Aterosklerotik Perifer Arter Hastalığı Cerrahi ve Endovasküler Tedavisi

Özet

Aterosklerotik perifer arter hastalığının tedavisinde cerrahi tedavi önemli bir yer tutar. Gerekli ekipman ve malzeme hazırlığı son yıllarda değişen eğilimler nedeniyle karmaşıklaşmıştır. Endovasküler tedavi tüm dünyada yaygın bir eğilim olarak kendine yer bulurken damar cerrahisi ameliyathanesinin mevcut haliyle kalamayacağı aşikârdır. Tartışmayı sınırlamak adına endovasküler ve robotik ve laparoskopik sistemlerden ayrıntılı olarak bahsedilmemiştir. Bu bölümde genel damar cerrahisi seti tanımlanmış, cerrahi teknikler özetlenerek yaklaşım anatomik bölgelere göre tanımlanmıştır. Endikasyonlar ise morfolojik olmaktan ziyade hastanın kliniğine göre yapılmaktadır.

Referanslar

Hoballah JJ. Chapter-1. Vascular Instruments. Şu Kitapta: Vascular Reconstructions. 2nd Ed. Hoballah JJ, Bechara CF Ed. pp:3-16; 2021, Springer, New York, NY, USA

Hoballah JJ, Wehbe MR. Chapter-2. Vascular Grafts, Patches and Sutures. Şu kitapta: Vascular Reconstructions. 2nd Ed. Hoballah JJ, Bechara CF Ed. pp:17-28; 2021, Springer, New York, NY, USA

Reilly BP, Dryjski ML. Chapter-65. Autogenous Grafts (Including Vein Harvest, Surgical and Endoscopic). Şu kitapta: Rutherford’s Vascular Surgery and Endovascular Therapy. 10th Ed. Sidawy AN, Perler BA Ed. pp:838-48; 2023, Elsevier, Philadelphia PA, USA

Gasper WJ, Owens CD, Kim JM, Hills N, Belkin M, Creager MA, Conte MS. Thirty-day vein remodeling is predictive of midterm graft patency after lower extremity bypass. J Vasc Surg. 2013;57(1):9-18. doi: 10.1016/j.jvs.2012.06.098

Conte MS, Bandyk DF, Clowes AW, Moneta GL, Seely L, Lorenz TJ, Namini H, Hamdan AD, Roddy SP, Belkin M, Berceli SA, DeMasi RJ, Samson RH, Berman SS; PREVENT III Investigators. Results of PREVENT III: a multicenter, randomized trial of edifoligide for the prevention of vein graft failure in lower extremity bypass surgery. J Vasc Surg. 2006;43(4):742-751; discussion 751. doi: 10.1016/j.jvs.2005.12.058

Nierlich P, Enzmann F, Dabernig W, Martin J, Akhavan F, Linni K, Hölzenbein T. Small Saphenous Vein and Arm Vein as Bypass Grafts for Upper Extremity Ischemia. Annals of vascular surgery. 2019;60:264-9 https://doi.org/10.1016/j.avsg.2019.02.015

Hamouda M, Zarrintan S, Vootukuru N, Thandra S, Quatromoni JG, Malas MB, Gaffey AC. Outcomes of prosthetic and biological grafts compared to arm vein grafts in patients with chronic limb-threatening ischemia. J Vasc Surg. 2025;81(3):682-92. doi: 10.1016/j.jvs.2024.10.069

Kalish J, Farber A. Chapter-67. Biologic Grafts. Şu kitapta: Rutherford’s Vascular Surgery and Endovascular Therapy. 10th Ed. Sidawy AN, Perler BA Ed. pp:864-73; 2023, Elsevier, Philadelphia PA, USA

Sanin GD, Negmadjanov U, Patterson JW, Hamid RN, Torosian T, Stafford JM, Sheehan MK, Goldman MP, Hurie J, Edwards MS, Velazquez G. Contemporary outcomes for arterial reconstruction with non-saphenous vein cryo-preserved conduits. J Vasc Surg. 2024;79(6):1457-1465. doi: 10.1016/j.jvs.2024.01.201

Neville RF. Chapter-66. Prostetic Grafts. Şu kitapta: Rutherford’s Vascular Surgery and Endovascular Therapy. 10th Ed. Sidawy AN, Perler BA Ed. pp:849-62; 2023, Elsevier, Philadelphia PA, USA

Dexter DJ, O'Neill F, Neville RF. Systematic literature review comparing clinical utility of heparin-bonded expanded polytetrafluoroethylene graft with autologous saphenous vein graft for the management of below-the-knee peripheral arterial disease. J Vasc Surg. 2024 Dec;80(6):1863-1870.e6. doi: 10.1016/j.jvs.2024.07.023

Farber A, Menard MT, Conte MS, Kaufman JA, Powell RJ, Choudhry NK, Hamza TH, Assmann SF, Creager MA, Cziraky MJ, Dake MD, Jaff MR, Reid D, Siami FS, Sopko G, White CJ, van Over M, Strong MB, Villarreal MF, McKean M, Azene E, Azarbal A, Barleben A, Chew DK, Clavijo LC, Douville Y, Findeiss L, Garg N, Gasper W, Giles KA, Goodney PP, Hawkins BM, Herman CR, Kalish JA, Koopmann MC, Laskowski IA, Mena-Hurtado C, Motaganahalli R, Rowe VL, Schanzer A, Schneider PA, Siracuse JJ, Venermo M, Rosenfield K; BEST-CLI Investigators. Surgery or Endovascular Therapy for Chronic Limb-Threatening Ischemia. N Engl J Med. 2022 Dec 22;387(25):2305-2316. doi: 10.1056/NEJMoa2207899

Neville RF, Sam II AD, Sidawy AN. Chapter-61 Open Surgical Technique. Şu kitapta: Rutherford’s Vascular Surgery and Endovascular Therapy. 10th Ed. Sidawy AN, Perler BA Ed. pp:771-89; 2023, Elsevier, Philadelphia PA, USA

Menard MT,Sharma G, Belkin M. Chapter-109 Aortoiliac Disease: Direct Reconstruction. Şu kitapta: Rutherford’s Vascular Surgery and Endovascular Therapy. 10th Ed. Sidawy AN, Perler BA Ed. pp:1434-51; 2023, Elsevier, Philadelphia PA, USA

Szilagyi DE, Elliott JP Jr, Smith RF, Reddy DJ, McPharlin M. A thirty-year survey of the reconstructive surgical treatment of aortoiliac occlusive disease. J Vasc Surg. 1986;3(3):421-36. doi: 10.1067/mva.1986.avs0030421

Tanaka A, Sandhu HK, Perlick A, Miller CC 3rd, Saqib NU, Safi HJ, Charlton-Ouw KM. Superficial Femoral Artery Occlusion Reduces Aortofemoral Bypass Graft Patency. Eur J Vasc Endovasc Surg. 2019;57(5):650-657. doi: 10.1016/j.ejvs.2018.10.031

Squizzato F, D'Oria M, Bozza R, Porcellato L, Grego F, Lepidi S. Propensity-Matched Comparison of Endovascular versus Open Reconstruction for TASC-II C/D AortoIliac Occlusive Disease. A Ten-Year Single-Center Experience with Self-Expanding Covered Stents. Ann Vasc Surg. 2021 Feb;71:84-95. doi: 10.1016/j.avsg.2020.08.139

Smith AH, Beach JM, Dash S, Rowse J, Parodi FE, Kirksey L, Caputo FJ, Lyden SP, Smolock CJ. Comparison of Aortobifemoral Bypass to Aortoiliac Stenting with Bifurcation Reconstruction for TASC II D Aortoiliac Occlusive Disease. Ann Vasc Surg. 2022 May;82:120-130. doi: 10.1016/j.avsg.2021.10.040

Schneider J. Chapter-111 Aortoiliac Disease: Open Extra-Anatomic Bypass. Şu kitapta: Rutherford’s Vascular Surgery and Endovascular Therapy. 10th Ed. Sidawy AN, Perler BA Ed. pp:1434-51; 2023, Elsevier, Philadelphia PA, USA

Mills Sr JL. Chapter-112 Infrainguinal Disease: Surgical Treatment. Şu kitapta: Rutherford’s Vascular Surgery and Endovascular Therapy. 10th Ed. Sidawy AN, Perler BA Ed. pp:1476-501; 2023, Elsevier, Philadelphia PA, USA

Raptis S, Miller JH. Influence of a vein cuff on polytetrafluoroethylene grafts for primary femoropopliteal bypass. Br J Surg. 1995;82(4):487-91. doi: 10.1002/bjs.1800820419

Khalil AA, Boyd A, Griffiths G. Interposition vein cuff for infragenicular prosthetic bypass graft. Cochrane Database Syst Rev. 2012;2012(9):CD007921. doi: 10.1002/14651858.CD007921.pub2

Yeung KK, Mills JL Sr, Hughes JD, Berman SS, Gentile AT, Westerband A. Improved patency of infrainguinal polytetrafluoroethylene bypass grafts using a distal Taylor vein patch. Am J Surg. 2001;182(6):578-83. doi: 10.1016/s0002-9610(01)00791-7

Kluckner M, Gruber L, Wippel D, Lobenwein D, Westreicher W, Pilz M, Enzmann FK. Long-Term Outcome of Bypass Surgery versus Endovascular Revascularization in Long Femoropopliteal Lesions. J Clin Med. 2023;12(10):3507. doi: 10.3390/jcm12103507

Betz T, Ingolf T, Markus S, Florian Z, Christian U. Evaluation of Long-Term Outcomes of Femoropopliteal Bypass Surgery in Patients With Chronic Limb-Threatening Ischemia in an Endovascular Era. Ann Vasc Surg. 2022;79:191-200. doi: 10.1016/j.avsg.2021.06.046

Polat A. Bölüm A. Periferik Arter Hastalığı. Şu kitapta:Periferik Arter ve Ven Hastalıkları: Ulusal Tedavi Kılavuzu 2021. Ed: Bozkurt AK, 2021; pp:1-99, Türk Kalp ve Damar Cerrahisi Derneği, Ulusal Vasküler ve Endovasküler Cerrahi Derneği, Fleboloji Derneği, 2021, Bayçınar Yayınevi, İstanbul.

Botelho FE, Cacione DG, Leite JO, Baptista-Silva JC. Endoluminal interventions versus surgical interventions for stenosis in vein grafts following infrainguinal bypass. Cochrane Database Syst Rev. 2021 28;4(4):CD013702. doi: 10.1002/14651858.CD013702.pub2

Yeh CC, Roddy SP, Daling III RC . Chapter-121 Upper Extremity Disease: Medical, Endovascular and Open Surgical Management. Şu kitapta: Rutherford’s Vascular Surgery and Endovascular Therapy. 10th Ed. Sidawy AN, Perler BA Ed. pp:1602-10; 2023, Elsevier, Philadelphia PA, USA

Lengyel BC, Chinnadurai P, Corr SJ, Lumsden AB, Bavare CS. Robot-assisted vascular surgery: literature review, clinical applications, and future perspectives. J Robot Surg. 2024;18(1):328. doi: 10.1007/s11701-024-02087-2

Lecot F, Sabbe T, Houthoofd S, Daenens K, Fourneau I. Long-term Results of Totally Laparoscopic Aortobifemoral Bypass. Eur J Vasc Endovasc Surg. 2016;52(5):581-587. doi: 10.1016/j.ejvs.2016.05.006

Ricco JB, Thaveau F. Chapter-64. Laparoscopic and Robotic Aortic Surgery. Şu kitapta: Rutherford’s Vascular Surgery and Endovascular Therapy. 10th Ed. Sidawy AN, Perler BA Ed. pp:826-37; 2023, Elsevier, Philadelphia PA, USA

Sutter W, Alsac JM, Ben Abdallah I, Michel C, Julia P, Empana JP, El Batti S. Treatment of Aortoiliac Occlusive Lesions by Aortic Robotic Surgery: Learning Curve and Midterm Outcome. Ann Vasc Surg. 2024;104:258-267. doi: 10.1016/j.avsg.2024.02.018

Polat A. Femoropopliteal Arter Hastalıklarında Endovasküler Tedavi. Şu kitapta: Endovasküler. Eds:, Kavala AA, İnce İ, Bozkurt AK. 2024; pp:121-38, Kare Tanıtım Hizmetleri, İstanbul

Voûte MT, Stathis A, Schneider PAve ark. Delphi Consensus Study Toward a Comprehensive Classification System for Angioplasty-Induced Femoropopliteal Dissection: The DISFORM Study. JACC Cardiovasc Interv. 2021;14(21):2391-401. doi: 10.1016/j.jcin.2021.07.056

Polat A. Bölüm-12. Stentler. Şu kitapta: Endovasküler Cerrahiye Giriş: Temel Tel ve Kateter Teknikleri. Ed. Polat A, pp:117-26; 2016, Türk Kalp ve Damar Cerrahisi Derneği, İstanbul, Türkiye

Kavala AA, Toz H. Aortoiliyak Periferik Arter Hastalığında Endovasküler Girişimler. Şu kitapta: Endovasküler. Eds:, Kavala AA, İnce İ, Bozkurt AK. 2024; pp:105-120, Kare Tanıtım Hizmetleri, İstanbul

Polat A. Bölüm-14. İleri Teknik Uygulamalar ve Yeni Malzemeler. Şu kitapta: Endovasküler Cerrahiye Giriş: Temel Tel ve Kateter Teknikleri. Ed. Polat A, pp:147-53; 2016, Türk Kalp ve Damar Cerrahisi Derneği, İstanbul, Türkiye

Ormiston W, Dyer-Hartnett S, Fernando R, Holden A. An update on vessel preparation in lower limb arterial intervention. CVIR Endovasc. 2020;3(1):86. doi: 10.1186/s42155-020-00175-6

Tepe G, Brodmann M, Werner M, ve ark; Disrupt PAD III Investigators. Intravascular Lithotripsy for Peripheral Artery Calcification: 30-Day Outcomes From the Randomized Disrupt PAD III Trial. JACC Cardiovasc Interv. 2021 Jun 28;14(12):1352-1361. doi: 10.1016/j.jcin.2021.04.010

Nordanstig J, Behrendt CA, Baumgartner I, ve ark. Editor's Choice -- European Society for Vascular Surgery (ESVS) 2024 Clinical Practice Guidelines on the Management of Asymptomatic Lower Limb Peripheral Arterial Disease and Intermittent Claudication. Eur J Vasc Endovasc Surg. 2024;67(1):9-96. doi: 10.1016/j.ejvs.2023.08.067

Tepe G, Laird J, Schneider P, Brodmann M, Krishnan P, Micari A, Metzger C, Scheinert D, Zeller T, Cohen DJ, Snead DB, Alexander B, Landini M, Jaff MR; IN.PACT SFA Trial Investigators. Drug-coated balloon versus standard percutaneous transluminal angioplasty for the treatment of superficial femoral and popliteal peripheral artery disease: 12-month results from the IN.PACT SFA randomized trial. Circulation. 2015;131(5):495-502. doi: 10.1161/CIRCULATIONAHA.114.011004

Laird JA, Schneider PA, Jaff MR, Brodmann M, Zeller T, Metzger DC, Krishnan P, Scheinert D, Micari A, Wang H, Masters M, Tepe G. Long-Term Clinical Effectiveness of a Drug-Coated Balloon for the Treatment of Femoropopliteal Lesions. Circ Cardiovasc Interv. 2019;12(6):e007702. doi: 10.1161/CIRCINTERVENTIONS.118.007702

Gouëffic Y, Torsello G, Zeller T, Esposito G, Vermassen F, Hausegger KA, Tepe G, Thieme M, Gschwandtner M, Kahlberg A, Schindewolf M, Sapoval M, Diaz-Cartelle J, Stavroulakis K; EMINENT Investigators. Efficacy of a Drug-Eluting Stent Versus Bare Metal Stents for Symptomatic Femoropopliteal Peripheral Artery Disease: Primary Results of the EMINENT Randomized Trial. Circulation. 2022;146(21):1564-1576. doi: 10.1161/CIRCULATIONAHA.122.059606

Real-world registry shows sustained efficacy for Eluvia DES in the SFA. Şu internet sitesinde: https://interventionalnews.com/real-world-registry-shows-sustained-efficacy-for-eluvia-des-in-the-sfa/ (son ziyaret tarihi: 11 Haziran 2025)

Behrendt CA, Sigvant B, Kuchenbecker J, Grima MJ, Schermerhorn M, Thomson IA, et al. Editor’s choice-international variations and sex disparities in the treatment of peripheral arterial occlusive disease: A report from VASCUNET and the International Consortium of Vascular Registries. Eur J Vasc Endovasc Surg 2020;60:873-80.

Klaphake S, Buettner S, Ultee KH, van Rijn MJ, Hoeks SE, Verhagen HJ. Combination of endovascular revascularization and supervised exercise therapy for intermittent claudication: A systematic review and meta-analysis. J Cardiovasc Surg (Torino) 2018;59:150-7.

Rocha-Singh KJ, Beckman JA, Ansel G, Lyden SP, Schneider P, Mehta M, et al. Patient-level meta-analysis of 999 claudicants undergoing primary femoropopliteal nitinol stent implantation. Catheter Cardiovasc Interv 2017;89:1250-6

Küçüker ŞA. Revaskülarizasyon yöntemleri. In: Bozkurt AK, editor. Periferik Arter ve Ven Hastalıkları: Ulusal Tedavi Kılavuzu 2016. Bölüm I.5.E. İstanbul: Bayçınar Tıbbi Yayınevi; 2016. s. 63-84

Anantha-Narayanan M, Sheikh AB, Nagpal S, Jelani QU, Smolderen KG, Regan C, et al. Systematic review and meta-analysis of outcomes of lower extremity peripheral arterial interventions in patients with and without chronic kidney disease or end-stage renal disease. J Vasc Surg 2021;73:331-40.e4.

Dayama A, Tsilimparis N, Kolakowski S, Matolo NM, Humphries MD. Clinical outcomes of bypass-first versus endovascular-first strategy in patients with chronic limb-threatening ischemia due to infrageniculate arterial disease. J Vasc Surg 2019;69:156-63.e1.

Conte MS, Bradbury AW, Kolh P, White JV, Dick F, Fitridge R, et al. Global vascular guidelines on the management of chronic limb-threatening ischemia. Eur J Vasc Endovasc Surg 2019;58:S1-S109.e33

Darling JD, Bodewes TCF, Deery SE, Guzman RJ, Wyers MC, Hamdan AD, et al. Outcomes after first-time lower extremity revascularization for chronic limb-threatening ischemia between patients with and without diabetes. J Vasc Surg 2018;67:1159-69.

Hsu CC, Kwan GN, Singh D, Rophael JA, Anthony C, van Driel ML. Angioplasty versus stenting for infrapopliteal arterial lesions in chronic limb-threatening ischaemia. Cochrane Database Syst Rev 2018;12:CD009195

Lavingia KS, Tran K, Dua A, Itoga N, Deslarzes-Dubuis C, Mell M, et al. Multivessel tibial revascularization does not improve outcomes in patients with critical limb ischemia. J Vasc Surg 2020;71:2083-8

Giannopoulos S, Jeon-Slaughter H, Kahlon RS, Tejani I, Baskar A, Banerjee S, et al. Comparative 12-month outcomes of drug-coated balloon versus non-drug-coated balloon revascularization strategy in chronic limb-threatening ischemia: Results from the XLPAD Registry. Cardiovasc Revasc Med 2020;21:1276-84

Giannopoulos S, Ghanian S, Parikh SA, Secemsky EA, Schneider PA, Armstrong EJ. Safety and efficacy of drug-coated balloon angioplasty for the treatment of chronic limb-threatening ischemia: A systematic review and meta-analysis. J Endovasc Ther 2020;27:647-57.

Bradbury AW, Hall JA, Popplewell MA, Meecham L, Bate GR, Kelly L, Deeks JJ, Moakes CA; BASIL-3 Investigators. Plain versus drug balloon and stenting in severe ischaemia of the leg (BASIL-3): open label, three arm, randomised, multicentre, phase 3 trial. BMJ. 2025;388:e080881. doi: 10.1136/bmj-2024-080881

McGinigle KL, Zhou CW, Freeman NLB, Conte MS, Strong MB, Barshes N, Bonaca M, Farber A, Rosenfield K, Menard MT. Anatomic Profile of Arterial Occlusive Disease in the BEST-CLI Trial. J Vasc Surg. 2025 Jun 18:S0741-5214(25)01360-6. doi: 10.1016/j.jvs.2025.06.019. Epub ahead of print

Mufarrih SH, Khan MS, Qureshi NQ, Akbar MS, Kazimuddin M, Goldsweig AM, Goodney PP, Aronow HD. An Endovascular- Versus a Surgery-First Revascularization Strategy for Chronic Limb-Threatening Ischemia: A Meta-Analysis of Randomized Controlled Trials. Am J Cardiol. 2024;214:149-156. doi: 10.1016/j.amjcard.2024.01.007

Reijnen MMPJ, van Wijck I, Zeller T, Micari A, Veroux P, Keirse K, et al. Outcomes after drug-coated balloon treatment of femoropopliteal lesions in patients with critical limb ischemia: A post hoc analysis from the IN.PACT Global Study. J Endovasc Ther 2019;26:305-15

Conte MS. Appropriate use of revascularization for claudication. J Vasc Surg 2020;71:131.

Sorber R, Alshaikh HN, Nejim B, Abularrage CJ, Black JH 3rd, Malas MB, et al. Quantifying the riskadjusted hospital costs of postoperative complications after lower extremity bypass in patients with claudication. J Vasc Surg 2020:S0741-5214(20)32016-4

Dakhel A, Zarrouk M, Ekelund J, Acosta S, Nilsson P, Miftaraj M, et al. Worse cardiovascular prognosis after endovascular surgery for intermittent claudication caused by infrainguinal atherosclerotic disease in patients with diabetes. Ther Adv Endocrinol Metab 2020;11:2042018820960294

Fakhry F, Fokkenrood HJ, Spronk S, Teijink JA, Rouwet EV, Hunink MGM. Endovascular revascularisation versus conservative management for intermittent claudication. Cochrane Database Syst Rev 2018;3:CD010512

Jansen SCP, van Nistelrooij LPJ, Scheltinga MRM, Rouwet EV, Teijink JAW, Vahl AC. Successful implementation of the exercise first approach for intermittent claudication in the Netherlands is associated with few lower limb revascularisations. Eur J Vasc Endovasc Surg 2020;60:881-7.

Hicks CW, Holscher CM, Wang P, Black JH 3rd, Abularrage CJ, Makary MA. Overuse of early peripheral vascular interventions for claudication. J Vasc Surg 2020;71:121-30.e1.

Raja A, Song Y, Li S, Parikh SA, Saab F, Yeh RW, Secemsky EA. Variations in Revascularization Strategies for Chronic Limb-Threatening Ischemia: A Nationwide Analysis of Medicare Beneficiaries. JACC Cardiovasc Interv. 2025 Feb 10;18(3):352-363. doi: 10.1016/j.jcin.2024.09.024

Mullins CH, Novak Z, Axley JC, Sutzko DC, Spangler EL, Pearce BJ, et al. Prevalence and outcomes of endovascular infrapopliteal interventions for intermittent claudication. Ann Vasc Surg 2021;70:79-86

Galyfos GC, Kakisis I, Maltezos C, Geroulakos G. Open versus endovascular treatment of subclavian artery atherosclerotic disease. J Vasc Surg 2019;69:269-79.e7.

Sayfalar

1835-1856

Yayınlanan

23 Mart 2026

Lisans

Lisans