Alt ekstremite periferik arter hastalığı BTA

Özet

Kladikasyon, istirahat ağrısı veya iyileşmeyen ayak yarası bulunan hastada periferik arter hastalığı, akımı sınırlayan lezyonların yerini ve ayağa uzanan damar yatağını belirlemek için incelenir. Runoff BTA, aortoiliak inflow'dan tibial ve pedal arterlere kadar plak, darlık, oklüzyon ve distal yeniden doluşu anatomik olarak haritalar; özellikle revaskülarizasyon planlamasında yol gösterir. Görüntüleme klinik bulgular, risk profili veya yönetim üzerindeki olası etkisiyle gerekçelendirilmelidir; asemptomatik damar yataklarının rutin anatomik taraması desteklenmez. Ağır kalsifikasyon veya yavaş distal kontrast geçişi doğru açıklığı maskeleyebilir; kullanılabilir runoff damarının yanlışlıkla kaybedilmesi doku kaybı riski taşıyan hastada planlamayı etkiler.

Faz ve pencere

BTA tanısal

İyotlu kontrastın arteriyel geçişinde aort bifurkasyonundan ayaklara uzanan kontrastlı lümen boyunca eksantrik/çevresel plak, darlık, oklüzyon ve distal kollateral doluş incelenir. Damar duvarı kalsiyumu lümeni örtebilir; tibial opasifikasyonun zayıf olması gerçek kapanma kadar yavaş akım veya bolus zamanlamasıyla da ilişkili olabilir. Değerlendirme aksiyel kaynak kesitlerde, damar eksenine dik rekonstrüksiyonlarda ve MIP görüntülerinde çapraz doğrulanır.

Önerilen pencereler: Anjiyo (G 600 / M 150), Kemik (G 1800 / M 400), Yumuşak doku (G 400 / M 40).

BT bulguları

• Aterosklerotik plak — ortak iliak, ortak femoral, yüzeyel femoral veya popliteal arter duvarında kalsifiye, yumuşak ya da karmaşık plak ve eşlik eden lümen düzensizliği.
• Lümen darlığı — kontrast kolonunun fokal veya uzun segmentli incelmesi; darlığın yerini, uzunluğunu ve çevresindeki referans damar kesitini tarif et.
• Kronik oklüzyon — bir arter segmentinde kontrastlı lümen devamlılığının kaybı ve kapanma sonrasında distal yatağın yeniden doluş paterni.
• Kollateral yeniden doluş — profunda femoris, kas dalları veya geniküler ağ üzerinden hastalıklı segmentin distalindeki artere ulaşan kontrast yolu.
• Femoropopliteal hastalık — yüzeyel femoral arterin adduktor kanalından popliteal arter trifurkasyonuna uzanan tek ya da çok odaklı plaklı lezyonlar.
• Tibial arter hastalığı — anterior tibial, posterior tibial ve fibular arterlerin lümen açıklığı ile çevresel medial kalsifikasyonun birlikte değerlendirilmesi.
• Distal runoff — kruris damarlarının ayak bileğine ve görülebildiği ölçüde dorsalis pedis veya plantar arterlere kadar kesintisiz izlenebilirliği; her damarı ayrı kaydet.

Normalde

Hastalıklı segmenti aynı damarın daha az etkilenmiş komşu bölümü ve karşı tarafla karşılaştırırken gerçek lümen çapına, kapanma sonrası yeniden doluşa ve ayağa kadar izlenebilen tibial damarların hangileri olduğuna bakın.

Ayırıcı tanı

Akut emboli

önceden belirgin plak taşımayan damarda ani intraluminal kesinti; kronik aterosklerotik segmentlerdeki yaygın düzensizlik ve gelişmiş kollateraller eşlik etmeyebilir.

Akut in situ tromboz

aterosklerotik darlık, stent veya greft üzerinde yeni dolum kaybı; komşu damar yatağındaki kronik plak yükü zemini gösterir.

Popliteal arter anevrizması

popliteal arterin fokal dış çap genişlemesi ve olası mural trombüs, yalnız stenozdan ayrılır.

Popliteal arter tuzaklanması

popliteal arterin gastroknemius veya popliteusla anormal ilişkisi ve odaklı bası/deformasyon; yaygın çok seviyeli aterom paterni beklenmez.

Tuzaklar

• Kruris arterlerindeki yoğun medial kalsiyum, kontrast lümenine taşan blooming ile stenozu olduğundan ağır gösterebilir; şüpheli kesiti aksiyel kaynaklarda ve mümkünse damar eksenine dik düzlemde incele.
• Tibial arterin tek bir MIP görüntüsünde seçilmemesi oklüzyonu kanıtlamaz; gecikmiş kontrast geçişi ve bolusun distal yatağı görüntüleme başlamadan önce geçmesi de zayıf opasifikasyon yapabilir.
• Distal kruris arterlerinde yoğun kalsiyum veya yavaş akım lümen değerlendirmesini zorlaştırabilir; damar devamlılığını kaynak kesitlerde ve damar eksenine dik düzlemde çapraz doğrulayın.
• Kıvrımlı kollateral damarlar aksiyel kesitte normal kruris arteri sanılabilir; beklenen anatomik seyir ve distal devamlılık üzerinden gerçek tibial damardan ayır.

Kendini dene

1. Diyabetli hastanın BTA'sında tibial arter çevresinde yoğun kalsiyum var; MIP'de lümen kapanmış görünürken ince aksiyel kesitte kontrast seçiliyor. En olası neden nedir?

   • Kalsiyum blooming artefaktı
   • Taze emboli
   • Popliteal anevrizma
   • Erken venöz doluş
   Cevabı göster

   Kalsiyum blooming artefaktı. Çevresel kalsiyumun blooming'i küçük tibial lümenin üzerine taşarak MIP'de yalancı kapanma izlenimi yaratabilir. Taze emboli intraluminal kesinti oluşturur; anevrizma damar dış çapını genişletir; erken venöz doluş arteriyovenöz şant düşündürür.

2. Yüzeyel femoral arterde uzun segmentli oklüzyon görülebilir. Bu bulgular hangi tanıyla en uyumludur?

   • Kronik aterosklerotik oklüzyon
   • İzole akut emboli
   • Popliteal arter tuzaklanması
   • Arteriyovenöz fistül
   Cevabı göster

   Kronik aterosklerotik oklüzyon. Uzun segmentli yüzeyel femoral kapanma çevresinde oluşmuş geniküler kollateraller kronik akım kısıtlanmasını destekler. İzole akut emboli genellikle önceden gelişmiş bu kollateral ağı açıklamaz; tuzaklanma odaklı popliteal bası yapar; fistülde arterle erken dolan ven arasında şant aranır.

İlgili konular

• Akut alt ekstremite iskemisi
• Akut emboli ve akut tromboz ayrımı
• Popliteal arter anevrizması

Kaynaklar

Bu sayfadaki 37 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla otomatik olarak karşılaştırıldı; 4 cümle bu karşılaştırmada düzeltildi (2026-10-09).

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Eğitim amaçlıdır; hasta başında tanı ve tedavi kararının yerine geçmez, tıbbi tavsiye değildir. Metinler yapay zekâ desteğiyle yazıldı ve otomatik bir adımda kaynak alıntılarıyla karşılaştırıldı; bu bir tıbbi doğrulama değildir ve içerik uzman radyolog incelemesinden geçmedi. Klinik kararlarda güncel kılavuzları, kurum protokollerini ve radyoloji raporunu esas alın.