Kalıcı kalp pili takılan hastalarda pil takılması sonrası gelişebilen venöz tıkanıklığı predikte eden faktörler
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Date
2010
Authors
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Publisher
Trakya Üniversitesi Tıp Fakültesi
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info:eu-repo/semantics/openAccess
Abstract
Kalıcı transvenöz lead implantasyonunun darlık, tıkanıklık ya da trombozis gibi lezyonları potansiyel olarak tetiklediği bilinmektedir. Bu tür lezyonlar çoğu olguda sessiz olmasına karşın bazı olgularda klinik sorunlara yol açabilmektedir. Çalışmamızda kalıcı kalp pili takılan hastalarda, kalp pili takılması sonrası gelişebilen venöz tıkanıklığı predikte eden nedenler araştırıldı. Çalışmaya toplam 166 hasta alındı. Tüm hastaların 86 (%51.8) tanesi erkek, 80 (%48.2) tanesi kadındı. Darlık yüzdesine göre hastalar iki gruba ayrıldı (darlık yüzdesi <%50 ve darlık yüzdesi ?%50). Çalışmaya alınan hastaların ilk implantasyon tarihinden venografi tarihine kadar geçen izlem süreleri 3 ay ile 184 ay arasında idi. İzlem süreleri açısından darlık grupları arasında istatistiksel olarak anlamlı fark yoktu. Referans ven çapı açısından her iki grup arasında anlamlı fark yoktu. Çalışmamızda venöz darlık oranı (?%50) %10.8 olarak belirledik. Tüm hastalar içerisindeki total tıkanıklık oranı ise %3 idi. Çalışmaya alınan hastaların tamamı asemptomatikti. Gruplar arasında yaş, cinsiyet, hipertansiyon, diyabet, sigara kullanımı, koroner arter hastalığı, obesite ve hiperlipidemi açısından anlamlı bir farklılık saptanmadı. Kalıcı kalp pili endikasyonu, bazal ritim, batarya yeri, lead kalınlığı ve lead kaplama materyali açısından gruplar arasında fark saptanmadı. Asetil salisilik asit kullanan hasta sayısı venöz darlığı olmayan grupta istatistiksel açıdan anlamlı olmasa da belirgin derecede fazla saptandı (%57-%33, p=0.052). Kalıcı kalp pili takılması sonrasında yapılan tekrar girişimsel işlemlerin, ilgili vende daralmayı arttırdığı saptandı (%38.9-%21.6). Sonuç olarak; kalıcı kalp pili takılması sonrası tüm hastalarda semptomatik olsun ya da olmasın venöz darlık gelişebilmektedir. Asetil salisilik asit tedavisi venöz tıkanıklık sıklığını azaltmaktadır. Asetil salisilik asit kullanmama ve tekrarlayan girişimler venöz tıkanıklığın önemli risk faktörleri olarak görünmektedir.
Abstract
It is known that permanent transvenous lead implantations potentially trigger lesions like stenosis, obstruction or thrombosis. These kinds of lesions despite being silent in many cases can cause clinic problems in some cases. In our study, the reasons have been searched for predictive factors of venous obstruction that can occur after implantation of pacemakers to the patients with permanent pacemakers. Totally 166 patients were included to the study. All patients 86 of them were men (51.8%), 80 of them were women (48.2%). Patients were divided into two groups according to percentage of stenosis (percentage of stenosis <50% and percentage of stenosis ?50%). The patients? were included to the study, observation duration was between 3 months and 184 months from their first implantation date to the venography date. There was no statistically significant difference between stenosis groups in terms of observation duration. It was not determined meaningful difference in each two groups in terms of reference vein diameter. In our study, we determined venous stenosis (?50%) 10.8%. Total stenosis percentage is 3% among all patients. All patients who were included to the study were asymptomatic. It was not determined meaningful difference in terms of age, gender, hypertension, diabetes mellitus, smoking, coroner artery disease, obesity and hyperlipidemia among groups. It was not determined difference among groups in terms of permanent pacemaker indication, baseline rhythm, battery site, lead thickness and lead insulation material. The number of patients who take acetylsalicylic acid in the group who do not have venous stenosis was clearly determined many despite not being meaningful in terms of statistical. (57%-33%, p=0.052). It was determined that the repeat invasive processes increased stenosis in related vein after permanent pacemaker implantation. In conclusion, after implantation of permanent pacemaker in all patients symptomatic or asymptomatic venous obstruction can occur. Acetylsalicylic acid therapy reduced the incidence of venous obstruction. Not using of acetylsalicylic acid and repeat invasive processes as venous obstruction predictive seem like important risk factors.
Abstract
It is known that permanent transvenous lead implantations potentially trigger lesions like stenosis, obstruction or thrombosis. These kinds of lesions despite being silent in many cases can cause clinic problems in some cases. In our study, the reasons have been searched for predictive factors of venous obstruction that can occur after implantation of pacemakers to the patients with permanent pacemakers. Totally 166 patients were included to the study. All patients 86 of them were men (51.8%), 80 of them were women (48.2%). Patients were divided into two groups according to percentage of stenosis (percentage of stenosis <50% and percentage of stenosis ?50%). The patients? were included to the study, observation duration was between 3 months and 184 months from their first implantation date to the venography date. There was no statistically significant difference between stenosis groups in terms of observation duration. It was not determined meaningful difference in each two groups in terms of reference vein diameter. In our study, we determined venous stenosis (?50%) 10.8%. Total stenosis percentage is 3% among all patients. All patients who were included to the study were asymptomatic. It was not determined meaningful difference in terms of age, gender, hypertension, diabetes mellitus, smoking, coroner artery disease, obesity and hyperlipidemia among groups. It was not determined difference among groups in terms of permanent pacemaker indication, baseline rhythm, battery site, lead thickness and lead insulation material. The number of patients who take acetylsalicylic acid in the group who do not have venous stenosis was clearly determined many despite not being meaningful in terms of statistical. (57%-33%, p=0.052). It was determined that the repeat invasive processes increased stenosis in related vein after permanent pacemaker implantation. In conclusion, after implantation of permanent pacemaker in all patients symptomatic or asymptomatic venous obstruction can occur. Acetylsalicylic acid therapy reduced the incidence of venous obstruction. Not using of acetylsalicylic acid and repeat invasive processes as venous obstruction predictive seem like important risk factors.
Description
Tıpta Uzmanlık Tezi
Keywords
Kardiyoloji, Cardiology, Teknoloji, Tıp Bilimleri, Hastalıklar, Kalp Damar Sistemi Hastalıkları, Venöz Tıkanıklığı
