Evaluation of Early and Mid-term Results of TEVAR Procedures with Various Etiology

Özet

Endovascular aneurysm repair in thoracic aorta (TEVAR) is now preferred primarily for the treatment of degenerative aneurysms, saccular aneurysms and acute thoracic aortic syndromes. The aim of this study was to evaluate the early and mid-term results of TEVAR procedures that performed in our clinic in the last 3 years. Materials and Method: Thirty patients (25 males, 5 females) underwent TEVAR procedure between January 2015 and December 2018. Valiant ™ Thoracic Stent Graft System (Medtronic®) was used in all patients. Results: The mean age of the patients was 60.4±18. Of the patients, 53.3% had degenerative aneurysm origin, 36.7% had acute thoracic aortic syndromes and 10% had aortic coarctation and concomitant post-stenotic aneurysm. 63.3% of the patients were symptomatic and had back or chest pain. Technical success of the procedures was 100%. The mean duration of stay in the intensive care unit was 1 ± 2 days and the mean hospital stay was 3.2 ± 2 days. There was no in-hospital mortality and one patient died of type 2 dissection in the first 30-day period. Two, type II endoleak was seen in two patients and we did not need a secondary intervention as the endoleaks resolved spontaneously. The subclavian artery was required to be closed in 3 patients. We did not observed stroke in those patients and no ischemia developed in the left upper extremity. Despite adequate hydration, in the early postoperative period, 2 patients had elevated creatinine levels and regressed to the normal values in the follow-up. The mean follow-up period was 6 ± 9 months and there were 2 mortality in the long term. One patient died of lung cancer and the second died of mesenteric ischemia independently from aneurysmal disease. Conclusion: TEVAR is the first line therapeutic option in anatomically suitable patients for the treatment of aneurysmal disease of thoracic aorta or acute thoracic aortic syndromes. TEVAR can be applied safely with low morbidity and mortality. Nowadays, as sporting amateur or professional participation increases, the importance of sportive performance and the factors affecting this performance increase. The genetic background in sports has a great impact on the strength, endurance, muscle mass, muscle fibers and lung capacity. Sports genetics studies include the whole range of studies in determining the genes affecting athletic performance, clarifying the mechanisms of action and determining their susceptibility to athletic performance. Examples of genes that can be associated with athletic performance include; can list genes such as myostatin, erythropoietin, growth hormone, nitric oxide synthase, vascular endothelial growth factor, angiotensin converting enzyme, angiotensinogen, monocarboxylate carrier 1, insulin-like growth factor-1, peroxisome proliferator active receptor, alpha-actinin-3. The aim of this study is to investigate genes that are effective in sports science and sports performance.

Abstract

Torasik endovasküler aort anevrizması tamiri (TEVAR), günümüzde dejeneratif anevrizmalar, sakküler anevrizmalar ve akut torasik aortik sendromların tedavisinde öncelikli tercih edilmektedir. Bu çalışmanın amacı son 3 yılda kliniğimizde uygulanan TEVAR girişimlerinin erken ve orta dönem sonuçlarını değerlendirmektir. Gereç ve Yöntem: Otuz hastaya (25 erkek, 5 kadın) Ocak 2015- Aralık 2018 arasında TEVAR işlemi uygulandı. Tüm hastalarda Valiant ™ Torasik Stent Greft Sistemi (Medtronic®) kullanıldı. Bulgular: Hastaların yaş ortalaması 60,4±18 idi. Hastaların %53,3'ünde dejeneratif anevrizma, %36,7'sinde akut aortik sendrom, %10'unda aort koarktasyonu ve eşlik eden poststenotik anevrizma mevcuttu. Hastaların %63,3'ü semptomatikti ve sırt veya göğüs ağrısı vardı. İşlemlerin teknik başarısı %100 idi. Yoğun bakım ünitesinde ortalama kalış süresi 1 ± 2 gün, hastanede kalış süresi ortalama 3,2 ± 2 gündü. Hastane mortalitesi olmadı ve ilk 30 günlük dönemde bir hasta tip 2 diseksiyon nedeniyle öldü. İki hastada tip II endoleak görüldü ve endoleak'ler kendiliğinden düzeldiği için ikincil bir müdahaleye ihtiyacımız olmadı. Subklaviyan arterin 3 hastada kapatılması gerekti. Bu hastalarda inme veya sol üst ekstremitede iskemisi gelişmedi. Yeterli hidrasyona rağmen, postoperatif erken dönemde 2 hastanın kreatinin düzeylerinde artış vardı ve izlemde normal değerlere geriledi. Ortalama takip süresi 6 ± 9 aydı ve uzun vadede 2 mortalite vardı. Bir hasta akciğer kanserinden öldü, ikincisi ise anevrizmal hastalıktan bağımsız olarak mezenterik iskemi nedeniyle öldü. Sonuç: TEVAR, torasik aort anevrizmaları veya akut aortik sendromların tedavisinde, anatomik olarak uygun hastalarda ilk tedavi seçeneğidir. TEVAR, düşük morbidite ve mortalite oranlarıyla, güvenle uygulanabilir