Turkiye Klinikleri Cardiovascular Sciences

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Behçet Hastalığına Sekonder Gelişen Derin Ven Trombozunda Farmakomekanik Trombolitik Tedavinin Kullanımı: Bir Yıllık Sonuçlar
The Use of Pharmacomechanical Thrombolytic Treatment in Deep Vein Thrombosis Associated with Behçet's Disease: One-Year Results
Ümit ARSLANa, Eyüp Serhat ÇALIKa
aKalp ve Damar Cerrahisi AD, Atatürk Üniversitesi Tıp Fakültesi, Erzurum, TÜRKİYE
Turkiye Klinikleri J Cardiovasc Sci. 2019;31(1):29-35
doi: 10.5336/cardiosci.2018-63041
Article Language: TR
Full Text
ÖZET
 Amaç: Behçet hastalığı (BH)'nda vasküler tutulum genellikle derin ven trombozu (DVT) şeklinde olmaktadır. Bu çalışmada, DVT gelişen Behçet hastalarında immünsupresif tedaviyle kom- bine edilen farmakomekanik trombektomi (FMT) yönteminin uygulanabilirliğini ve bu yöntemin klinik iyileşme üzerine olan etkilerinin bir yıllık sonuçlarının sunulması amaçlanmıştır. Gereç ve Yöntemler: Alt ekstremite akut veya subakut, ilk atak DVT tanısıyla kliniğimize yönlendirilen ve FMT uygulanan 27 Behçet hastası çalışmaya alındı. Hastalara, işlemden önce geçici vena kava in- ferior filtresi yerleştirildi ve işlemden sonra kateter yardımıyla 24 saat boyunca 1 mg/saat doku plazminojen aktivatörü (tPA) infüzyonu uygulandı. Takipte, hastaların fizik muayeneleri ve Villalta skorlaması yapıldı. Derin venöz sistem reflü süreleri 3. 6. ve 12. aylarda Doppler ultrasonografi (USG) ile değerlendirildi. Bulgular: Yirmi yedi (22 erkek ve 5 kadın) hastanın yaş ortalaması 28,8±5,8 yıl idi. BH'nın ortalama süresi 19,5±13,5 ay ve semptomların başlama süresi ortalama 6,4±4,0 gün bulundu. On yedi hastada femoropopliteal DVT ve 10 hastada iliofemoral DVT saptandı. Altı hastada bilateral femoropopliteal segment trombozu mevcuttu. FMT yöntemi, 33 alt ekstremiteye uy- gulandı ve işlemin ortalama süresi 104±23 dk idi. Yirmi (%74) hastada trombüsün tamamen uzaklaştırıldığı Grade III akım, 3 (%11)'ünde Grade II (%50-99) akım elde edildi. Altıncı ay takibinde iki hastada tekrarlayan DVT atağı gelişti. Villalta skoruna göre, on ikinci ay takibinde, altı hastada hafif posttrombotik sendrom (PTS) ve dört hastada ılımlı PTS kliniği saptandı. Sonuç: İlk atak akut veya subakut DVT ile başvuran seçilmiş Behçet hastalarında, immünsupresif ve antikoagülan tedaviye ek olarak, FMT yöntemi ile trombüs yükünün azaltılmasının faydalı olabileceği düşünülmektedir. Ülkemizde BH'nın yaygın olması nedeni ile, bu hastalarda gelişen venöz tutulum tedavisini optimal düzeyde sağlayabilmek için daha kapsamlı ve karşılaştırmalı çalışmalara ihtiyaç vardır.

Anahtar Kelimeler: Behçet hastalığı; derin ven trombozu; posttrombotik sendrom
ABSTRACT
 Objective:Vascular involvement in Behçet's disease (BD) is usually seen as deep vein thrombosis (DVT). We aimed to investigate the feasibility of pharmacomechanical thrombolytic (PMT) method for treatment of venous involvement in Behçet's patients and its one year results on clinical improvement. Material and Methods: Twenty-seven BD patients who referred to our clinic with the lower extremity acute DVT and underwent PMT were included in the study. Temporary vena cava inferior filter was placed before the procedure and 1 mg/h of tissue plasminogen activator (tPA) infusion was applied to patients for 24 hours via catheter. Follow-up examinations included physical examinations and Villalta scoring. Venous reflux was evaluated by Doppler ultrasonography (USG) follow-up at months 3, 6 and 12. Results: The mean age of 27 (22 males and 5 females) patients was 28.8±5.8 years. The duration of BD was 19.5±13.5 months and duration of onset of symptoms was 6.4 ± 4.0 days. 17 patients had femoropopliteal DVT and 10 patients had iliofemoral DVT. Six patients had bilateral femoropopliteal thrombosis. PMT was performed in 33 lower extremities and the mean duration of the procedure was 104±23 min. 20 (74%) patients had Grade III (complete lysis) flow and 3 (11%) patients had Grade II (50-99%) flow. Recurrent DVT was detected in 2 patients follow-up at 6 month. According to Villalta score, six patients had mild post-thrombotic syndrome (PTS) and four patients had moderate PTS. Conclusion: In addition to immunosuppressive and anticoagulant therapy, it may be beneficial to reduce thrombus burden by FMT method in selected patients with Behcet's disease who presented with acute or subacute DVT. Because of the high prevalence of BD in our country, comparative and more comprehensive studies are needed to provide optimal treatment of venous involvement in these patients.

Keywords: Behcet's disease; deep venous thrombosis; post-thrombotic syndrom
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