Alt ekstremite periferik arter hastalığı tanısında Doppler US ve Multidedektör Bilgisayarlı Tomografi Anjiyografi bulgularının karşılaştırılması

Bülent Yıldız; İsmail Caymaz

Alt ekstremite periferik arter hastalığı tanısında Doppler US ve Multidedektör Bilgisayarlı Tomografi Anjiyografi bulgularının karşılaştırılması

Yıl 2013, Cilt: 35 Sayı: 4, 503 - 509, 16.12.2013

Bülent Yıldız , İsmail Caymaz

Öz

Özet

Amaç. Sistemik aterosklerozun bir belirtisi olan periferik arter hastalığı (PAH) aort kavsinin distalinde kalan arterlerde anlamlı daralmaya neden olur. Lezyonun yerinin belirlenmesi için sıklıkla kullanılan ve invazif olmayan inceleme yöntemleri Doppler ultrasonografi (US), manyetik rezonans anjiyografi (MRA) ve bilgisayarlı tomografi anjiyografidir (BTA). Girişim öncesinde damar patolojisinin kesin olarak lokalize edilebilmesi için kullanılan yöntem konvansiyonel anjiyografidir. Multidedektör teknolojisinin gelişmesi ile BTA çoğu olguda konvansiyonel anjiyografinin yerini almaya başlamıştır. Çalışmamızın amacı alt ekstremite PAH olan olgularda Doppler US’nin tanı değerini BTA bulguları ile birlikte değerlendirmektir. Yöntem. Bu çalışmaya PAH bulguları olan 45 hasta dahil edildi. Hastaların 35’inde (%77,8) intermittan kladikasyon, 7 hastada (%15,5) istirahat ağrısı, 3 hastada (%6,7) iskemik ülserasyon mevcut idi. Her bir bacak 7 arterial segmente ayrılıp 45 hastadaki 90 bacak olarak 630 arter segmenti BTA ve Doppler US ile değerlendirildi. Her bir hastaya aynı gün içerisinde önce Doppler US sonra BTA uygulandı .Doppler US ve BT sonuçları değerlendirildi. BTA ile saptanan darlık derecesine göre Doppler US bulgularındaki değişimler değerlendirildi. Bulgular. Kırk beş hasta (32 erkek 13 kadın; ortalama yaş 53,8±4,8) ile çalışma tamamlandı. Femoropopliteal arterin patolojik segmente sahip olma yüzdesi diğer damarlarinkine göre anlamlı olarak daha yüksek bulundu (p<0,05) Çalışılan diğer damarların patolojik segmente sahip olma yüzdeleri arasında anlamlı fark bulunmadı (p>0,05). Olguların çoğunluğu (%85) normal damar çapına sahipti ve bu olguların %98,1’inde pik sistolik hız oranı(PSHO) 1 olarak bulundu ve %6,4’ünde ise puls yokluğu saptandı. Olguların %7,3’inde damar tam oklüde olmasına rağmen bu olguların %0,8’inde PSVR 1 idi ve %85,1’inde puls yokluğu vardı. Sonuç. Genel olarak BTA bulguları ile oldukça paralel sonuçlar veren Doppler US PAH olgularının değerlendirmesinde başarılı bir yöntemdir.

Anahtar sözcükler: Periferik arter hastalığı, Doppler ultrasonografi, BT anjiyografi

Abstract

Aim. Peripheral arterial disease (PAD) is indication of systemic atherosclerosis that give rise to significant stenosis of the out of the distal aortic arch arteries. Doppler Ultrasonography (US), magnetic resonance angiography (MRA) and computed tomography angiography (CTA) are noninvasive methods and frequently used for determining to the lesion location. Contrast arteriography is a method to localized exact vessel pathology before intervention.With the enhance of multidetector technology, CTA sit in conventional angiography.The aim of study is that lower extremity PAD with cases, the evaluate of the diagnostic value of Doppler US with the findings of CTA. Method. 45 patients were included with the PAD findings in this study. There were 35 (77.8%) intermitten claudication, 7 (15.5%) rest pain and 3 (6.7%) ischemic ulseration of the patients. Each leg divided into 7 arterial segments, 630 arterial segments as 90 leg of the 45 patients were evaluated with CTA and Doppler US. Each of the patients were performed before Doppler US after CTA within the same day then were evaluated Doppler US and CT angiography results. Doppler US findings were evaluated in according to the degree of stenosis determined by CTA. Results. This study completed forty- five patients (32 males 13 females; mean age 53.8±4.8). We found significantly higher that have percentage of the pathologic segments of the femoropopliteal artery as to the other vessels (p<0.05). There was no significant difference that between percentages possession of pathologic segments of the studied other vessels (p>0.05). The majority of cases (85%) had normal vessel diamater and peak systolic velocity ratio (PSVR) was found 1 in 98.1% of cases and non pulsed was found in 6.4 %. Although being vessel complete ocluded in 7.3% of cases, PSVR was found 1 in 0.85% of this cases and there were no pulsed in 85,1%.Conclusion. Generally gives to notably parallel results with CTA findings which Doppler US is a successful modality for the evaluation of PAD cases.

Keywords: Peripheral arterial disease, Doppler ultrasonography, CT angiography

Anahtar Kelimeler

Peripheral arterial disease, Doppler ultrasonography, CT angiography

Kaynakça

1. Welten GM, Schouten O, Chonchol M, Hoeks SE, Bax JJ, Van Domburg RT, et al. Welten GM, Schouten O, Chonchol M, Hoeks SE, Bax JJ, Van Domburg RT, Poldermans D. Prognosis of patients with peripheral arterial disease. J Cardiovasc Surg (Torino) 2009; 50: 109-21.
2. Kannel WB, McGee DL. Update on some epidemiologic features of intermittent claudication: The Framingham Study. J Am Geriatr Soc 1985; 33: 13-8.
3. Slot HB, Strijbosch L, Greep JM. Interobserver variability in single-plane aortography. Surgery 1981; 90: 497-503.
4. Thiele BL, Strandness DE Jr. Accuracy of angiographic quantification of peripheral atherosclerosis. Prog Cardiovasc Dis 1983; 26: 223-36.
5. Hatsukami TS, Primozich J, Zierler RE, Strandness DE Jr. Color Doppler characteristics in normal lower extremity arteries. Ultrasound Med Biol. 1992; 18: 167-71.
6. Waugh JR, Sacharias N. Arteriographic complications in the DSA era. Radiology 1992; 182: 243-6.
7. Hankey GJ, Warlow CP, Sellar RJ. Cerebral angiographic risk in mild cerebrovascular disease. Stroke 1990; 21: 209-22.
8. Catalano C, Fraioli F, Laghi A, Napoli A, Bezzi M, Pediconi F, Danti M, Nofroni I, Passariello R. Infrarenal aortic and lower-extremity arterial disease: diagnostic performance of multi-detector row CT angiography. Radiology 2004; 231: 555-63.
9. Prokop M. Multislice CT angiography. Eur J Radiol 2000; 36: 86-96.
10. Rubin GD, Shiau MC, Schmidt AJ, Fleischmann D, Logan L, Leung AN, Jeffrey RB, Napel S. Computed tomographic angiography: historical perspective and new state-of-the-art using multi detector-row helical computed tomography. J Comput Assist Tomogr 1999; 23: S83-90.
11. Jager KA, Phillips DJ, Martin RL, Hanson C, Roederer GO, Langlois YE, Ricketts HJ, Strandness DE Jr. Noninvasive mapping of lower limb arterial lesions. Ultrasound Med Biol 1985; 11: 515-21.
12. Moneta GL, Yeager RA, Antonovic R, Hall LD, Caster JD, Cummings CA, Porter JM. Accuracy of lower extremity arterial duplex mapping. J Vasc Surg 1992; 15: 275-83.
13. Allard L, Cloutier G, Durand LG, Roederer GO, Langlois YE. Limitations of ultrasonic duplex scanning for diagnosing lower limb arterial stenoses in the presence of adjacent segment disease. J Vasc Surg 1994; 19: 650-7.
14. Polak JF, Karmel MI, Mannick JA, O'Leary DH, Donaldson MC, Whittemore AD. Determination of the extent of lower-extremity peripheral arterial disease with color-assisted duplex sonography: comparison with angiography. AJR Am J Roentgenol 1990; 155: 1085-9.
15. Moneta GL, Yeager RA, Antonovic R, Hall LD, Caster JD, Cummings CA, Porter JM. Accuracy of lower extremity arterial duplex mapping. J Vasc Surg 1992; 15: 275-84.
16. Lai DT, Huber D, Glasson R, Grayndler V, Evans J, Hogg J, Etheridge S. Colour duplex ultrasonography versus angiography in the diagnosis of lower-extremity arterial disease. Cardiovasc Surg 1996; 4: 384-8.
17. Krnic A, Vucic N, Sucic Z. Duplex scanning compared with intra-arterial angiography in diagnosing peripheral arterial disease: three analytical approaches. Vasa 2006; 35: 86-91.
18. Aly S, Sommerville K, Adiseshiah M, Raphael M, Coleridge Smith PD, Bishop CC. Comparison of duplex imaging and arteriography in the evaluation of lower limb arteries. Br J Surg 1998; 85: 1099-102.
19. Kannel WB, McGee DL. Update on some epidemiologic features of intermittent claudication: the Framingham Study. J Am Geriatr Soc 1985; 33: 13-8.
20. Cronenwett JL, Warner KG, Zelenock GB, Whitehouse WM Jr, Graham LM, Lindenauer M, Stanley JC. Intermittent claudication. Current results of nonoperative management. Arch Surg 1984; 119: 430-6.
21. Elsman BH, Legemate DA, van der Heijden FH, de Vos HJ, Mali WP, Eikelboom BC. Impact of ultrasonographic duplex scanning on therapeutic decision making in lower-limb arterial disease. Br J Surg 1995; 82: 630-3.
22. Rieker O, Düber C, Schmiedt W, von Zitzewitz H, Schweden F, Thelen M. Prospective comparison of CT angiography of the legs with intraarterial digital subtraction angiography. AJR Am J Roentgenol 1996; 166: 269-76.
23. Carpenter JP, Owen RS, Baum RA, Cope C, Barker CF, Berkowitz HD, Golden MA, Perloff LJ. Magnetic resonance angiography of peripheral runoff vessels. J Vasc Surg 1992; 16: 807-13.

Alt ekstremite periferik arter hastalığı tanısında Doppler US ve Multidedektör Bilgisayarlı Tomografi Anjiyografi bulgularının karşılaştırılması

Yıl 2013, Cilt: 35 Sayı: 4, 503 - 509, 16.12.2013

Bülent Yıldız , İsmail Caymaz

Öz

Özet

Anahtar sözcükler: Periferik arter hastalığı, Doppler ultrasonografi, BT anjiyografi

Abstract

Aim. Peripheral arterial disease (PAD) is indication of systemic atherosclerosis that give rise to significant stenosis of the out of the distal aortic arch arteries. Doppler Ultrasonography (US), magnetic resonance angiography (MRA) and computed tomography angiography (CTA) are noninvasive methods and frequently used for determining to the lesion location. Contrast arteriography is a method to localized exact vessel pathology before intervention.With the enhance of multidetector technology, CTA sit in conventional angiography.The aim of study is that lower extremity PAD with cases, the evaluation of the diagnostic value of Doppler US with the findings of CTA. Method. 45 patients were included with the PAD findings in this study. There were 35 (77.8%) intermitten claudication, 7 (15.5%) rest pain and 3 (6.7%) ischemic ulseration of the patients. Each leg divided into 7 arterial segments, 630 arterial segments as 90 leg of the 45 patients were evaluated with CTA and Doppler US. Each of the patients were performed before Doppler US after CTA within the same day then were evaluated Doppler US and CT angiography results. Doppler US findings were evaluated in according to the degree of stenosis determined by CTA. Results. This study completed forty- five patients (32 males 13 females; mean age 53.8±4.8). We found significantly higher that have percentage of the pathologic segments of the femoropopliteal artery as to the other vessels (p<0.05). There was no significant difference that between percentages possession of pathologic segments of the studied other vessels (p>0.05). The majority of cases (85%) had normal vessel diamater and peak systolic velocity ratio (PSVR) was found 1 in 98.1% of cases and non pulsed was found in 6.4 %. Although being vessel complete ocluded in 7.3% of cases, PSVR was found 1 in 0.85% of this cases and there were no pulsed in 85,1%.Conclusion. Generally gives to notably parallel results with CTA findings which Doppler US is a successful modality for the evaluation of PAD cases.

Keywords: Peripheral arterial disease, Doppler ultrasonography, CT angiography

Anahtar Kelimeler

Periferik arter hastalığı, Doppler ultrasonografi, BT anjiyografi

Kaynakça

1. Welten GM, Schouten O, Chonchol M, Hoeks SE, Bax JJ, Van Domburg RT, et al. Welten GM, Schouten O, Chonchol M, Hoeks SE, Bax JJ, Van Domburg RT, Poldermans D. Prognosis of patients with peripheral arterial disease. J Cardiovasc Surg (Torino) 2009; 50: 109-21.
2. Kannel WB, McGee DL. Update on some epidemiologic features of intermittent claudication: The Framingham Study. J Am Geriatr Soc 1985; 33: 13-8.
3. Slot HB, Strijbosch L, Greep JM. Interobserver variability in single-plane aortography. Surgery 1981; 90: 497-503.
4. Thiele BL, Strandness DE Jr. Accuracy of angiographic quantification of peripheral atherosclerosis. Prog Cardiovasc Dis 1983; 26: 223-36.
5. Hatsukami TS, Primozich J, Zierler RE, Strandness DE Jr. Color Doppler characteristics in normal lower extremity arteries. Ultrasound Med Biol. 1992; 18: 167-71.
6. Waugh JR, Sacharias N. Arteriographic complications in the DSA era. Radiology 1992; 182: 243-6.
7. Hankey GJ, Warlow CP, Sellar RJ. Cerebral angiographic risk in mild cerebrovascular disease. Stroke 1990; 21: 209-22.
8. Catalano C, Fraioli F, Laghi A, Napoli A, Bezzi M, Pediconi F, Danti M, Nofroni I, Passariello R. Infrarenal aortic and lower-extremity arterial disease: diagnostic performance of multi-detector row CT angiography. Radiology 2004; 231: 555-63.
9. Prokop M. Multislice CT angiography. Eur J Radiol 2000; 36: 86-96.
10. Rubin GD, Shiau MC, Schmidt AJ, Fleischmann D, Logan L, Leung AN, Jeffrey RB, Napel S. Computed tomographic angiography: historical perspective and new state-of-the-art using multi detector-row helical computed tomography. J Comput Assist Tomogr 1999; 23: S83-90.
11. Jager KA, Phillips DJ, Martin RL, Hanson C, Roederer GO, Langlois YE, Ricketts HJ, Strandness DE Jr. Noninvasive mapping of lower limb arterial lesions. Ultrasound Med Biol 1985; 11: 515-21.
12. Moneta GL, Yeager RA, Antonovic R, Hall LD, Caster JD, Cummings CA, Porter JM. Accuracy of lower extremity arterial duplex mapping. J Vasc Surg 1992; 15: 275-83.
13. Allard L, Cloutier G, Durand LG, Roederer GO, Langlois YE. Limitations of ultrasonic duplex scanning for diagnosing lower limb arterial stenoses in the presence of adjacent segment disease. J Vasc Surg 1994; 19: 650-7.
14. Polak JF, Karmel MI, Mannick JA, O'Leary DH, Donaldson MC, Whittemore AD. Determination of the extent of lower-extremity peripheral arterial disease with color-assisted duplex sonography: comparison with angiography. AJR Am J Roentgenol 1990; 155: 1085-9.
15. Moneta GL, Yeager RA, Antonovic R, Hall LD, Caster JD, Cummings CA, Porter JM. Accuracy of lower extremity arterial duplex mapping. J Vasc Surg 1992; 15: 275-84.
16. Lai DT, Huber D, Glasson R, Grayndler V, Evans J, Hogg J, Etheridge S. Colour duplex ultrasonography versus angiography in the diagnosis of lower-extremity arterial disease. Cardiovasc Surg 1996; 4: 384-8.
17. Krnic A, Vucic N, Sucic Z. Duplex scanning compared with intra-arterial angiography in diagnosing peripheral arterial disease: three analytical approaches. Vasa 2006; 35: 86-91.
18. Aly S, Sommerville K, Adiseshiah M, Raphael M, Coleridge Smith PD, Bishop CC. Comparison of duplex imaging and arteriography in the evaluation of lower limb arteries. Br J Surg 1998; 85: 1099-102.
19. Kannel WB, McGee DL. Update on some epidemiologic features of intermittent claudication: the Framingham Study. J Am Geriatr Soc 1985; 33: 13-8.
20. Cronenwett JL, Warner KG, Zelenock GB, Whitehouse WM Jr, Graham LM, Lindenauer M, Stanley JC. Intermittent claudication. Current results of nonoperative management. Arch Surg 1984; 119: 430-6.
21. Elsman BH, Legemate DA, van der Heijden FH, de Vos HJ, Mali WP, Eikelboom BC. Impact of ultrasonographic duplex scanning on therapeutic decision making in lower-limb arterial disease. Br J Surg 1995; 82: 630-3.
22. Rieker O, Düber C, Schmiedt W, von Zitzewitz H, Schweden F, Thelen M. Prospective comparison of CT angiography of the legs with intraarterial digital subtraction angiography. AJR Am J Roentgenol 1996; 166: 269-76.
23. Carpenter JP, Owen RS, Baum RA, Cope C, Barker CF, Berkowitz HD, Golden MA, Perloff LJ. Magnetic resonance angiography of peripheral runoff vessels. J Vasc Surg 1992; 16: 807-13.

Toplam 23 adet kaynakça vardır.

Ayrıntılar

Birincil Dil	Türkçe
Bölüm	Dahili Tıp Bilimleri Araştırma Yazıları
Yazarlar	Bülent Yıldız İsmail Caymaz
Yayımlanma Tarihi	16 Aralık 2013
Yayımlandığı Sayı	Yıl 2013Cilt: 35 Sayı: 4

Kaynak Göster

AMA	Yıldız B, Caymaz İ. Alt ekstremite periferik arter hastalığı tanısında Doppler US ve Multidedektör Bilgisayarlı Tomografi Anjiyografi bulgularının karşılaştırılması. CMJ. Aralık 2013;35(4):503-509.

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