Ankara Med J. 2020; 20(1): 242-250 | DOI: 10.5505/amj.2020.42103

Santral venöz stenoz ve oklüzyonlarda endovasküler tedavi seçenekleri;Anjioplasti mi?, Stent mi ?

Behlül Ýgüs¹, Ali Fýrat¹, Hüseyin Yüce Bircan^2
1Baþkent Üniversitesi Ýstanbul Hastanesi, Radyoloji Bölümü,i̇stanbul
²Baþkent Üniversitesi Ýstanbul Hastanesi,Genel Cerrahi Bölümü,Ýstanbul

GÝRÝÞ ve AMAÇ: Bu çalýþmada santral ven darlýðý veya týkanýklýðý olan hemodiyaliz hastalarýnýn perkütan transluminal anjiyoplasti (PTA) ve perkütan transluminal stentleme (PTS) ile tedavinin etkinliðini ve patensi oranlarýnýn sonuçlarý karþýlaþtýrýlmasý amaçlanmýþtýr.
YÖNTEM ve GEREÇLER: Yüz kýrk iki santral venöz darlýðý veya týkanmasý olan 71 kronik hemodiyaliz hasta grubunda (36 erkek, 35 kadýn) Mart 2013 ile Haziran 2018 arasýnda 109 endovasküler giriþim uygulandý. Hastalarýn klinik takibi kontrol venografi ile 1, 3 ve 6. aylarda yapýldý ve asemptomatik hastalarda 6 ay intervallerle kontrollere devam edildi.
BULGULAR: Tedavi süresince 45 hastada PTA, 26 hastada PTS iþlemi yapýldý. Primer açýklýk oranlarý sýrasýyla 3., 6., 12. ve 24. aylarda PTA grubunda; % 97,74, %88,23, % 73,76, % 50,76 ve PTS grubunda; % 96,23, %92,34, %65,96, %47 olarak saptandý. Yardýmcý primer açýklýk oranlarý sýrasýyla 3., 6. ve12. aylarda PTA grubunda; % 97,73, %90,76, %75,92 ve PTS grubunda; %96,25 %84,38, %79,87 olarak saptandý. Primer ve yardýmcý açýklýk oranlarý açýsýndan gruplar arasýnda istatistiksel olarak anlamlý bir fark bulunmadý (p=0,216, p=0,121). PTS grubundaki ortalama müdahale sayýsý (2,62 ± 1,23), PTA grubundan (1,43 ± 0,62) anlamlý derecede yüksekti.
TARTIÞMA ve SONUÇ: Endovasküler tedavi, santral ven týkanýklýðý tedavisinde güvenli ve etkili bir yöntemdir. PTS, tedavide daha uzun açýklýk saðlamamakla birlikte aksine tedaviye daha yüksek ek maliyetler ve damar açýklýðýný saðlamak için daha fazla giriþimler getirmektedir. PTS, anjioplasti dirençli veya sýk tekrarlayan lezyonlarda tercih edilmelidir.

Anahtar Kelimeler: Santral ven týkanýklýðý, Kronik böbrek yetmezliði, Perkütan transluminal anjiyoplasti, Perkütan transluminal stentleme

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Endovascular treatment options in central venous stenosis and occlusion: Angioplasty or Stent ?

Behlül Ýgüs¹, Ali Fýrat¹, Hüseyin Yüce Bircan^2
1Baskent University Istanbul Hospital,Department of Radiology,ýstanbul
²Baskent University Istanbul Hospital Department of General Surgery, Istanbul

INTRODUCTION: The purpose of this study was to compare the patency rate outcomes and efficacy of percutaneous transluminal angioplasty (PTA) versus percutaneous transluminal stenting (PTS) for the treatment of central vein stenosis and occlusion in hemodialysis patients.
METHODS: A total of 71 chronic hemodialysis patients (36 males, 35 females) with 142 events of central venous stenosis or occlusion underwent 109 endovascular interventions between March 2013 and June 2018. The clinical follow-up of the patients was performed with control venography at 1, 3, and 6 months, and then at 6-month intervals for asymptomatic patients.
RESULTS: PTA was applied to 45 patients and PTS to 26 patients during the study period. At 3, 6,12 and 24 months, primary patency rates were 97.74%, 88.23%, 73.76% and 50.76% respectively in the PTA group and 96.23%, 92.34%, 65.96% and 47% in the PTS group. Assisted primary patency at 3, 6, and 12 months was 97.73%, 90.76%, and 75.92% respectively in the PTA group and 96.25%, 84.38%, and 79.87% in the PTS group. No statistically significant difference was determined between the groups in respect of primary and assisted patency rates (p=0.216, p=0.121). The average number of interventions in the PTS group (2.62± 1.23) was significantly higher than that in the PTA group (1.43±0.62).
DISCUSSION AND CONCLUSION: Endovascular treatment is a safe and effective method in the management of central vein occlusion. PTS does not result in longer patency in the treatment, but conversely incurs greater costs and necessitates more interventions to provide patency. Therefore, PTS should only be preferred for PTA-resistant lesions or concurrent lesions.

Keywords: Central venous obstruction, End stage renal disease, Percutaneous transluminal angioplasty, Percutaneous transluminal stenting

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