{"id":9690,"date":"2020-11-14T13:06:08","date_gmt":"2020-11-14T18:06:08","guid":{"rendered":"https:\/\/cornflowerblue-rail-980953.hostingersite.com\/?p=9690"},"modified":"2020-11-15T01:09:44","modified_gmt":"2020-11-15T06:09:44","slug":"whats-new-in-interventional-radiology-turkish-november-2020","status":"publish","type":"post","link":"https:\/\/staging-hub.acoredu.com\/tr\/whats-new-in-interventional-radiology-turkish-november-2020\/","title":{"rendered":"What&#8217;s new in Interventional Radiology (Turkish) &#8211; November 2020"},"content":{"rendered":"<h5><strong><span style=\"color: #3366ff;\">Derin Ven Trombozu Hastalar\u0131nda Farmakomekanik Tromboliziz Sonras\u0131 Rezid\u00fc Tromb\u00fcs Hacmi \u0130le Klinik Ak\u0131bet Aras\u0131ndaki \u0130li\u015fki: Bir \u00c7ok Merkezli Randomize \u00c7al\u0131\u015fma<\/span> <\/strong><\/h5>\n<p>Mahmood K. Razavi, MD, Amber Salter, PhD, Samuel Z. Goldhaber, MD, Samantha Lancia, MSc, Susan R. Kahn, MD, MSc, Ido Weinberg, MD, Clive Kearon, MB, PhD, Ezana M. Azene, MD, PhD, Nilesh H. Patel, MD, and Suresh Vedantham, MD<\/p>\n<p>J Vasc Interv Radiol 2020; 31:1517\u20131528<\/p>\n<p>Yay\u0131n tarihi: Eyl\u00fcl 15, 2020<\/p>\n<p>DOI:<a href=\"https:\/\/doi.org\/10.1016\/j.jvir.2020.07.010\">https:\/\/doi.org\/10.1016\/j.jvir.2020.07.010<\/a><\/p>\n<p>Post-trombotik sendrom (PTS), proksimal derin ven trombozu (DVT) ge\u00e7iren hastalar\u0131n yakla\u015f\u0131k %40-%50\u2019sinde ortaya \u00e7\u0131kar. DVT\u2019de katater-arac\u0131l\u0131 tromboliz tedavisi a\u00e7\u0131k ven hipotezinde, tromb\u00fcs\u00fcn erken \u00e7\u0131kar\u0131lmas\u0131n\u0131n uzun d\u00f6nem ven\u00f6z patensiyi, ya\u015fam kalitesini art\u0131rd\u0131\u011f\u0131n ve\u00a0 PTS\u2019yi azaltt\u0131\u011f\u0131n\u0131 s\u00f6yleyen hipotez, b\u00fcy\u00fck \u00f6l\u00e7\u00fcde g\u00f6sterilmi\u015ftir.<\/p>\n<p>Bu \u00e7al\u0131\u015fma post-farmakomekanik katater-arac\u0131l\u0131 tromboliz (PCDT) sonras\u0131 venografideki rezid\u00fc tromb\u00fcs miktar\u0131 ile hastan\u0131n \u00f6zellikle PTS a\u00e7\u0131s\u0131ndan ak\u0131beti aras\u0131ndaki ili\u015fkiyi bulmay\u0131 ama\u00e7l\u0131yor.<\/p>\n<p>\u00c7al\u0131\u015fma ATTRACT\u2019nin faz 3, \u00e7ok merkezli, a\u00e7\u0131k u\u00e7lu bir randomize kontroll\u00fc klinik \u00e7al\u0131\u015fmas\u0131d\u0131r. ABD\u2019de 56 merkezden, 317 hastay\u0131 (200 iliofemoral DVT, 117 femoropopliteal DVT) i\u00e7eriyor. Hastalara PCDT i\u015fleminden \u00f6nce ve hemen sonra venografi yap\u0131ld\u0131. PCDT, rt-PA infuzyonu ile ger\u00e7ekle\u015ftirildi ve baz\u0131 vakalarda Trellis-8 ve AngioJet cihazlar\u0131 kullan\u0131ld\u0131. Doktorlar, tromb\u00fcs regresyonundaki ve ven\u00f6z ak\u0131mdaki g\u00f6rsel de\u011ferlendirmelerini kay\u0131t alt\u0131na ald\u0131lar. Rezid\u00fc tromb\u00fcs ayr\u0131ca ba\u011f\u0131ms\u0131z bir ki\u015fi taraf\u0131ndan modifiye Marder skalas\u0131 kullan\u0131larak de\u011ferlendirildi.\u00a0 \u0130\u015flem sonras\u0131 bu sonu\u00e7lar hastalar\u0131n 1, 12 ve 24. aydaki\u00a0 sonu\u00e7lar\u0131 ile ili\u015fkilendirildi. RDUS\u2019ta rezid\u00fcel tromb\u00fcs varl\u0131\u011f\u0131, PTS varl\u0131\u011f\u0131 ve \u015fiddeti, hastan\u0131n ya\u015fam kalitesi dikkate al\u0131nan fakt\u00f6rler oldu.<\/p>\n<p>Bu \u00e7al\u0131\u015fma PCDT\u2019nin akut proksimal DVT\u2019de tromb\u00fcs\u00fc yok etmede ba\u015far\u0131l\u0131 oldu\u011funu g\u00f6sterdi. PCDT sonras\u0131 hastalar\u0131n %99\u2019unda iliofemoral segmentlerde, %89\u2019unda femoropopliteal segmentlerde spontan ven\u00f6z ak\u0131m mevcuttu. Fakat ne yaz\u0131kki hemen PCDT\u2019nin ard\u0131ndan \u00f6l\u00e7\u00fclen rezid\u00fc tromb\u00fcs miktar\u0131n\u0131n PTS s\u0131kl\u0131\u011f\u0131nda azalma ile ili\u015fkisi bulunmad\u0131. Klinik iyile\u015fme veya kapak refl\u00fcs\u00fcnde istatistiksel olarak anlam g\u00f6zlenmedi. Ancak iliofemoral DVT\u2019lerde d\u00fc\u015f\u00fck rezid\u00fc tromb\u00fcs hacminin 24 ayl\u0131k PTS \u015fiddetinde azalmaya yol a\u00e7t\u0131\u011f\u0131 g\u00f6sterildi.<\/p>\n<p>\u00c7al\u0131\u015fma, a\u00e7\u0131k ven hipotezinin ge\u00e7erlili\u011fini sorguluyor ve PTS\u2019nin patogenezini anlayacak ileri \u00e7al\u0131\u015fmalar\u0131 te\u015fvik ediyor.<\/p>\n<p>Yazarlar ayr\u0131ca klinisyenlerin hastalara tromb\u00fcs\u00fcn \u00e7\u0131kar\u0131lmas\u0131n\u0131n PTS&#8217;yi \u00f6nleyece\u011fini s\u00f6ylememeleri gerekti\u011fini ve femoropopliteal DVT i\u00e7in PCDT uygulanmas\u0131n\u0131n nadir oldu\u011funu s\u00f6ylemeleri gerekti\u011fini belirtmektedir.<\/p>\n<p><strong>\u00a0<\/strong><\/p>\n<h5><strong><span style=\"color: #3366ff;\">Akut Pulmoner Embolide Uzat\u0131lm\u0131\u015f Katater-Arac\u0131l\u0131 Tromboliz ve Seri Anjiyografilerin Yararl\u0131l\u0131\u011f\u0131n\u0131n De\u011ferlendirilmesi<\/span> <\/strong><\/h5>\n<p>Assaf Graif, MD, Keval D. Patel, DO, MS, Neil J. Wimmer, MD, MS, George Kimbiris, MD, FSIR, Christopher J. Grilli, DO, and Daniel A. Leung, MD, FSIR<\/p>\n<p>Yay\u0131n tarihi: Ekim 19, 2020<\/p>\n<p>J Vasc Interv Radiol 2020; 1\u201310<\/p>\n<p>DOI:<a href=\"https:\/\/doi.org\/10.1016\/j.jvir.2020.08.004\">https:\/\/doi.org\/10.1016\/j.jvir.2020.08.004<\/a><\/p>\n<p>Pulmoner arter katater-arac\u0131l\u0131 tromboliz, masif ve submasif akut pulmoner embolide (PE) bir tedavi se\u00e7ene\u011fidir. Rezid\u00fc pulmoner arter tromb\u00fcs\u00fc ise uzun d\u00f6nem k\u00f6t\u00fc klinik sonu\u00e7lara ve tekrarlayan tromboembolik olaylara yol a\u00e7ar.<\/p>\n<p>Bu \u00e7al\u0131\u015fma akut PE tedavisinde\u00a0 tekrarlayan, uzat\u0131lm\u0131\u015f katater-arac\u0131l\u0131 trombolizin yararl\u0131\u011f\u0131n\u0131 incelemektedir.<\/p>\n<p>Bu \u00e7al\u0131\u015fma, 2009-2019 y\u0131llar\u0131n\u0131 kapsayan tek merkezli, retrospektif bir kohort \u00e7al\u0131\u015fmas\u0131d\u0131r. \u00c7al\u0131\u015fma, semptomlar\u0131n ba\u015flang\u0131c\u0131ndan itibaren ilk 14 g\u00fcn i\u00e7inde ba\u015fvuran, r-tPA(rekombinan doku plazminojen aktivat\u00f6r\u00fc) ile pulmoner arter katater-arac\u0131l\u0131 tromboliz yap\u0131lan ve bu i\u015flem sonras\u0131 en az 1 kez takip anjiyografisi yap\u0131lan toplam 156 masif ve submasif PE hastas\u0131n\u0131n klinik sonu\u00e7lar\u0131n\u0131 de\u011ferlendirdi. 111 tedavi tek takip viziti ile sonland\u0131r\u0131ld\u0131. 45 vakada ise ek takip vizitleri yap\u0131ld\u0131 (40 hastada 2 takip viziti, 5 hastada 3 takip viziti).\u00a0 Ba\u015flang\u0131\u00e7 pulmoner arter bas\u0131nc\u0131 (PAB) \u00f6l\u00e7\u00fcm\u00fc, pulmoner anjiyografi ve katater-arac\u0131l\u0131 tromboliz ger\u00e7ekle\u015ftirildi. T\u00fcm hastalar ortalama 19.4\u00a0 \u00b1 5.1 saat sonra tekrar anjiyografi odas\u0131na al\u0131nd\u0131 ve tekrar PAB \u00f6l\u00e7\u00fcl\u00fcp\u00a0 Miller PE \u015fiddet indeksine g\u00f6re rezid\u00fc tromb\u00fcs\u00fc de\u011ferlendirmek i\u00e7in pulmoner anjiyografi yap\u0131ld\u0131.<\/p>\n<p>1 takip vizitinden daha fazla katater-arac\u0131l\u0131 tromboliz yap\u0131lan hastalarda benzer nihai Miller skoruna ve sistolik PAB\u2019de benzer d\u00fc\u015f\u00fc\u015fe ula\u015fmak i\u00e7in daha y\u00fcksek doz tPA\u2019ya ihtiya\u00e7 duyuldu. Sistolik PAB ve kalp h\u0131z\u0131, birden fazla takip yap\u0131lan hasta grubunda hem ba\u015flang\u0131\u00e7ta hem de ilk vizitte daha y\u00fcksekti. Her iki grupta da ilk i\u015flem ve ard\u0131\u015f\u0131k takipler aras\u0131nda sistolik PAB\u2019de anlaml\u0131 d\u00fc\u015f\u00fc\u015f g\u00f6zlendi.<\/p>\n<p>Ek takip vizitleri ve uzat\u0131lm\u0131\u015f katater-arac\u0131l\u0131 tromboliz bu kohortta y\u00fcksek komplikasyon oranlar\u0131na yol a\u00e7mad\u0131 ancak bulgular\u0131 do\u011frulamak daha b\u00fcy\u00fck \u00e7al\u0131\u015fmalar gerekmektedir.<\/p>\n<p>&nbsp;<\/p>\n<h5><strong><span style=\"color: #3366ff;\">Pulmoner Emboliyi \u00d6nlemek \u0130\u00e7in Absorbabl Vena Kava Filtresi Kullan\u0131lan 8 hastal\u0131k \u0130lk \u0130nsan \u00c7al\u0131\u015fmas\u0131<\/span> <\/strong><\/h5>\n<p>Guillermo Elizondo, MD, Mitchell Eggers, PhD, MBA, Mario Falcon, MD, Miguel Trevino, MD, Roberto Marrufo, MD, Carlos Perez, MD, Edgar Nunez, MD, Rudy Moreno, BS, Alexis Mitchell, PhD, Audrey Sheppard, BS, Stephen Dria, MS, Turner Jay, BS, Ray Kirk, MD, David Hovsepian, MD, and Joseph Steele, MD<\/p>\n<p>Yay\u0131n tarihi: Eyl\u00fcl 29, 2020<\/p>\n<p>J Vasc Interv Radiol 2020<\/p>\n<p>DOI:<a href=\"https:\/\/doi.org\/10.1016\/j.jvir.2020.07.021\">https:\/\/doi.org\/10.1016\/j.jvir.2020.07.021<\/a><\/p>\n<p>Antikoaguasyondan fayda g\u00f6rmeyen veya kontrendike oldu\u011fu i\u00e7in uygulanamayan DVT hastalar\u0131, pulmoner embolinin (PE) \u00f6nlenmesi i\u00e7in inferior vena kava (IVC) filtrelerinden fayda g\u00f6rebilir. Fakat konvansiyonel metal IVC filtrelerinin migrasyon, k\u0131r\u0131lma, embolizasyon ve organ perforasyonu gibi yan etkileri vard\u0131r. Bu y\u00fczden, kurumlar aras\u0131 farkl\u0131l\u0131k g\u00f6stermekle beraber, s\u0131kl\u0131kla bu filtrelerin birka\u00e7 hafta i\u00e7erisinde yeniden de\u011ferlendirilmesi \u00f6nerilir.<\/p>\n<p>Bu \u00e7al\u0131\u015fma, absorbabl vena kava filtrelerini de\u011ferlendiren ilk prospektif insan \u00e7al\u0131\u015fmas\u0131d\u0131r. \u00c7al\u0131\u015fma 8 hastay\u0131 kapsayan 36 haftal\u0131k periyodu (Aral\u0131k 2018-Nisan 2019) i\u00e7eriyor. Hastalar\u0131n neredeys tamam\u0131 kad\u0131nd\u0131 (%78) ve tek bir \u0131rktan olu\u015fuyordu.<\/p>\n<p>Antikoagulan tedavinin kontrendike\/ba\u015far\u0131s\u0131z oldu\u011fu DVT\/PE hastalar\u0131 ya da artm\u0131\u015f ven\u00f6z tromboemboli riski nedeniyle 5 hafta ge\u00e7ici profilaksi almas\u0131 gereken ancak kontrendike oldu\u011fu i\u00e7in antikoagulasyon alamayan hastalar \u00e7al\u0131\u015fmaya dahil edildi. IVK \u00e7ap\u0131 16 mm\u2019nin alt\u0131nda olan hastalar hari\u00e7 tutuldu.<\/p>\n<p>Absorbabl filtre 6 radioopak marker ve 33-mm balona y\u00fckl\u00fc polimerden olu\u015fuyordu. Polimer filaman ise polidiaksondan yap\u0131lm\u0131\u015f olup yakla\u015f\u0131k 6 ayda y\u0131k\u0131lan bir malzemedir. IVK filtresi yerle\u015ftirildikten sonra PE ve filtre endotelizasyonunu de\u011ferlendirmek i\u00e7in 5 hafta, filtre sepeti par\u00e7alanmadan \u00f6nce tromb\u00fcs olmad\u0131\u011f\u0131n\u0131 garantiye almak i\u00e7in 11 hafta ve IVK\u2019y\u0131 filtre \u00f6ncesi ve filtre rezorbsiyonu sonras\u0131 kar\u015f\u0131la\u015ft\u0131rmak i\u00e7in 36 hafta aral\u0131k ile takip yap\u0131ld\u0131. Hastalar, komplikasyonlar\u0131 de\u011ferlendirmek i\u00e7in implantasyondan \u00f6nce ve 5, 11, 36 hafta sonra BT ve bat\u0131n grafi ile de\u011ferlendirildi. Olas\u0131 PE i\u00e7in ise filtre yerle\u015ftirilmeden \u00f6nce ve yerle\u015ftirildikten 5 hafta sonra BT anjiyografi ile de\u011ferlendirme yap\u0131ld\u0131.<\/p>\n<p>Absorbabl filtrenin yerle\u015ftirme kolayl\u0131\u011f\u0131 konvansiyonel endovask\u00fcler cihazlar\u0131nkine benzerdi. \u0130\u015flem sonras\u0131 komplikasyon ya da yan etki 36 haftal\u0131k takip sonras\u0131 g\u00f6zlenmedi.\u00a0 2 hastada ise bu 36 haftal\u0131k takip yap\u0131lamad\u0131.<\/p>\n<p>Bu \u00e7al\u0131\u015fmadaki az say\u0131da \u00f6rne\u011fe ra\u011fmen, insanlardaki ilk absorbabl filtre deneyimi %100 klinik ba\u015far\u0131ya ula\u015ft\u0131. Filtrenin etkinli\u011fini g\u00f6stermek i\u00e7in bu alanda ileri \u00e7al\u0131\u015fmalara ihtiya\u00e7 vard\u0131r.<\/p>\n<p><strong>\u00a0<\/strong><\/p>\n<h5><span style=\"color: #3366ff;\"><strong>Orta ve Y\u00fcksek Riskli Pulmoner Embolinin De\u011ferlendirilmesi ve Y\u00f6netimi<\/strong><\/span><\/h5>\n<p>Ramsey Al-Hakim, Ningcheng Li, Stephanie Nonas, Bishoy Zakhary, Brandon Maughan, Ryan Schenning, Khashayar Farsad, and John A. Kaufman<\/p>\n<p>Yay\u0131n tarihi: Mart 2020<\/p>\n<p>American Journal of Roentgenology 2020 214:3, 671-678<\/p>\n<p>DOI:<a href=\"https:\/\/doi.org\/10.2214\/AJR.19.21861\">https:\/\/doi.org\/10.2214\/AJR.19.21861<\/a><\/p>\n<p>Pulmoner emboli bir\u00e7ok uzun d\u00f6nem sekel de\u011fi\u015fiklikler ile ilgilidir.\u00a0 Bunlardan baz\u0131lar\u0131 kronik tromboembolik pulmoner hipertansiyon ve egzersiz tolerans\u0131 ile ya\u015fam kalitesini d\u00fc\u015f\u00fcren post pulmoner emboli sendromudur.<\/p>\n<p>Bu derleme\u00a0 \u00f6zellikle orta ve y\u00fcksek riskli pulmoner embolilerde mortaliteyi d\u00fc\u015f\u00fcren tedavi se\u00e7eneklerini g\u00f6zden ge\u00e7irmektedir.\u00a0 \u0130ncelenen iki klavuz 2014 Avrupa Kardiyoloji Cemiyeti (ESC) ve 2016 Ven\u00f6z Tromboembolik Hastal\u0131kta Antitrombotik Tedavi k\u0131lavuzlar\u0131d\u0131r.<\/p>\n<p>Makale pulmoner embolinin(PE) ilk, ba\u015flang\u0131\u00e7 s\u0131n\u0131fland\u0131rmas\u0131na vurgu yap\u0131yor. Masif ve submasif terimleri PE\u2019nin radyolojik\u00a0 de\u011fil yaln\u0131zca olas\u0131 klinik sonu\u00e7lar\u0131n\u0131 kastetti\u011fi i\u00e7in\u00a0 yazarlar taraf\u0131ndan \u00e7ok geni\u015f ve kafa kar\u0131\u015ft\u0131r\u0131c\u0131 olarak de\u011ferlendirilmi\u015f. Bunun yerine PE\u2019yi hipotansiyonun (&gt;15 dk, &lt;90 mmHg sistolik bas\u0131n\u00e7)\u00a0 e\u015flik etti\u011fi y\u00fcksek riskli, hipotansiyon olmaks\u0131z\u0131n sa\u011f ventrik\u00fcl disfonksiyonunu g\u00f6steren g\u00f6r\u00fcnt\u00fcleme bulgular\u0131 ve kardiyak biyobelirte\u00e7lerin oldu\u011fu orta riskli ve bunlardan hi\u00e7birinin e\u015flik etmedi\u011fi d\u00fc\u015f\u00fck riskli olmak \u00fczere \u00fc\u00e7 kategoriye ay\u0131ran ESC k\u0131lavuzunu uygun g\u00f6r\u00fcyorlar.\u00a0 Sa\u011f ventrik\u00fcl disfonksiyonu, BT\u2019de sa\u011f ventrik\u00fcl\/sol ventrik\u00fcl oran\u0131n\u0131n 0.9\u2019dan b\u00fcy\u00fck olmas\u0131 veya ekokardiyografide sa\u011f ventrik\u00fcl disfonksiyon bulgular\u0131n\u0131n varl\u0131\u011f\u0131 ile tan\u0131mlanm\u0131\u015ft\u0131r.<\/p>\n<p>2014 ESC k\u0131lavuzuna g\u00f6re, y\u00fcksek-orta riskli PE \u015f\u00fcphesi olan hastalarda s\u00fcre\u00e7 devam ederken antikoagulasyon ba\u015flanmas\u0131 \u00f6neriliyor (S\u0131n\u0131f I, d\u00fczey C). Orta riskli PE\u2019de e\u011fer hemodinamik ya da kardiyopulmoner instabilite mevcutsa sistemik trombolitik tedavi \u00f6neriliyor. Hemodinamik dekompansasyon yak\u0131nsa ve sistemik tromboliz sonras\u0131 beklenen kanama ihtmali y\u00fcksek ise perk\u00fctan katater-arac\u0131l\u0131 tromboliz veya cerrahi pulmoner embolektomi dikkate al\u0131nmal\u0131d\u0131r. Y\u00fcksek riskli PE\u2019de hastalar\u00a0 h\u0131zl\u0131ca sistemik tromboliz i\u00e7in de\u011ferlendirilmelidir. E\u011fer sistemik trombolizin riskleri y\u00fcksekse, kontrendikeyse veya ba\u015far\u0131s\u0131z olursa kateter trombektomi veya cerrahi embolektomi dikkate al\u0131nmal\u0131d\u0131r. \u0130nferior vena kava filtresi ise hasta bazl\u0131 olarak yap\u0131lmal\u0131d\u0131r. 2014 ESC k\u0131lavuzu, e\u011fer antikoagulasyon tedavi i\u00e7in mutlak kontrendikasyon varsa veya terap\u00f6tik dozlardaki antikoagulasyona ra\u011fmen tekrarlayan PE varsa IVK filtrelerini \u00f6neriyor. 2011 Amerikan Kalp Cemiyeti k\u0131lavuzu ise\u00a0 masif PE\u2019yi de i\u00e7eren k\u00f6t\u00fc kardiyopulmoner rezervli PE hastalar\u0131nda IVK filtresini \u00f6neriyor.<\/p>\n<p>Kateter trombektominin ve orta-y\u00fcksek riskli hastalarda IVK filtrelerinin risklerini ve faydalar\u0131n\u0131 daha iyi anlamak i\u00e7in ilave ara\u015ft\u0131rmalar gereklidir.<\/p>\n<p><strong>\u00a0<\/strong><\/p>\n<h5><span style=\"color: #3366ff;\"><strong>Covid-19 Hastas\u0131nda Akut Aortoiliak Okl\u00fczyon<\/strong><\/span><\/h5>\n<p>Iris Naudin, Anne Long, Christophe Michel, Bertrand Devigne, Antoine Millon, Nellie Della-Schiava<\/p>\n<p>Yay\u0131n tarihi: Ekim 16, 2020<\/p>\n<p>Journal of Vascular Surgery &#8211; Journal Pre-proof<\/p>\n<p>DOI: <a href=\"https:\/\/doi.org\/10.1016\/j.jvs.2020.10.018\">https:\/\/doi.org\/10.1016\/j.jvs.2020.10.018<\/a><\/p>\n<p>Covid-19 pandemisi hemen hemen t\u00fcm \u00fclkeleri etkilemi\u015ftir. Solunum semptomlar\u0131 ile bilinmesine ra\u011fmen hastal\u0131kta g\u00f6r\u00fclen proinflamatuar durum bir\u00e7ok organ\u0131 etkilemektedir.<\/p>\n<p>Bu vaka sunumu, a\u011f\u0131r Covid-19 enfeksiyonu ge\u00e7iren bir hastada akut aortoiliak ve alt ekstremite arteryel okl\u00fczyonlar\u0131ndan bahsetmektedir.<\/p>\n<p>56 ya\u015f\u0131nda bilinen DM, HT ve obezitesi olan hasta alt ekstremitede akut kas g\u00fc\u00e7s\u00fczl\u00fc\u011f\u00fc ve duyu kayb\u0131 ile ba\u015fvurdu. Yap\u0131lan torakoabdominopelvik BT g\u00f6r\u00fcnt\u00fclemede distal aorta ve sol iliak arterde okl\u00fczyonlar, arkus aortada da serbest tromb\u00fcs materyali saptand\u0131. Hastan\u0131n s\u00fcr\u00fcnt\u00fc testi negatif olmas\u0131na ra\u011fmen Covid-19\u2019un tipik akci\u011fer bulgular\u0131 olmas\u0131 sebebiyle hasta Covid-19 pozitif olarak kabul edildi.<\/p>\n<p>Hasta operasyona al\u0131n\u0131p perk\u00fctan sa\u011f ana femoral ve a\u00e7\u0131k sol ana femoral yakla\u015f\u0131mlar yap\u0131ld\u0131. Kapl\u0131 kissing-stentler konuldu ve arteriografide sol popliteal okl\u00fczyon tespit edilip a\u00e7\u0131k popliteal trombektomi ile tedavi edildi. 13 dakika sonra hastada sa\u011f akut alt ekstremite iskemi bulgular\u0131 geli\u015fti ve sa\u011f a\u00e7\u0131k femoral yakla\u015f\u0131m yap\u0131ld\u0131. Arteriografide sa\u011f popliteal ve distal krural arterlerde tromb\u00fcs saptand\u0131 ve komplet sa\u011f diz alt\u0131 trombektomi yap\u0131ld\u0131.\u00a0 Birka\u00e7 saat sonra hasta tekrardan sa\u011fda alt ekstremite iskemisi ve solda irreversibl ayak iskemisi bulgular\u0131 g\u00f6sterdi. BT incelemede tatmin edici aortailiak revask\u00fclarizasyon ve sa\u011f popliteal arterden distal krural arterlere uzanan yeni tromb\u00fcs materyalleri g\u00f6r\u00fcld\u00fc. Ayr\u0131ca sol derin femoral arterde yeni okl\u00fczyon ve sol ayak bile\u011finden itibiaren arteryel sistemde ak\u0131mda total kay\u0131p izlendi. \u0130kinci kez sa\u011f popliteal trombektomi yap\u0131ld\u0131. Bu s\u0131ralarda hastan\u0131n s\u00fcr\u00fcnt\u00fc \u00f6rne\u011fi Covid-19 pozitif olarak sonu\u00e7land\u0131. Hemodinamik instabilitesi olan hastada \u00fc\u00e7\u00fcnc\u00fc kez BT g\u00f6r\u00fcnt\u00fcleme yap\u0131ld\u0131. Bu g\u00f6r\u00fcnt\u00fclemede aortoiliak kissing stent ve sa\u011f popliteal arterin patent oldu\u011fu ancak yeni geli\u015fmi\u015f k\u00fc\u00e7\u00fck sa\u011f renal enfarkt g\u00f6r\u00fcld\u00fc.\u00a0 Hemodinamik stabilizasyon i\u00e7in sol transtibial amputasyon karar\u0131 al\u0131nd\u0131. 1 May\u0131s 2020\u2019de revask\u00fclarizasyon kontrol\u00fc i\u00e7in ger\u00e7ekle\u015ftirilen son BT\u2019de torasik aortadaki tromb\u00fcs\u00fcn tamamen kayboldu\u011fu izlendi.<\/p>\n<p>Hastadaki okl\u00fczyon mekanizmas\u0131n\u0131n arkus aortadaki viral enfeksiyon kaynakl\u0131 serbest tromb\u00fcsten olaca\u011f\u0131 d\u00fc\u015f\u00fcn\u00fcld\u00fc. Vir\u00fcs, sistemik inflamatuar yan\u0131t sendromuna yol a\u00e7m\u0131\u015ft\u0131. Bu durum da hiperkoagulasyon ve endotelyal hasara neden olmu\u015ftu. Tromb\u00fcs\u00fcn endovask\u00fcler \u00e7\u0131kar\u0131lmas\u0131 kaynakl\u0131 olas\u0131 embolileri engellemek i\u00e7in antikogulasyon yap\u0131ld\u0131.<\/p>\n<p>&nbsp;<\/p>\n<p>Translated by: Hakan Do\u011fan<\/p>\n","protected":false},"excerpt":{"rendered":"Derin Ven Trombozu Hastalar\u0131nda Farmakomekanik Tromboliziz Sonras\u0131 Rezid\u00fc Tromb\u00fcs Hacmi \u0130le Klinik Ak\u0131bet Aras\u0131ndaki \u0130li\u015fki: [&hellip;]","protected":false},"author":3,"featured_media":2916,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_bbp_topic_count":0,"_bbp_reply_count":0,"_bbp_total_topic_count":0,"_bbp_total_reply_count":0,"_bbp_voice_count":0,"_bbp_anonymous_reply_count":0,"_bbp_topic_count_hidden":0,"_bbp_reply_count_hidden":0,"_bbp_forum_subforum_count":0,"footnotes":""},"categories":[209],"tags":[],"class_list":["post-9690","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-uncategorized-tr"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v25.1 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>What&#039;s new in Interventional Radiology (Turkish) - November 2020 - ACORE<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/staging-hub.acoredu.com\/whats-new-in-interventional-radiology-november-2020\/\" \/>\n<meta property=\"og:locale\" content=\"tr_TR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"What&#039;s new in Interventional Radiology (Turkish) - November 2020 - ACORE\" \/>\n<meta property=\"og:description\" content=\"Derin Ven Trombozu Hastalar\u0131nda Farmakomekanik Tromboliziz Sonras\u0131 Rezid\u00fc Tromb\u00fcs Hacmi \u0130le Klinik Ak\u0131bet Aras\u0131ndaki \u0130li\u015fki: [&hellip;]\" \/>\n<meta property=\"og:url\" content=\"https:\/\/staging-hub.acoredu.com\/whats-new-in-interventional-radiology-november-2020\/\" \/>\n<meta property=\"og:site_name\" content=\"ACORE\" \/>\n<meta property=\"article:published_time\" content=\"2020-11-14T18:06:08+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2020-11-15T06:09:44+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/staging-hub.acoredu.com\/wp-content\/uploads\/2020\/07\/radiology-x-ray-scanning-P6TDVLL-1-scaled.jpg\" \/>\n\t<meta property=\"og:image:width\" content=\"2560\" \/>\n\t<meta property=\"og:image:height\" content=\"1709\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/jpeg\" \/>\n<meta name=\"author\" content=\"Abdelrahman\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Yazan:\" \/>\n\t<meta name=\"twitter:data1\" content=\"Abdelrahman\" \/>\n\t<meta name=\"twitter:label2\" content=\"Tahmini okuma s\u00fcresi\" \/>\n\t<meta name=\"twitter:data2\" content=\"11 dakika\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\/\/staging-hub.acoredu.com\/whats-new-in-interventional-radiology-november-2020\/\",\"url\":\"https:\/\/staging-hub.acoredu.com\/whats-new-in-interventional-radiology-november-2020\/\",\"name\":\"What's new in Interventional Radiology (Turkish) - November 2020 - ACORE\",\"isPartOf\":{\"@id\":\"https:\/\/staging-hub.acoredu.com\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\/\/staging-hub.acoredu.com\/whats-new-in-interventional-radiology-november-2020\/#primaryimage\"},\"image\":{\"@id\":\"https:\/\/staging-hub.acoredu.com\/whats-new-in-interventional-radiology-november-2020\/#primaryimage\"},\"thumbnailUrl\":\"https:\/\/staging-hub.acoredu.com\/wp-content\/uploads\/2020\/07\/radiology-x-ray-scanning-P6TDVLL-1-scaled.jpg\",\"datePublished\":\"2020-11-14T18:06:08+00:00\",\"dateModified\":\"2020-11-15T06:09:44+00:00\",\"author\":{\"@id\":\"https:\/\/staging-hub.acoredu.com\/#\/schema\/person\/75293c6e4870f3aa293e1394c53df6b7\"},\"breadcrumb\":{\"@id\":\"https:\/\/staging-hub.acoredu.com\/whats-new-in-interventional-radiology-november-2020\/#breadcrumb\"},\"inLanguage\":\"tr\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\/\/staging-hub.acoredu.com\/whats-new-in-interventional-radiology-november-2020\/\"]}]},{\"@type\":\"ImageObject\",\"inLanguage\":\"tr\",\"@id\":\"https:\/\/staging-hub.acoredu.com\/whats-new-in-interventional-radiology-november-2020\/#primaryimage\",\"url\":\"https:\/\/staging-hub.acoredu.com\/wp-content\/uploads\/2020\/07\/radiology-x-ray-scanning-P6TDVLL-1-scaled.jpg\",\"contentUrl\":\"https:\/\/staging-hub.acoredu.com\/wp-content\/uploads\/2020\/07\/radiology-x-ray-scanning-P6TDVLL-1-scaled.jpg\",\"width\":2560,\"height\":1709,\"caption\":\"Radiology X Ray Scanning. 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