Karın Ağrısında Görüntüleme İlkeleri Anjiografik Çalışmalar
Özet
Bu bölümde, karın ağrısının vasküler kökenli nedenlerinin tanı ve yönetiminde anjiyografik görüntüleme yöntemlerinin yeri ve klinik önemi ele alınmaktadır. Akut mezenterik iskemi (AMİ), gastrointestinal sistem kanamaları, büyük damar patolojileri ve travmaya bağlı vasküler yaralanmalar gibi potansiyel olarak yaşamı tehdit eden klinik tabloların erken tanısında bilgisayarlı tomografi anjiyografi (BTA) rolü vurgulanmakta; arteriyel ve venöz patolojilerin ayırt edilmesinde sağladığı avantajlar tartışılmaktadır. Ayrıca, venöz tromboembolik hastalıklar ve nadir görülen vasküler tabloların karın ağrısı ayırıcı tanısındaki yeri bütüncül bir bakış açısıyla değerlendirilmektedir. Bölümde konvansiyonel kateter anjiyografinin güncel klinik pratikteki konumu ağırlıklı olarak terapötik perspektiften incelenmekte; embolizasyon, intraarteriyel farmakolojik uygulamalar ve endovasküler onarım gibi girişimsel tedavi seçenekleri ele alınmaktadır. Tanısal ve terapötik yaklaşımların birbirini tamamlayıcı nitelikte olduğu vurgulanarak, hasta seçimi, zamanlama ve multidisipliner işbirliğinin klinik sonuçlar üzerindeki belirleyici rolü ortaya konulmaktadır. Bu çerçevede bölüm, akut karın ağrısının değerlendirilmesinde anjiyografik görüntülemenin rasyonel ve algoritmik kullanımına yönelik güncel bir rehber sunmayı amaçlamaktadır.
This chapter discusses the role and clinical significance of angiographic imaging methods in the diagnosis and management of vascular causes of abdominal pain. The role of computed tomography angiography (CTA) in the early diagnosis of potentially life-threatening clinical conditions such as acute mesenteric ischemia, gastrointestinal bleeding, large vessel pathologies, and traumatic vascular injuries is emphasized, and its advantages in differentiating arterial and venous pathologies are discussed. Furthermore, the role of venous thromboembolic diseases and rare vascular conditions in the differential diagnosis of abdominal pain is evaluated from a holistic perspective. The chapter primarily examines the current role of conventional catheter angiography in clinical practice from a therapeutic standpoint, addressing interventional treatment options such as embolization, intraarterial pharmacological applications, and endovascular repair. The complementary nature of diagnostic and therapeutic approaches is highlighted, with particular emphasis on the decisive role of patient selection, timing, and multidisciplinary collaboration in clinical outcomes. Within this framework, the chapter aims to provide a contemporary guide to the rational and algorithmic use of angiographic imaging in the evaluation of acute abdominal pain.
Referanslar
Tintinalli JE, Stapczynski JS, Ma OJ, Yealy DM, Meckler GD, Cline DM, et al., 2020. Tintinalli’s emergency medicine: A comprehensive study guide. 9th ed., pp. 392–396, 413–414. New York, NY: McGraw-Hill.
Brant WE, Helms CA, 2019. Fundamentals of diagnostic radiology. 5th ed., pp. 1183–1201. Philadelphia, PA: Wolters Kluwer.
Adam A, Dixon AK, Gillard JH, Schaefer-Prokop C, 2021. Grainger & Allison’s diagnostic radiology, 7th ed., pp. 1015–1042. Edinburgh, UK: Elsevier.
Kandarpa K, Machan L, 2016. Handbook of interventional radiologic procedures, 5th ed., pp. 289–310. Philadelphia, PA: Wolters Kluwer.
Mauro MA, Murphy KPJ, Thomson KR Venbrux AC, Zollikofer CL, Kandarpa K, et al.,2014. Image-guided interventions, 2nd ed., pp. 415–438. Philadelphia, PA: Elsevier.
Kärkkäinen JM, Lehtimäki TT, Manninen H, Paajanen H, 2015. Acute mesenteric ischemia: A challenge for the surgeon. World Journal of Emergency Surgery, 10, 21.
American College of Radiology, 2023. ACR appropriateness criteria: Acute abdominal pain. Reston, VA: American College of Radiology.
Chaer RA, Abularrage CJ, Coleman DM, Eslami MH, Kashyap VS, Rockman C, et al., 2017. The Society for Vascular Surgery clinical practice guidelines on the management of visceral aneurysms. Journal of Vascular Surgery, 66(1), 3–25.
Menke J, 2010. Diagnostic accuracy of multidetector CT in acute mesenteric ischemia: Systematic review and meta-analysis. Radiology, 256(1), 93–101.
García-Blázquez V, Vicente-Bártulos A, Olavarria-Delgado A, Plana MN, van der Winden D, Zamora J, et al., 2013. Accuracy of CT angiography in the diagnosis of acute gastrointestinal bleeding: Systematic review and. meta-analysis. European Radiology, 23(5), 1181–1190.
Coccolini F, Stahel PF, Montori G, Biffl W, Horer TM, Catena F, et al., 2017. Pelvic trauma: WSES classification and guidelines. World Journal of Emergency Surgery, 12, 5.
Acosta S, Alhadad A, Svensson PJ, 2009. Epidemiology, risk and prognostic factors in mesenteric venous thrombosis. British Journal of Surgery, 96(10), 1118–1127.
Jennette JC, Falk RJ, Bacon PA, Basu N, Cid MC, Ferrario F, et al., 2013. 2012 revised International Chapel Hill Consensus Conference nomenclature of vasculitides. Arthritis & Rheumatism, 65(1), 1–11.
Referanslar
Tintinalli JE, Stapczynski JS, Ma OJ, Yealy DM, Meckler GD, Cline DM, et al., 2020. Tintinalli’s emergency medicine: A comprehensive study guide. 9th ed., pp. 392–396, 413–414. New York, NY: McGraw-Hill.
Brant WE, Helms CA, 2019. Fundamentals of diagnostic radiology. 5th ed., pp. 1183–1201. Philadelphia, PA: Wolters Kluwer.
Adam A, Dixon AK, Gillard JH, Schaefer-Prokop C, 2021. Grainger & Allison’s diagnostic radiology, 7th ed., pp. 1015–1042. Edinburgh, UK: Elsevier.
Kandarpa K, Machan L, 2016. Handbook of interventional radiologic procedures, 5th ed., pp. 289–310. Philadelphia, PA: Wolters Kluwer.
Mauro MA, Murphy KPJ, Thomson KR Venbrux AC, Zollikofer CL, Kandarpa K, et al.,2014. Image-guided interventions, 2nd ed., pp. 415–438. Philadelphia, PA: Elsevier.
Kärkkäinen JM, Lehtimäki TT, Manninen H, Paajanen H, 2015. Acute mesenteric ischemia: A challenge for the surgeon. World Journal of Emergency Surgery, 10, 21.
American College of Radiology, 2023. ACR appropriateness criteria: Acute abdominal pain. Reston, VA: American College of Radiology.
Chaer RA, Abularrage CJ, Coleman DM, Eslami MH, Kashyap VS, Rockman C, et al., 2017. The Society for Vascular Surgery clinical practice guidelines on the management of visceral aneurysms. Journal of Vascular Surgery, 66(1), 3–25.
Menke J, 2010. Diagnostic accuracy of multidetector CT in acute mesenteric ischemia: Systematic review and meta-analysis. Radiology, 256(1), 93–101.
García-Blázquez V, Vicente-Bártulos A, Olavarria-Delgado A, Plana MN, van der Winden D, Zamora J, et al., 2013. Accuracy of CT angiography in the diagnosis of acute gastrointestinal bleeding: Systematic review and. meta-analysis. European Radiology, 23(5), 1181–1190.
Coccolini F, Stahel PF, Montori G, Biffl W, Horer TM, Catena F, et al., 2017. Pelvic trauma: WSES classification and guidelines. World Journal of Emergency Surgery, 12, 5.
Acosta S, Alhadad A, Svensson PJ, 2009. Epidemiology, risk and prognostic factors in mesenteric venous thrombosis. British Journal of Surgery, 96(10), 1118–1127.
Jennette JC, Falk RJ, Bacon PA, Basu N, Cid MC, Ferrario F, et al., 2013. 2012 revised International Chapel Hill Consensus Conference nomenclature of vasculitides. Arthritis & Rheumatism, 65(1), 1–11.
