Vasküler Yaralar: Arteriyel Vasküler Yaralar
Özet
Arteriyel vasküler yaralar, genellikle 50 yaş üstü bireylerde görülen ve dokulara yetersiz kan ile oksijen sunumu sonucu kronik bir süreçte gelişen iskemik ülserlerdir. En güçlü risk faktörü hipertansiyon olmakla birlikte sigara kullanımı, dislipidemi, diyabet ve sol ventrikül bozuklukları da hastalığın sıklığını ve alt ekstremite yaralanmalarını belirgin şekilde artırır. İskemik süreç, arter darlığı veya tıkanıklığı nedeniyle nitrik oksit sentezinin azalması, endotel hasarı ve enflamatuvar belirteçlerin artmasıyla patofizyolojik bir yolak izler. Tanı aşamasında detaylı anamnez ve fizik muayenenin yanı sıra, Buerger testi, kapiller dolum testi ve anjiyografiyle yüksek sensitivite sunan Ayak Bileği/Kol Basınç İndeksi (ABİ) yaygın olarak kullanılır. Radyolojik değerlendirmelerde ise noninvaziv ve hızlı olmaları nedeniyle Doppler ultrasonografi, BT anjiyografi ve MR anjiyografi tercih edilirken; altın standart haritalama için kateter anjiyografisinden yararlanılır. Tedavi ve yönetim süreçlerinde hastaya egzersiz programları uygulanır; nekrotik dokuları uzaklaştırmak amacıyla cerrahi, otolitik veya biyolojik debridman yöntemlerine başvurulur. Medikal tedavide aspirin veya klopidogrel gibi antitrombositer ajanlar, statinler, ACE inhibitörleri ve HbA1c düzeyini %7’nin altına indirmeyi hedefleyen antidiyabetik ilaçlar kullanılır. İleri evrelerde stentleme gibi endovasküler girişimsel radyolojik teknikler ve bypass greftleme gibi vasküler cerrahi müdahaleler uygulanırken, negatif basınçlı pansumanlar ve kök hücre gibi biyomoleküler uygulamalar da ek tedaviler arasında yer alır.
Arterial vascular wounds are ischemic ulcers that generally occur in individuals over the age of 50 and develop over a chronic process as a result of insufficient blood and oxygen supply to tissues. Although hypertension is the strongest risk factor, smoking, dyslipidemia, diabetes, and left ventricular dysfunctions also significantly increase the incidence of the disease and lower extremity injuries. The ischemic process follows a pathophysiological pathway with decreased nitric oxide synthesis, endothelial damage, and increased inflammatory markers due to arterial stenosis or occlusion. In the diagnosis phase, along with a detailed medical history and physical examination, the Buerger test, capillary refill test, and Ankle-Brachial Index (ABI), which offers high sensitivity with angiography, are widely used. In radiological evaluations, Doppler ultrasonography, CT angiography, and MR angiography are preferred because they are noninvasive and fast, whereas catheter angiography is utilized for near-perfect mapping. In the treatment and management processes, exercise programs are implemented for the patient, and surgical, autolytic, or biological debridement methods are applied to remove necrotic tissues. Medical treatment includes antiplatelet agents such as aspirin or clopidogrel, statins, ACE inhibitors, and antidiabetic drugs aiming to reduce HbA1c levels below 7%. In advanced stages, endovascular interventional radiological techniques like stenting and vascular surgical interventions such as bypass grafting are performed, while negative pressure dressings and biomolecular applications like stem cell therapy are among the additional treatments.
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