Öz
Objective: It is reported that additional techniques such as atherectomy or stent implantation can be used to increase the effectiveness of balloon angioplasty in the treatment of occlusive peripheral artery disease, and it is reported that atherectomy is performed based on the principle of reducing the volume of serious plaques, reducing the pressures required for balloon angioplasty, and allowing vessel reshaping. It is reported that the available data for this procedure are generally limited to very few single-arm data and single-center studies involving patients with occlusive peripheral arteries. In our study, we aimed to publish early results of our atherectomy experience in patients with infrainguinal occlusive arterial disease and discuss them in the light of the literature.
Material and Methods: Our retrospective study was conducted on patients with occlusive infrainguinal arterial disease who underwent successful endovascular revascularization, and those who underwent peripheral rotational atherectomy. Occlusive infrainguinal arterial disease of the patients included in the study was detected by imaging methods before the procedure. Patients who underwent hybrid revascularization procedure, acute thromboembolectomy, endovascular aneurysm repair, or peripheral bypass surgery due to existing diseases in the same session were not included in the study. All procedures were performed in the angiography unit or in the cardiovascular surgery operating room accompanied by a fluoroscopy device.
Results: The average age of the 13 patients evaluated in the study was 65.23±13.57. Intraprocedural dissection was detected in 3 of the procedures and was treated with simultaneous stent implantation. Stent implantation (due to dissection or insufficient lumen patency) was performed in 8 of the rocedures. No mortality or pseudoaneurysm was detected in the post-procedure service follow-up of the study patients.
Conclusion: We think that atherectomy may be a safe and effective treatment alternative in occlusive infrainguinal arterial disease, especially in the presence of severe calcifications and long segment occlusions, and that prospective studies on this subject would be beneficial.
Anahtar Kelimeler
Atherectomy endovascular peripheral arterial disease angioplasty
Kaynakça
- Abdullah O, Omran J, Al-Dadah AS, Aggarwal K, Enezate T. Atherectomy-assisted versus percutaneous angioplasty interventions for treatment of symptomatic infra-inguinal peripheral arterial disease. Arch Med Sci Atheroscler Dis. 2019;4:e231-e242.
- Hirsch AT, Criqui MH, Treat-Jacobson D, et al. Peripheral arterial disease detection, awareness, and treatment in primary care. JAMA. 2001;286(11):1317-1324.
- Sathish M, Julie MF, Edward JA, et al. Peripheral atherectomy practice patterns in the United States from the Vascular Quality Initiative. J Vasc Surg. 2018;68(6):1806- 1816.
- Siracuse JJ, Menard MT, Eslami MH, et al. Comparison of open and endovascular treatment of patients with critical limb ischemia in the Vascular Quality Initiative. J Vasc Surg. 2016;63(4):958-965.e1.
- Henry M, Amor M, Ethevenot G, Henry I, Allaoui M. Percutaneous peripheral atherectomy using the rotablator: A single-center experience. J Endovasc Surg. 1995;2(1):51-66.
- Shammas NW, Lam R, Mustapha J, et al. Comparison of orbital atherectomy plus balloon angioplasty vs. balloon angioplasty alone in patients with critical limb ischemia: Results of the CALCIUM 360 randomized pilot trial. J Endovasc Ther. 2012;19(4):480-488.
- Eskelinen E, Alback A, Roth WD, et al. Infra-inguinal percutaneous transluminal angioplasty for limb salvage: A retrospective analysis in a single center. Acta Radiol. 2005; 46(2):155-162.
- Gallagher KA, Meltzer AJ, Ravin RA, et al. Endovascular management as first therapy for chronic total occlusion of the lower extremity arteries: Comparison of balloon angioplasty, stenting, and directional atherectomy. J Endovasc Ther. 2011;18(5):624-623.
- Shammas NW, Coiner D, Shammas GA, Dippel EJ, Christensen L, Jerin M. Percutaneous lower-extremity arterial interventions with primary balloon angioplasty versus Silverhawk atherectomy and adjunctive balloon angioplasty: Randomized trial. J Vasc Interv Radiol. 2011;22(9):1223-1228.
- Yilmaz S, Kızıltan F, Kalender M, Parlar H, Şaşkın H, Barış Ö. Popliteal access for endovascular procedures in femoropopliteal artery occlusive disease. Adv Interv Cardiol. 2023;19(3):277-283.
- Akkus N, Abdulbaki A, Jimenez E, Tandon N. Atherectomy devices: Technology update. Med Devices: Evid Res. 2015;8:1-10.
- Engelberger S, van den Berg JC. Atherectomy in complex infrainguinal lesions: A review. J Cardiovasc Surg (Torino.) 2015;56(1):43-54.
- Mukherjee D, Hashemi H, Contos B. The disproportionate growth of office-based atherectomy. J Vasc Surg. 2017;65(2):495-500.
- Panaich SS, Arora S, Patel N, et al. In-hospital outcomes of atherectomy during endovascular lower extremity revascularization. Am J Cardiol. 2016;117(4):676-684.
- Zeller T, Krankenberg H, Steinkamp H, et al. One-year outcome of percutaneous rotational atherectomy with aspiration in infrainguinal peripheral arterial occlusive disease: The multicenter pathway PVD trial. J Endovasc Ther. 2009;16(6):653-662.
- Gürkan S, Gür Ö, Yüksel V. Kalsifiye stenotik süperfisyal femoral arter lezyonlarının tedavisinde direksiyonel aterektomi ile kombine edilmiş paklitaksel salınımlı balon anjioplasti ve kendiliğinden açılan nitinol stent uygulamasının karşılaştırılması. Düzce Tıp Fak Derg. 2019;21(1):9-13.
- Yancey AE, Minion DJ, Rodriguez C, Patterson DE, Endean ED. Peripheral atherectomy in TransAtlantic InterSociety Consensus type C femoropopliteal lesions for limb salvage. J Vasc Surg. 2006;44(3):503-509.
- Zeller T, Rastan A, Schwarzwalder U, et al. Percutaneous peripheral atherectomy of femoropopliteal stenoses using a new-generation device: Six-month results from a single- center experience. J Endovasc Ther. 2004;11(6):676-685.
- Ramaiah V, Gammon R, Kiesz S, et al. Midterm outcomes from the TALON Registry: Treating peripherals with SilverHawk: Outcomes collection. J Endovasc Ther. 2006;13(5):592-602.
- McKinsey JF, Zeller T, Rocha-Singh KJ, Jaff MR, Garcia LA, DEFINITIVE LE Investigators. Lower extremity revascularization using directional atherectomy: 12-month prospective results of the DEFINITIVE LE study. JACC Cardiovasc Interv. 2014;7(8):923-933.
- Janas A, Milewski K, Buszman P, et al. Comparison of long-term outcomes after directional versus rotational atherectomy in peripheral artery disease. Postepy Kardiol Interwencyjnej. 2020;16(1):76-81.
- Sixt S, Scheinert D, Rastan A, et al. One-year outcome after percutaneous rotational and aspiration atherectomy in infrainguinal arteries in patient with and without type 2 diabetes mellitus. Ann Vasc Surg. 2011;25(4):520-529.
- Shrikhande GV, Khan SZ, Hussain HG, Dayal R, McKinsey JF, Morrissey N. Lesion types and device characteristics that predict distal embolization during percutaneous lower extremity interventions. J Vasc Surg. 2011;53(2):347-352.
- Bhat TM, Afari ME, Garcia LA. Atherectomy in peripheral artery disease: A review. J Invasive Cardiol. 2017;29(4):135-144
Öz
Amaç: Tıkayıcı periferik arter hastalığı tedavisinde aterektomi veya stent implantasyonu gibi ek tekniklerin balon anjioplastinin etkinliğini arttırmak için kullanılabilecekleri bildirilmekte olup aterektomi işleminin ciddi plakların hacminin azaltılması, balon anjiyoplasti için gerekli olan basınçların düşürülmesi ve damarın yeniden şekillendirilmesine imkân sağlama prensibi temelinde gerçekleştirdiği bildirilmektedir. Bu işleme yönelik mevcut verilerin genellikle tıkayıcı periferik arter hastalarını içeren çok az sayıdaki tek kollu veriler ve tek merkezli çalışmalarla sınırlı olduğu bildirilmektedir. Çalışmamızda infrainguinal tıkayıcı arteryel hastalıklı hastalarda aterektomi deneyimimize ait erken dönem sonuçlarımızı yayınlamayı ve literatür eşliğinde tartışmayı amaçladık.
Gereç ve Yöntemler: Retrospektif çalışmamız şikâyetleri nedeniyle başarılı endovasküler revaskülarizasyon uygulanmış tıkayıcı infrainguinal arteryel hastalıklı hastalardan periferik rotasyonel aterektomi işlemi uygulanmış olanlarda gerçekleştirildi. Çalışmaya dahil edilen hastaların tıkayıcı infrainguinal arteryel hastalığı işlem öncesinde görüntüleme yöntemleri ile tespit edilmişti. Aynı seansta hibrit revaskülarizasyon prosedürü uygulanmış, akut tromboembolektomi uygulanmış, endovasküler anevrizma tamiri uygulanmış, mevcut hastalıkları nedeniyle periferik bypass operasyonu uygulanmış hastalar çalışmaya dahil edilmediler. Tüm işlemler angiografi ünitesinde veya skopi cihazı eşliğinde kalp ve damar cerrahisi ameliyat salonunda gerçekleştirilmişti.
Bulgular: Çalışmada değerlendirilen 13 hastanın yaş ortalaması 65.23±13.57 idi. İşlemlerin 3 tanesinde intraprosedürel diseksiyon saptandı ve eş zamanlı stent implantasyonu ile tedavi edilmişlerdi. İşlemlerin 8 tanesinde stent implantasyonu (diseksiyon veya yetersiz lümen açıklığı nedeniyle) gerçekleştirilmişti. Çalışma hastalarının işlem sonrası servis takibinde mortalite ve psödoanevrizma saptanamamıştı.
Sonuç: Özellikle ciddi kalsifikasyonlar ve uzun segment oklüzyonların varlığında aterektomi ygulanmasının tıkayıcı infrainguinal arteryel hastalıkta güvenli ve etkili bir tedavi alternatifi olabileceğini ve bununla ilgili prospektif çalışmalar yapılmasının faydalı olacağını düşünmekteyiz.
Anahtar Kelimeler
Aterektomi endovasküler periferik arter hastalığı anjioplasti
Etik Beyan
‘’İnfrainguinal arteryel tıkayıcı hastalıkta aterektominin erken sonuçları’’ başlıklı retrospektif çalışmanın verileri 2020 yılı öncesi döneme ait olduğundan etik kurul izni gerektirmeyen çalışmalar kapsamında değerlendirilmesini bildiririm/talep ederim.
Destekleyen Kurum
yok
Teşekkür
yok
Kaynakça
- Abdullah O, Omran J, Al-Dadah AS, Aggarwal K, Enezate T. Atherectomy-assisted versus percutaneous angioplasty interventions for treatment of symptomatic infra-inguinal peripheral arterial disease. Arch Med Sci Atheroscler Dis. 2019;4:e231-e242.
- Hirsch AT, Criqui MH, Treat-Jacobson D, et al. Peripheral arterial disease detection, awareness, and treatment in primary care. JAMA. 2001;286(11):1317-1324.
- Sathish M, Julie MF, Edward JA, et al. Peripheral atherectomy practice patterns in the United States from the Vascular Quality Initiative. J Vasc Surg. 2018;68(6):1806- 1816.
- Siracuse JJ, Menard MT, Eslami MH, et al. Comparison of open and endovascular treatment of patients with critical limb ischemia in the Vascular Quality Initiative. J Vasc Surg. 2016;63(4):958-965.e1.
- Henry M, Amor M, Ethevenot G, Henry I, Allaoui M. Percutaneous peripheral atherectomy using the rotablator: A single-center experience. J Endovasc Surg. 1995;2(1):51-66.
- Shammas NW, Lam R, Mustapha J, et al. Comparison of orbital atherectomy plus balloon angioplasty vs. balloon angioplasty alone in patients with critical limb ischemia: Results of the CALCIUM 360 randomized pilot trial. J Endovasc Ther. 2012;19(4):480-488.
- Eskelinen E, Alback A, Roth WD, et al. Infra-inguinal percutaneous transluminal angioplasty for limb salvage: A retrospective analysis in a single center. Acta Radiol. 2005; 46(2):155-162.
- Gallagher KA, Meltzer AJ, Ravin RA, et al. Endovascular management as first therapy for chronic total occlusion of the lower extremity arteries: Comparison of balloon angioplasty, stenting, and directional atherectomy. J Endovasc Ther. 2011;18(5):624-623.
- Shammas NW, Coiner D, Shammas GA, Dippel EJ, Christensen L, Jerin M. Percutaneous lower-extremity arterial interventions with primary balloon angioplasty versus Silverhawk atherectomy and adjunctive balloon angioplasty: Randomized trial. J Vasc Interv Radiol. 2011;22(9):1223-1228.
- Yilmaz S, Kızıltan F, Kalender M, Parlar H, Şaşkın H, Barış Ö. Popliteal access for endovascular procedures in femoropopliteal artery occlusive disease. Adv Interv Cardiol. 2023;19(3):277-283.
- Akkus N, Abdulbaki A, Jimenez E, Tandon N. Atherectomy devices: Technology update. Med Devices: Evid Res. 2015;8:1-10.
- Engelberger S, van den Berg JC. Atherectomy in complex infrainguinal lesions: A review. J Cardiovasc Surg (Torino.) 2015;56(1):43-54.
- Mukherjee D, Hashemi H, Contos B. The disproportionate growth of office-based atherectomy. J Vasc Surg. 2017;65(2):495-500.
- Panaich SS, Arora S, Patel N, et al. In-hospital outcomes of atherectomy during endovascular lower extremity revascularization. Am J Cardiol. 2016;117(4):676-684.
- Zeller T, Krankenberg H, Steinkamp H, et al. One-year outcome of percutaneous rotational atherectomy with aspiration in infrainguinal peripheral arterial occlusive disease: The multicenter pathway PVD trial. J Endovasc Ther. 2009;16(6):653-662.
- Gürkan S, Gür Ö, Yüksel V. Kalsifiye stenotik süperfisyal femoral arter lezyonlarının tedavisinde direksiyonel aterektomi ile kombine edilmiş paklitaksel salınımlı balon anjioplasti ve kendiliğinden açılan nitinol stent uygulamasının karşılaştırılması. Düzce Tıp Fak Derg. 2019;21(1):9-13.
- Yancey AE, Minion DJ, Rodriguez C, Patterson DE, Endean ED. Peripheral atherectomy in TransAtlantic InterSociety Consensus type C femoropopliteal lesions for limb salvage. J Vasc Surg. 2006;44(3):503-509.
- Zeller T, Rastan A, Schwarzwalder U, et al. Percutaneous peripheral atherectomy of femoropopliteal stenoses using a new-generation device: Six-month results from a single- center experience. J Endovasc Ther. 2004;11(6):676-685.
- Ramaiah V, Gammon R, Kiesz S, et al. Midterm outcomes from the TALON Registry: Treating peripherals with SilverHawk: Outcomes collection. J Endovasc Ther. 2006;13(5):592-602.
- McKinsey JF, Zeller T, Rocha-Singh KJ, Jaff MR, Garcia LA, DEFINITIVE LE Investigators. Lower extremity revascularization using directional atherectomy: 12-month prospective results of the DEFINITIVE LE study. JACC Cardiovasc Interv. 2014;7(8):923-933.
- Janas A, Milewski K, Buszman P, et al. Comparison of long-term outcomes after directional versus rotational atherectomy in peripheral artery disease. Postepy Kardiol Interwencyjnej. 2020;16(1):76-81.
- Sixt S, Scheinert D, Rastan A, et al. One-year outcome after percutaneous rotational and aspiration atherectomy in infrainguinal arteries in patient with and without type 2 diabetes mellitus. Ann Vasc Surg. 2011;25(4):520-529.
- Shrikhande GV, Khan SZ, Hussain HG, Dayal R, McKinsey JF, Morrissey N. Lesion types and device characteristics that predict distal embolization during percutaneous lower extremity interventions. J Vasc Surg. 2011;53(2):347-352.
- Bhat TM, Afari ME, Garcia LA. Atherectomy in peripheral artery disease: A review. J Invasive Cardiol. 2017;29(4):135-144
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Özgün Araştırma |
| Yazarlar | |
| Yayımlanma Tarihi | 24 Nisan 2024 |
| Gönderilme Tarihi | 5 Ocak 2024 |
| Kabul Tarihi | 11 Ocak 2024 |
| Yayımlandığı Sayı | Yıl 2024 Cilt: 26 Sayı: 1 |
Kaynak Göster
Bu Dergi, Kırıkkale Üniversitesi Tıp Fakültesi Yayınıdır.