseudoaneurysms were arteriosclerosis and iatrogenic factors. Frequent localization of the 26 (74.2%)
aneurysms were the femoral and popliteal arteries. It was noted that, aneurysmectomy combined
with interposition of sapheneous vein or synthetic graft was the most commonly applied surgical
method in patients with true anevrisms. Conclusions. In one true anevrism (2.9%), amputation of
the lower extremity toes was required due to ischemia more than eight hours. It is suggested that
peripheral aneurysms (even asymptomatic cases) must be surgically treated since they may cause
serious complications.
Anahtar Kelimeler
Kaynakça
- Keçeligil HT, Kolbakır F, Keyik T, Erk MK. Periferik arter psödoanevrizmaları. Türk Göğüs Kalp Damar Cerrahisi Dergisi 1994; 2: 323-5.
- Trubel W, Staudacher M, Wolner E. Aneurysm spurium after iatrogenic arterial puncture- incidence, risk factors and surgical therapy. Wien Clin Wochenschr 1993; 105: 139-43.
- Anthony S, Charles MM, Steven FH, Lois S, Julius HJ, Jonathan LH. Femoral Pseudoaneurysm following Nonpenetrating Trauma in a Patient with Aortic Insufficiency. Am. J. Med 1985; 78: 719-20.
- Messina LM, Brothers TE, Wakefield TW, Zelenock GB, Lindenauer SM, Greenfield LJ, Jacobs LA, Fellows EP, Grube SV, Stanley JC. Clinical characteristics and surgical management of vascular complications in patients undergoing cardiac catheterization: Interventional versus diagnostic procedures. J Vasc Surg 1991; 13: 593-600.
- Kurtoglu M, Aksoy M, Karaaslan C, Zilan A. Renkli Doppler ultrasonografi, psödoanevrizmaların tanısında olduğu kadar tedavisinde de etkin bir seçenektir. Ulusal Travma Dergisi 2003; 9: 300-3
- Kang SS, Labropoulos N, Mansour MA, Baker WH. Percutaneous ultrasound guided thrombin injection: A new method for treating postcatheterization femoral pseudoaneurysms. J Vasc Surg 1998; 27:1032-8.
- 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.
- Clark ET, Gewertz BL. Pseudoaneurysms. In: Rutherford RB (Ed). Vascular Surgery. 4th edition. Philadelphia (USA): W.B. Saunders Company, 1995: pp1153-61.
- Johns JP, Pupa LE, Bailey SR. Spontaneous thrombosis of iatrogenic femoral artery pseudoaneurysms:Documentation ultrasonography. J Vasc Surg 1991; 14: 24-9. with color Doppler and two dimensional
- Zahn R, Thoma S, Fromm E, Lotter R, Zander M, Seidl K, Senges J. Do 5-F-catheters reduce the incidence of a pseudoaneurysm. Int Angiol 1996; 15: 257-60.
- Rudolphi D. An update on the peripheral pseudoaneurysm. J Vasc Nurs 1993; 11: 67-70.
- Roggo A, Brunner U, Ottinger LW, Largiader F. The continuing challenge of aneurysms of the popliteal artery. Surg GynecolObstet 1993; 177: 565-72.
- Ouriel K, Shortell CK. Popliteal and Femoral Aneursyms. In: Rutherford RB (Ed). Vascular Surgery. 4. Edition. New-York (USA): W.B. Saunders. 1995: pp1103-112.
- Ting ACW, Cheng SWK. Femoral pseudoaneurysms in drug addicts. World J Surg 1997; 21: 783-87.
- Ylönen K, Biancari F, Leo E, Rainio P, Salmela E, Lahtinen J, Satta J, Pokela R, Lepojärvi M, Juvonen T. Predictors of development of anastomotic femoral pseudoaneurysms after aortobifemoral reconstruction for abdominal aortic aneurysm. Am J Surg 2004; 187: 83-7.
- Mahmood A, Salaman R, Sintler M, Smith SR, Simms MH, Vohra RK. Surgery of popliteal artery aneurysms: a 12-year experience. J Vasc Surg 2003; 37: 586-93.
Öz
Amaç. Son yıllarda tanı ve tedavi amaçlı invaziv metotların yaygın kullanımı nedeniyle pseudo
anevrizma olguları artmıştır. Bu çalışmamızın amacı, kliniğimizde opere edilen periferik arter
gerçek ve pseudo anevrizma olgularının preoperatif özelliklerinin, cerrahi tedavi sonuçlarının
retrospektif olarak değerlendirilmesidir. Yöntem. Kliniğimizde 1999-2008 yılları arasında
periferik arter anevrizması saptanan 35 olgu retrospektif olarak incelendi. Bulgular. Akut ve
kronik olmak üzere toplam 12 (%34,3) olguda ekstremite iskemisi mevcuttu. Gerçek anevrizma 12
(%34,3) (1 olguda birden fazla anevrizma), psödoanevrizma ise 23 (%65,7) olguda tespit edildi.
Etiyolojide gerçek anevrizmalarda en sık ateroskleroz, psödoanevrizmalarda ise iyatrojenik
nedenler saptandı. 26 (%74,2) olguda anevrizmanın en sık yerleştiği bölge femoral ve popliteal
arterler olup en sık uygulanan cerrahi yöntemin psödo anevrizmada primer tamir, gerçek
anevrizmada ise anevrizmektomi ile birlikte safen ven veya sentetik greft interpozisyonu idi.
Sonuçlar. Toplam 1 (%2,9) gerçek anevrizmada 8 saatlik bir iskemi nedeniyle alt ekstremite
parmaklarında ampütasyon gerekti. Elektif cerrahi onarımın, bu komplikasyonun tedavisini
kolaylaştırdığı görülmüştür. Komplikasyon gelişimi, yapılacak müdahalelerin başarı şansını
azaltacağı için asemptomatik bile olsa periferik anevrizmalar mutlaka cerrahi olarak tedavi
edilmelidir.
Anahtar Kelimeler
Kaynakça
- Keçeligil HT, Kolbakır F, Keyik T, Erk MK. Periferik arter psödoanevrizmaları. Türk Göğüs Kalp Damar Cerrahisi Dergisi 1994; 2: 323-5.
- Trubel W, Staudacher M, Wolner E. Aneurysm spurium after iatrogenic arterial puncture- incidence, risk factors and surgical therapy. Wien Clin Wochenschr 1993; 105: 139-43.
- Anthony S, Charles MM, Steven FH, Lois S, Julius HJ, Jonathan LH. Femoral Pseudoaneurysm following Nonpenetrating Trauma in a Patient with Aortic Insufficiency. Am. J. Med 1985; 78: 719-20.
- Messina LM, Brothers TE, Wakefield TW, Zelenock GB, Lindenauer SM, Greenfield LJ, Jacobs LA, Fellows EP, Grube SV, Stanley JC. Clinical characteristics and surgical management of vascular complications in patients undergoing cardiac catheterization: Interventional versus diagnostic procedures. J Vasc Surg 1991; 13: 593-600.
- Kurtoglu M, Aksoy M, Karaaslan C, Zilan A. Renkli Doppler ultrasonografi, psödoanevrizmaların tanısında olduğu kadar tedavisinde de etkin bir seçenektir. Ulusal Travma Dergisi 2003; 9: 300-3
- Kang SS, Labropoulos N, Mansour MA, Baker WH. Percutaneous ultrasound guided thrombin injection: A new method for treating postcatheterization femoral pseudoaneurysms. J Vasc Surg 1998; 27:1032-8.
- 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.
- Clark ET, Gewertz BL. Pseudoaneurysms. In: Rutherford RB (Ed). Vascular Surgery. 4th edition. Philadelphia (USA): W.B. Saunders Company, 1995: pp1153-61.
- Johns JP, Pupa LE, Bailey SR. Spontaneous thrombosis of iatrogenic femoral artery pseudoaneurysms:Documentation ultrasonography. J Vasc Surg 1991; 14: 24-9. with color Doppler and two dimensional
- Zahn R, Thoma S, Fromm E, Lotter R, Zander M, Seidl K, Senges J. Do 5-F-catheters reduce the incidence of a pseudoaneurysm. Int Angiol 1996; 15: 257-60.
- Rudolphi D. An update on the peripheral pseudoaneurysm. J Vasc Nurs 1993; 11: 67-70.
- Roggo A, Brunner U, Ottinger LW, Largiader F. The continuing challenge of aneurysms of the popliteal artery. Surg GynecolObstet 1993; 177: 565-72.
- Ouriel K, Shortell CK. Popliteal and Femoral Aneursyms. In: Rutherford RB (Ed). Vascular Surgery. 4. Edition. New-York (USA): W.B. Saunders. 1995: pp1103-112.
- Ting ACW, Cheng SWK. Femoral pseudoaneurysms in drug addicts. World J Surg 1997; 21: 783-87.
- Ylönen K, Biancari F, Leo E, Rainio P, Salmela E, Lahtinen J, Satta J, Pokela R, Lepojärvi M, Juvonen T. Predictors of development of anastomotic femoral pseudoaneurysms after aortobifemoral reconstruction for abdominal aortic aneurysm. Am J Surg 2004; 187: 83-7.
- Mahmood A, Salaman R, Sintler M, Smith SR, Simms MH, Vohra RK. Surgery of popliteal artery aneurysms: a 12-year experience. J Vasc Surg 2003; 37: 586-93.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Cerrahi Tıp Bilimleri Araştırma Yazıları |
| Yazarlar | |
| Yayımlanma Tarihi | 13 Mayıs 2009 |
| Yayımlandığı Sayı | Yıl 2009Cilt: 31 Sayı: 3 |