Femoropopliteal Arter Darlık ve Kronik Oklüzyonlarının Endovasküler Tedavisi
Synopsis
Femoropopliteal arter hastalığı, alt ekstremite periferik arter hastalığının en sık karşılaşılan anatomik tutulum alanlarından biridir. Bu segmentin belirgin biyomekanik strese maruz kalması, uzun ve kalsifiye lezyonların sık görülmesi ve kronik total oklüzyonların varlığı endovasküler tedaviyi teknik açıdan güçleştirmektedir. Güncel tedavi yaklaşımı; lezyon anatomisi, kalsifikasyon yükü, klinik tablo ve hastanın cerrahi uygunluğu dikkate alınarak bireyselleştirilmektedir. Kronik total oklüzyonlarda intralüminal ve subintimal geçiş teknikleri, re-entry cihazları ve retrograd yaklaşımlar teknik başarıyı artırabilmektedir. Damar hazırlığında balon anjiyoplasti, aterektomi ve intravasküler litotripsi kullanılabilirken, definitif tedavide ilaç kaplı balonlar, ilaç salınımlı stentler, interwoven nitinol stentler ve stent-graftlar önemli seçeneklerdir. İntravasküler ultrason, özellikle kompleks lezyonlarda işlem optimizasyonuna katkı sağlayabilir. Kronik ekstremiteyi tehdit eden iskemide endovasküler ve cerrahi revaskülarizasyon seçimi hasta ve anatomiye göre yapılmalıdır. İşlem sonrası uygun antitrombotik tedavi ve uzun dönem takip, revaskülarizasyon başarısının sürdürülebilmesi açısından önem taşımaktadır.
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