{"id":719,"date":"2025-09-12T18:06:57","date_gmt":"2025-09-12T15:06:57","guid":{"rendered":"https:\/\/tatd.org.tr\/geriatri\/?p=719"},"modified":"2025-09-12T18:07:00","modified_gmt":"2025-09-12T15:07:00","slug":"yaslilarda-periferik-arter-hastaliklari-ve-acil-prezentasyonlar","status":"publish","type":"post","link":"https:\/\/tatd.org.tr\/geriatri\/genel\/yaslilarda-periferik-arter-hastaliklari-ve-acil-prezentasyonlar\/","title":{"rendered":"Ya\u015fl\u0131larda Periferik Arter Hastal\u0131klar\u0131 ve Acil Prezentasyonlar"},"content":{"rendered":"\n<p><strong>Yazar:<\/strong> Do\u00e7.Dr. Tanzer Korkmaz         <strong>Edit\u00f6r: <\/strong>Do\u00e7.Dr. Rana Di\u015fel<\/p>\n\n\n\n<p>Periferik arter hastal\u0131\u011f\u0131, g\u00f6vde, \u00fcst ve alt ekstremiteler ile beyin, mezenter ve b\u00f6brek gibi organlara kan ta\u015f\u0131yan; koroner arterler ve aort d\u0131\u015f\u0131ndaki t\u00fcm arterleri etkileyebilen, bu arterlerde kan ak\u0131m\u0131n\u0131n azalmas\u0131yla karakterize bir vask\u00fcler hastal\u0131k grubudur (1,2). Bu terim genellikle ateroskleroza ba\u011fl\u0131 olarak bacak arterlerinde zay\u0131f dola\u015f\u0131m\u0131 tan\u0131mlamak i\u00e7in kullan\u0131lmakla birlikte di\u011fer sistemleri de etkiler (1). Ya\u015flanma ile birlikte sarkopeni geli\u015fiminin yan\u0131 s\u0131ra diyabet, hipertansiyon, dislipidemi ve atriyal fibrilasyon gibi komorbid durumlar\u0131n artan prevalans\u0131 ile birlikte, polifarmasi de etkili olmak \u00fczere arteriyel sertlik, endotelyal disfonksiyon ve ateroskleroz geli\u015fimi h\u0131zlanmaktad\u0131r. Sarkopeni, 50 ya\u015f sonras\u0131nda belirgin hale gelen kas k\u00fctlesi ve g\u00fcc\u00fcnde azalma durumu olup, 75 ya\u015f ve \u00fczeri periferik arter hastalar\u0131n\u0131n yaln\u0131zca %0,2\u2019sinde kodlanmakta ve yeterince tan\u0131mlanmamaktad\u0131r.&nbsp;Almanya\u2019da yap\u0131lan uzun d\u00f6nemli bir \u00e7al\u0131\u015fmada, sarkopeni prevalans\u0131n\u0131n 2005 y\u0131l\u0131nda %0,05 iken 2020 y\u0131l\u0131nda %0,34\u2019e y\u00fckseldi\u011fi rapor edilmi\u015ftir&nbsp;(3)&nbsp;Geriatrik hastalarda acil servis ba\u015fvurular\u0131nda periferik arter hastal\u0131klar\u0131 genellikle atipik klinik tablolarla prezente olur; frailty (k\u0131r\u0131lganl\u0131k) ve kognitif bozukluklar ise semptomlar\u0131n do\u011fru tan\u0131mlanmas\u0131n\u0131 g\u00fc\u00e7le\u015ftiren \u00f6nemli fakt\u00f6rlerdir (4). Nadir g\u00f6r\u00fclen olgularda, \u00f6rne\u011fin; bir y\u0131ld\u0131r bacak a\u011fr\u0131s\u0131 olan geriatrik bir hastada 38 y\u0131l \u00f6nceki travmaya ba\u011fl\u0131 geli\u015fen arteriyoven\u00f6z fist\u00fcl ile ili\u015fkili anevrizma gibi karma\u015f\u0131k vakalar tespit edilebilir (5).&nbsp;Tan\u0131da gecikme ciddi morbidite ve mortaliteye yol a\u00e7abilir.<\/p>\n\n\n\n<p><strong>Periferik Arter Hastal\u0131klar\u0131 genel olarak d\u00f6rt ana alt gruba ayr\u0131labilir:<\/strong><strong><\/strong><\/p>\n\n\n\n<p><strong>1. Alt Ekstremite Periferik Arter Hastal\u0131klar\u0131 (AEPAH)<\/strong><\/p>\n\n\n\n<p>En s\u0131k g\u00f6r\u00fclen periferik arter hastal\u0131\u011f\u0131 (PAH) formudur. Genellikle ateroskleroz kaynakl\u0131d\u0131r; ancak tromboemboli, vask\u00fclit, travma ve iyatrojenik nedenler de etken olabilir (6). Ya\u015fl\u0131 bireylerde AEPAH %40\u201350 oran\u0131nda asemptomatik seyredebilir. Yorgunluk, y\u00fcr\u00fcy\u00fc\u015f intolerans\u0131 ve bacaklarda g\u00fc\u00e7s\u00fczl\u00fck gibi atipik semptomlar da s\u0131k g\u00f6r\u00fcl\u00fcr (4).&nbsp; Ya\u015f ile beraber prevelansta art\u0131\u015f mevcuttur (40 ya\u015f, 60 ya\u015f ve &gt;80 ya\u015f ta s\u0131ras\u0131 ile %3, %6 ve %15) (6,7). Ancak n\u00fcfus tarama \u00e7al\u0131\u015fmalar\u0131nda bu hastalar\u0131n %10 -50&#8217;sinin bu semptomlar i\u00e7in sa\u011fl\u0131k kurulu\u015funa ba\u015fvurmam\u0131\u015f olmalar\u0131 ilgin\u00e7 bir sonu\u00e7tur (6).&nbsp;<\/p>\n\n\n\n<p><strong>\u0130ntermittan klaudikasyon<\/strong>&nbsp;(genellikle egzersiz s\u0131ras\u0131nda k\u0131sa bir dinlenme ile rahatlayan kas kaynakl\u0131 bacak a\u011fr\u0131s\u0131 \u00f6yk\u00fcs\u00fc) ve&nbsp;<strong>kritik ekstremite iskemisi<\/strong>&nbsp;(\u00fclser, gangren, dinlenme a\u011fr\u0131s\u0131) gibi tipik bulgular\u0131n yan\u0131s\u0131ra geriatrik prezentasyonda hastalar \u00e7o\u011funlukla asemptomatik olabilirler (%40\u201350) (4,6,8). Akut ekstremite iskemisi, asemptomatik bireylerde emboli veya lokal trombozla geli\u015febilir; atriyal fibrilasyonun daha iyi y\u00f6netilmesiyle embolik olaylar azal\u0131rken, trombotik iskemilerin insidans\u0131 artmaktad\u0131r. Modern endovask\u00fcler tekniklere ra\u011fmen, literat\u00fcrde %10\u201330 oran\u0131nda 30 g\u00fcnl\u00fck amputasyon bildirilmektedir (7). Acil serviste tan\u0131da&nbsp;<strong>\u201cAlt\u0131 P\u201d (Six Ps)&nbsp;<\/strong>bulgular\u0131 kritik \u00f6neme sahiptir: A\u011fr\u0131 (Pain), Solukluk (Pallor), Nab\u0131zs\u0131zl\u0131k (Pulselessness), Parestezi (Paresthesia), Fel\u00e7 (Paralysis) ve So\u011fukluk (Perishing Cold) (7,9). Klinik&nbsp;sunum atipik olabilir; ay\u0131r\u0131c\u0131 tan\u0131da n\u00f6rojenik ve ven\u00f6z patolojiler \u00f6nemlidir.&nbsp;<strong>N\u00f6rojenik klaudikasyon&nbsp;<\/strong>(lomber spinal stenoz- \u00d6ne e\u011filmekle rahatlama tipik) (4),&nbsp;<strong>periferik n\u00f6ropati<\/strong>&nbsp;(diyabet ili\u015fkili),&nbsp;<strong>derin ven trombozu<\/strong>&nbsp;(DVT-\u015ei\u015flik ve \u0131s\u0131 art\u0131\u015f\u0131; periferik arter hastal\u0131\u011f\u0131nda so\u011fukluk \u00f6n planda),&nbsp;<strong>kronik ven\u00f6z yetmezlik<\/strong>&nbsp;(Pigmentasyon ve \u00f6dem), Kas-iskelet sistemi a\u011fr\u0131lar\u0131&nbsp;(Artrit, osteoartrit) ve&nbsp;<strong>akut arteriyel emboli<\/strong>&nbsp;(Ani ba\u015flang\u0131\u00e7l\u0131 a\u011fr\u0131 ve nab\u0131z kayb\u0131) dikkate al\u0131nmal\u0131d\u0131r (8).&nbsp;<strong><em>Alt ekstremite periferik arter hastal\u0131\u011f\u0131 ile ilgili daha kapsaml\u0131 bilgi TATDGAT (geriatrik acil t\u0131p \u00e7al\u0131\u015fma grubu) 17 May\u0131s 2023 tarihli blog yaz\u0131s\u0131ndan okunabilir.Link: https:\/\/tatd.org.tr\/geriatri\/genel\/yaslilarda-periferik-arter-hastaligi\/<\/em><\/strong><strong><em><\/em><\/strong><\/p>\n\n\n\n<p><strong>2. \u00dcst Ekstremite Periferik Arter Hastal\u0131klar\u0131 (\u00dcEPAH)<\/strong><\/p>\n\n\n\n<p>\u00dcst ekstremite periferik arter hastal\u0131klar\u0131 daha nadir g\u00f6r\u00fcl\u00fcr. En s\u0131k nedeni&nbsp;subklavian arter stenozudur. Geriatrik hastalarda&nbsp;\u00e7o\u011funlukla karotis ve koroner arter hastal\u0131\u011f\u0131 ile birlikte seyreder (8). Kolda g\u00fc\u00e7s\u00fczl\u00fck, eforla a\u011fr\u0131, ani nab\u0131z kayb\u0131 ve so\u011fukluk klinik tablosu ile acil servise ba\u015fvurabilirler.&nbsp;<\/p>\n\n\n\n<p><strong>3. Serebrovask\u00fcler Hastal\u0131klar (Karotis ve Vertebral Arter)<\/strong><\/p>\n\n\n\n<p>Periferik arter hastal\u0131klar\u0131n\u0131n \u00f6nemli bir alt grubudur. Ge\u00e7ici iskemik atak (TIA), inme, ba\u015f d\u00f6nmesi, senkop gibi semptomlarla acil servise ba\u015fvurular olurken geriatrik ya\u015f grubunda kognitif bozukluk, dengesizlik, tekrarlayan d\u00fc\u015fmeler gibi atipik bulgular g\u00f6r\u00fclebilir (2). Acil servise en s\u0131k ba\u015fvuru yap\u0131lan periferik arter hastal\u0131\u011f\u0131 tipi inmedir.&nbsp;<\/p>\n\n\n\n<p><strong>4. Mezenterik Arter Hastal\u0131\u011f\u0131<\/strong><\/p>\n\n\n\n<p>Postprandiyal kar\u0131n a\u011fr\u0131s\u0131 (\u201cintestinal angina\u201d), kilo kayb\u0131, i\u015ftahs\u0131zl\u0131k klinik tablolar\u0131n\u0131n yan\u0131s\u0131ra geriatrik hasta grubunda&nbsp;non-spesifik semptomlarla seyredebilece\u011fi i\u00e7in tan\u0131 gecikebilir, bu da mortalite riskini art\u0131r\u0131r.&nbsp;Acil serviste \u015fiddetli kar\u0131n a\u011fr\u0131s\u0131 ve laktik asidoz varl\u0131\u011f\u0131nda mortalitenin \u00e7ok y\u00fcksek oldu\u011fu ak\u0131lda bulundurulmal\u0131d\u0131r (6).<\/p>\n\n\n\n<p><strong>5. Renal Arter Hastal\u0131\u011f\u0131<\/strong><\/p>\n\n\n\n<p>Genellikle sessiz seyreder. Diren\u00e7li hipertansiyon ve akut b\u00f6brek fonksiyon bozuklu\u011fu ile ba\u015fvurabilir. En yayg\u0131n etiyoloji aterosklerotik darl\u0131kt\u0131r&nbsp;(9). Daha nadir nedenler aras\u0131nda&nbsp;fibrom\u00fcsk\u00fcler displazi, vask\u00fclitler ve travma say\u0131labilir.&nbsp;Uzun d\u00f6nemde iskemi, b\u00f6brek parankiminde fibrozis ve&nbsp;kronik b\u00f6brek hastal\u0131\u011f\u0131na yol a\u00e7ar (8). Ani veya h\u0131zla k\u00f6t\u00fcle\u015fen b\u00f6brek fonksiyon bozuklu\u011fu yan\u0131nda bilateral darl\u0131kta akut akci\u011fer \u00f6demi ve a\u011f\u0131r hipertansiyon krizi g\u00f6r\u00fclebilir (\u201cflash pulmonary edema\u201d). Geriatrik hastalarda diyabet ve hipertansiyon birlikteli\u011fi b\u00f6brek fonksiyon bozuklu\u011funu h\u0131zland\u0131r\u0131r (9). Ya\u015fl\u0131 hastalarda \u00e7o\u011fu zaman&nbsp;asemptomatik ilerler, sadece hipertansiyonun diren\u00e7li olmas\u0131 veya ani kreatinin y\u00fckseli\u015fi ile fark edilebilir.&nbsp;<\/p>\n\n\n\n<p><strong>Etiyolojik S\u0131n\u0131fland\u0131rma<\/strong><\/p>\n\n\n\n<p><strong>1. Okluziv Periferik Arter Hastal\u0131klar\u0131:<\/strong>\u00a0Genellikle aterosklerotik plak birikimine ba\u011fl\u0131 olarak arteriyel l\u00fcmenin k\u0131smen veya tamamen daralmas\u0131 ya da t\u0131kanmas\u0131 sonucu ekstremiteye giden kan ak\u0131m\u0131n\u0131n ciddi \u015fekilde azalmas\u0131 durumudur.\u00a0Okl\u00fcziv periferik arter hastal\u0131\u011f\u0131 en s\u0131k alt ekstremite arterlerinde geli\u015fir. \u00c7ok daha az yayg\u0131n olarak, hastal\u0131k omuzlar\u0131n veya kollar\u0131n arterlerinde geli\u015fir\u00a0(1).\u00a0Klasik klaudikasyon, kritik uzuv iskemisi veya akut iskemik tablolara yol a\u00e7ar. \u0130stisna olarak Fibrom\u00fcsk\u00fcler Displazi (FMD)\u00a0aterosklerozdan ziyade damar duvar\u0131ndaki h\u00fccrelerdeki anormalliklerin neden oldu\u011fu okl\u00fcziv periferik arter hastal\u0131\u011f\u0131na bir \u00f6rnektir ve\u00a0nadiren alt ekstremiteleri etkiler.\u00a0<\/p>\n\n\n\n<p><strong>2. Fonksiyonel Periferik Arter Hastal\u0131klar\u0131:<\/strong>\u00a0T\u0131kanma olmadan arterik ak\u0131m\u0131 bozan mekanik, inflamatuvar veya kistsel nedenlere dayan\u0131r ve tan\u0131 s\u00fcre\u00e7lerinde dikkatli klinik ve g\u00f6r\u00fcnt\u00fcleme de\u011ferlendirmesi gerektirir. Bu etyolojiler otoimm\u00fcn, konjenital, dejeneratif, enflamatuar, enfeksiy\u00f6z, metabolik, neoplastik veya travmatik nitelikte olabilir. Ba\u015fl\u0131ca neden\u00a0vazospazmlara\u00a0ba\u011fl\u0131\u00a0d\u00fc\u015f\u00fck kan ak\u0131m\u0131 (\u00f6rne\u011fin Raynaud fenomeni, eritromelalji, akrosiyanoz) neden olmaktad\u0131r (1).\u00a0<\/p>\n\n\n\n<p><strong>3. Vask\u00fclit:<\/strong>\u00a0Damar duvar\u0131n\u0131n inflamasyonu nedeniyle ak\u0131m bozulmas\u0131 sonucu geli\u015fir.\u00a0\u00a0Takayasu arteriti ve Beh\u00e7et hastal\u0131\u011f\u0131 gibi inflamatuvar vask\u00fclopatiler \u00f6rnek verilebilir\u00a0(1).\u00a0<\/p>\n\n\n\n<p><strong>4. Popliteal Arter Entrapment\u00a0<em>(Tuzak Sendromu):<\/em><\/strong>\u00a0Kas ya da tendon yap\u0131lar\u0131n\u0131n arter \u00fczerindeki kompresyonu ile ge\u00e7irilmi\u015f ak\u0131m bozuklu\u011fu (1). \u00d6rnek olarak \u201cpopliteal artery entrapment syndrome\u201d dola\u015f\u0131m\u0131 bozarak klaudikasyon yol a\u00e7abilen bir durumdur.<\/p>\n\n\n\n<p><strong>5. Kistik Adventisyel Hastal\u0131k\u00a0<em>(Cystic Adventitial Disease):<\/em><\/strong>\u00a0Nadir g\u00f6r\u00fclen bu durum, arter duvar\u0131nda adventisyel katmanda mukoid yap\u0131l\u0131 kistlerin olu\u015fmas\u0131 ile ortaya \u00e7\u0131kar. En s\u0131k popliteal arterde g\u00f6r\u00fclmektedir. Kistik yap\u0131 arter l\u00fcmenine bas\u0131 yaparak klaudikasyon veya akut iskemik tabloya neden olabilir (10).\u00a0<\/p>\n\n\n\n<p><strong>6. Medial\u00a0arterioskleroz\u00a0<em>(Monckeberg Sklerozu):<\/em>\u00a0<\/strong>Ya\u015fl\u0131 bireylerde arter duvar\u0131nda medial kalsifikasyonla karakterize bir durumdur ve ABI \u00f6l\u00e7\u00fcmlerinde yan\u0131lmalara neden olabilir\u00a0(11).\u00a0<\/p>\n\n\n\n<p><strong>Klinik prezentasyonlar<\/strong><\/p>\n\n\n\n<p>Periferik arter hastal\u0131klar\u0131n\u0131n klinik bulgular\u0131, hastal\u0131\u011f\u0131n ciddiyetine, etkilenen damar\u0131n yerine ve e\u015flik eden komorbiditelere ba\u011fl\u0131 olarak de\u011fi\u015fkenlik g\u00f6sterir.&nbsp;Periferik arter hastal\u0131klar\u0131nda geli\u015fen semptomlar etkilenen b\u00f6lgeye ba\u011fl\u0131 de\u011fi\u015fiklikler g\u00f6sterir. \u00d6rne\u011fin istirahatte veya eforla ba\u015flayan ayak a\u011fr\u0131s\u0131, iyile\u015fmeyen yaralar\u0131n varl\u0131\u011f\u0131 AEPAH d\u00fc\u015f\u00fcnd\u00fcr\u00fcrken, ba\u015f d\u00f6nmesi ve vertigonun e\u015flik etti\u011fi hareketle ortaya \u00e7\u0131kan kol a\u011fr\u0131s\u0131 varl\u0131\u011f\u0131nda UEPAH d\u00fc\u015f\u00fcn\u00fcl\u00fcr. Kal\u0131c\u0131 veya ge\u00e7ici n\u00f6rolojik belirtilerin varl\u0131\u011f\u0131nda karotis arter hastal\u0131\u011f\u0131, yemek sonras\u0131 kar\u0131n a\u011fr\u0131s\u0131 varl\u0131\u011f\u0131nda mezenterik arter hastal\u0131\u011f\u0131 ara\u015ft\u0131r\u0131lmal\u0131d\u0131r.&nbsp;<strong>En s\u0131k kar\u015f\u0131la\u015f\u0131lan alt ekstremite periferik arter hastal\u0131\u011f\u0131nda<\/strong>&nbsp;klinik prezentasyonlar genel olarak \u00fc\u00e7 grupta ele al\u0131nabilir:<strong><\/strong><\/p>\n\n\n\n<p><strong>1. Tipik Semptomlar:<\/strong>&nbsp;&nbsp;<strong>\u0130ntermittan klaudikasyon<\/strong>&nbsp;(genellikle egzersiz s\u0131ras\u0131nda k\u0131sa bir dinlenme ile rahatlayan kas kaynakl\u0131 bacak a\u011fr\u0131s\u0131 \u00f6yk\u00fcs\u00fc) ve&nbsp;<strong>kritik ekstremite iskemisi<\/strong>&nbsp;(\u00fclser, gangren, dinlenme a\u011fr\u0131s\u0131) gibi tipik bulgular\u0131n yan\u0131s\u0131ra geriatrik prezentasyonda hastalar \u00e7o\u011funlukla asemptomatik olabilirler (%40\u201350) (2,4,6,8).&nbsp;&nbsp;Acil serviste tan\u0131da&nbsp;<strong>\u201cAlt\u0131 P\u201d (Six Ps)&nbsp;<\/strong>bulgular\u0131 kritik \u00f6neme sahiptir: A\u011fr\u0131 (Pain), Solukluk (Pallor), Nab\u0131zs\u0131zl\u0131k (Pulselessness), Parestezi (Paresthesia), Fel\u00e7 (Paralysis) ve So\u011fukluk (Perishing Cold) (7,9). Klinik&nbsp;sunum atipik olabilir; ay\u0131r\u0131c\u0131 tan\u0131da n\u00f6rojenik ve ven\u00f6z patolojiler \u00f6nemlidir.&nbsp;<strong>N\u00f6rojenik klaudikasyon&nbsp;<\/strong>(lomber spinal stenoz- \u00d6ne e\u011filmekle rahatlama tipik) (4),&nbsp;<strong>periferik n\u00f6ropati<\/strong>&nbsp;(diyabet ili\u015fkili),&nbsp;<strong>derin ven trombozu<\/strong>&nbsp;(DVT-\u015ei\u015flik ve \u0131s\u0131 art\u0131\u015f\u0131; periferik arter hastal\u0131\u011f\u0131nda so\u011fukluk \u00f6n planda),&nbsp;<strong>kronik ven\u00f6z yetmezlik<\/strong>&nbsp;(Pigmentasyon ve \u00f6dem), Kas-iskelet sistemi a\u011fr\u0131lar\u0131&nbsp;(Artrit, osteoartrit) ve&nbsp;<strong>akut arteriyel emboli<\/strong>&nbsp;(Ani ba\u015flang\u0131\u00e7l\u0131 a\u011fr\u0131 ve nab\u0131z kayb\u0131) dikkate al\u0131nmal\u0131d\u0131r (8).&nbsp;<strong><em>Alt ekstremite periferik arter hastal\u0131\u011f\u0131 ile ilgili daha kapsaml\u0131 bilgi TATDGAT (geriatrik acil t\u0131p \u00e7al\u0131\u015fma grubu) 17 May\u0131s 2023 tarihli blog yaz\u0131s\u0131ndan okunabilir.Link:&nbsp;<\/em><\/strong><a href=\"https:\/\/tatd.org.tr\/geriatri\/genel\/yaslilarda-periferik-arter-hastaligi\/\"><strong><em>https:\/\/tatd.org.tr\/geriatri\/genel\/yaslilarda-periferik-arter-hastaligi\/<\/em><\/strong><\/a><strong><em><\/em><\/strong><\/p>\n\n\n\n<p><strong>2. Atipik Semptomlar:<\/strong>&nbsp;Ya\u015fl\u0131 bireylerde yorgunluk, y\u00fcr\u00fcy\u00fc\u015f intolerans\u0131 ve kas zay\u0131fl\u0131\u011f\u0131 gibi daha belirsiz belirtilerle prezente olabilir (4). Bu durum tan\u0131da gecikmelere yol a\u00e7abilir.<\/p>\n\n\n\n<p><strong>3. Akut Ekstremite \u0130skemisi:<\/strong>&nbsp;Arterin aniden geli\u015fen emboli ya da trombozu sonucunda olu\u015fur. Bu durum, zaman\u0131nda tedavi edilmezse amp\u00fctasyon riski %10-30 aras\u0131nda de\u011fi\u015fir&nbsp;(6).&nbsp;Akut ekstremite iskemisi, asemptomatik bireylerde emboli veya lokal trombozla geli\u015febilir; atriyal fibrilasyonun daha iyi y\u00f6netilmesiyle embolik olaylar azal\u0131rken, trombotik iskemilerin insidans\u0131 artmaktad\u0131r. Modern endovask\u00fcler tekniklere ra\u011fmen, literat\u00fcrde %10\u201330 oran\u0131nda 30 g\u00fcnl\u00fck amputasyon bildirilmektedir (7).<\/p>\n\n\n\n<p><strong>Tan\u0131&nbsp;<\/strong><\/p>\n\n\n\n<p>Tedavi s\u00fcrecinde zaman kritik \u00f6nemdedir; iskelet kas\u0131 iskemiyi yaln\u0131zca 4\u20136 saat tolere edebilir. Bu nedenle, uzuv canl\u0131l\u0131\u011f\u0131n\u0131n ve arteriyel perf\u00fczyonun h\u0131zl\u0131 de\u011ferlendirilmesi, uygun revask\u00fclarizasyonun gecikmeden sa\u011flanmas\u0131 a\u00e7\u0131s\u0131ndan zaman hayati \u00f6nem ta\u015f\u0131r. Aksi takdirde, geri d\u00f6n\u00fc\u015f\u00fc olmayan doku nekrozu geli\u015febilir ve amputasyon gerekebilir (7). Ekstremite periferik arter hastal\u0131klar\u0131nda tan\u0131 s\u00fcrecinde, hastan\u0131n \u00f6yk\u00fcs\u00fc, fizik muayene bulgular\u0131 ve g\u00f6r\u00fcnt\u00fcleme y\u00f6ntemleri birlikte de\u011ferlendirilmelidir.<\/p>\n\n\n\n<p><strong>Fizik muayenede<\/strong>&nbsp;etkilenen ekstremitede nab\u0131z zay\u0131fl\u0131\u011f\u0131 veya yoklu\u011fu, solukluk, so\u011fukluk, \u00fclser, atrofi ve gangren gibi cilt&nbsp;&nbsp;bulgular\u0131 de\u011ferlidir.<\/p>\n\n\n\n<p><strong>Ayak Bile\u011fi-Kol \u0130ndeksi (AK\u0130) [Ankle-Brachial Index (ABI)]:&nbsp;<\/strong>Non-invaziv ve kolay uygulanabilir bir testtir.&nbsp;Alt ekstremiteler i\u00e7in dorsalis pedis ile tibialis posterior arterlerinden al\u0131nan \u00f6l\u00e7\u00fcmlerden y\u00fcksek olan\u0131, \u00fcst ekstremitelerden y\u00fcksek olarak al\u0131nan brakial arter sistolik de\u011ferine b\u00f6l\u00fcnerek AK\u0130 de\u011ferleri saptan\u0131r.&nbsp;Normal de\u011fer 1.0\u20131.4 aras\u0131d\u0131r. &lt;0.9 olmas\u0131 periferik arter lehine, &lt;0.4 olmas\u0131 ciddi iskemiyi g\u00f6sterir (6).&nbsp;AK\u0130 de\u011feri d\u00fc\u015ft\u00fck\u00e7e PAH etkilenmesinin \u015fiddeti de artmaktad\u0131r.&nbsp;Yalanc\u0131 negatiflik potansiyeli ta\u015f\u0131yan durumlar i\u00e7erisinde ileri kalsifikasyona ba\u011fl\u0131 tansiyon aleti man\u015fonu ile komprese edilemeyen ileri kalsifik arteriyel bulunan diyabetes mellitus, kronik b\u00f6brek yetmezli\u011fi bulunan ve diyaliz uygulanan hastalar say\u0131labilir (12). Ya\u015fl\u0131 hasta pop\u00fclasyonu i\u00e7in herhangi bir risk fakt\u00f6r\u00fc olup olmamas\u0131na bak\u0131lmaks\u0131z\u0131n 65 ya\u015f \u00fczeri t\u00fcm hastalarda yap\u0131lan fizik muayeneye ek olarak AK\u0130 \u00f6l\u00e7\u00fcm\u00fc yap\u0131lmal\u0131d\u0131r.<\/p>\n\n\n\n<p><strong>G\u00f6r\u00fcnt\u00fcleme Y\u00f6ntemleri:<\/strong>&nbsp;Tan\u0131da zamanlama ve do\u011fruluk, \u00f6zellikle geriatrik kritik hastalarda mortalite ve morbiditeyi etkileyebildi\u011finden klinik tan\u0131 konulmas\u0131 ve h\u0131zl\u0131 revask\u00fclarizasyon stratejisi \u00f6nem ta\u015f\u0131r.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Doppler Ultrasonografi (USG):<\/strong>\u00a0\u0130lk basamak de\u011ferlendirme y\u00f6ntemidir. Ekstremite ve karotis stenozunu ve renal arterleri\u00a0de\u011ferlendirmek i\u00e7in genellikle ilk tercih edilen tan\u0131 arac\u0131d\u0131r.<\/li>\n\n\n\n<li><strong>Duplex USG<\/strong>\u00a0:\u00a0Kronik mezenterik iskemi de\u011ferlendirmesinde ba\u015flang\u0131\u00e7 tarama arac\u0131 olarak kullan\u0131labilir.\u00a0<\/li>\n\n\n\n<li><strong>Bilgisayarl\u0131 Tomografi Anjiyografi (CTA) ve Manyetik Rezonans Anjiyografi (MRA) Testleri<\/strong><strong>:<\/strong>\u00a0Anatomik ayr\u0131nt\u0131y\u0131 net g\u00f6sterir ve anatomik planlama i\u00e7in kullan\u0131l\u0131r. \u00d6zellikle non-invaziv olarak tercih edilir\u00a0. CTA Akut mezenterik iskemi tan\u0131s\u0131nda alt\u0131n standartt\u0131r. Hem vask\u00fcler t\u0131kan\u0131kl\u0131klar\u0131 hem de ba\u011f\u0131rsak hasar\u0131n\u0131 g\u00f6sterir.\u00a0Ekstremite iskemilerinde daha detayl\u0131 anatomik bilgi sa\u011flamak a\u00e7\u0131s\u0131ndan da kritik olup, invaziv giri\u015fim planlamas\u0131nda kullan\u0131\u015fl\u0131d\u0131r. Fibr\u00f6z Mekanik De\u011fi\u015fiklikler (\u00f6r. FMD) de genellikle renal veya karotis arterlerde anjiyoplasti \u00f6ncesi kullan\u0131l\u0131r.<\/li>\n\n\n\n<li><strong>Konvansiyonel Renal Arteriografi:<\/strong>\u00a0Tan\u0131 ve m\u00fcdahale planlamas\u0131nda alt\u0131n standart olarak kabul edilir (13).\u00a0<\/li>\n\n\n\n<li><strong>Kateter Anjiyografi:<\/strong>\u00a0Hem tan\u0131sal hem de terap\u00f6tik ama\u00e7la kullan\u0131labilir, \u00f6zellikle endovask\u00fcler giri\u015fim planlan\u0131yorsa tercih edilir (7,9).\u00a0\u00a0\u00a0<\/li>\n<\/ul>\n\n\n\n<p><strong>Non-okl\u00fczif (Fonksiyonel veya Di\u011fer) hastal\u0131klardan vask\u00fclitlerde&nbsp;<\/strong>klinik, laboratuvar ve anjiografik bulgular\u0131n de\u011ferlendirilmesi gibi \u00f6n tan\u0131daki di\u011fer hastal\u0131klara uygun tetkikler planlanabilir.<\/p>\n\n\n\n<p><strong>Tedavi<\/strong><\/p>\n\n\n\n<p>Geriatrik hastalarda frailite, kognitif durum ve e\u015flik eden komorbiditeler dikkate al\u0131narak acil servislerde tan\u0131 ve tedavi s\u00fcre\u00e7leri h\u0131zl\u0131 ve multidisipliner \u015fekilde y\u00fcr\u00fct\u00fclmelidir (4). Tedaviye erken ba\u015flanmal\u0131, uygun \u015fekilde triyaj sa\u011flanmal\u0131 ve hastan\u0131n terminal tedavi s\u00fcrecine eri\u015fimi geciktirilmemelidir. Bu kapsamda, okl\u00fcziv hastal\u0131klar kadar non-okl\u00fcziv etyolojilere sahip periferik arter hastal\u0131klar\u0131n\u0131n da \u00f6zg\u00fcn tan\u0131 ve tedavi yakla\u015f\u0131mlar\u0131 ak\u0131lda tutulmal\u0131d\u0131r. \u00d6rne\u011fin kistik adventisyal hastal\u0131kta&nbsp;tedavi cerrahi eksizyon veya kist aspirasyonudur (10).&nbsp;Fibrom\u00fcsk\u00fcler displaziside&nbsp;anjiyoplasti; vask\u00fclitte imm\u00fcns\u00fcpresif tedavi gibi.<\/p>\n\n\n\n<p><strong>Genel tedavi stratejileri;<\/strong>&nbsp;risk fakt\u00f6rlerinin kontrol\u00fc, ya\u015fam tarz\u0131 de\u011fi\u015fiklikleri, antikoag\u00fclan (\u00f6rne\u011fin heparin), analjezi, cerrahi veya endovask\u00fcler revask\u00fclarizasyon, sekonder korunma (statin, antiplatelet tedavi, fiziksel egzersiz) gibi yakla\u015f\u0131mlar\u0131 i\u00e7erir.<\/p>\n\n\n\n<p>G\u00fcncel k\u0131lavuzlar, aterosklerozun farkl\u0131 vask\u00fcler yataklar\u0131n\u0131 e\u015f zamanl\u0131 etkileyebilece\u011fini vurgulamakta ve bu nedenle tan\u0131 ve tedavi s\u00fcrecinde multidisipliner bir vask\u00fcler ekip kurulmas\u0131n\u0131 \u00f6nermektedir. Serebrovask\u00fcler hastal\u0131klar ve alt ekstremite PAH \u00f6zelinde hasta ve sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131 a\u00e7\u0131s\u0131ndan fark\u0131ndal\u0131\u011f\u0131n&nbsp;artt\u0131r\u0131lmas\u0131&nbsp;\u00f6nerilmektedir (14).<\/p>\n\n\n\n<p><strong>Aspirin veya di\u011fer antitrombotik ila\u00e7lar<\/strong>&nbsp;semptomatik PAH, koroner arter hastal\u0131\u011f\u0131 veya serebrovask\u00fcler hastal\u0131\u011f\u0131 olan hastalarda miyokard enfarkt\u00fcs\u00fc, iskemik inme ve vask\u00fcler \u00f6l\u00fcmleri azaltmada kullan\u0131l\u0131r.<\/p>\n\n\n\n<p>Revask\u00fclarizasyon planlanmayan hastalarda&nbsp;<strong>\u00e7ift antiplatelet tedavi<\/strong>&nbsp;(\u00f6rne\u011fin aspirin + klopidogrel) veya g\u00fc\u00e7l\u00fc ajanlar (\u00f6rne\u011fin vorapaksar) \u00f6nerilirken, y\u00fcksek kanama riski nedeniyle dikkatli de\u011ferlendirme yap\u0131lmal\u0131d\u0131r (7). 2024 ACC\/AHA k\u0131lavuzuna g\u00f6re akut ekstremite iskemisinde antikoag\u00fclan tedaviye s\u0131n\u0131f I \u00f6neri verilmi\u015ftir. Aspirin ile d\u00fc\u015f\u00fck doz rivaroksaban kombinasyonu, trombozun \u00f6nlenmesinde fayda sa\u011flayabilir ancak kanama riski art\u0131\u015f\u0131 g\u00f6z \u00f6n\u00fcne al\u0131nmal\u0131d\u0131r&nbsp;&nbsp;(1,7)&nbsp;<\/p>\n\n\n\n<p><strong>Revask\u00fclarizasyon prosed\u00fcrleri<\/strong>&nbsp;uygulanabilir.&nbsp;Zaman\u0131nda yap\u0131lan revask\u00fclarizasyon \u00f6nemlidir. Ancak baz\u0131 durumlarda istenilen sonu\u00e7lar al\u0131namayabilir. Ekstremite periferik arter hastal\u0131\u011f\u0131nda fasiyotomi gibi giri\u015fimler, kompartman sendromu riskine kar\u015f\u0131 uzvu korumak amac\u0131yla uygulanabilir.<\/p>\n\n\n\n<p><strong>Dislipidemi&nbsp;<\/strong>yayg\u0131n bir aterosklerotik risk fakt\u00f6r\u00fcd\u00fcr.&nbsp;Statinlerle yap\u0131lan lipit d\u00fc\u015f\u00fcr\u00fcc\u00fc tedavi, klinik sonu\u00e7lar\u0131 iyile\u015ftirmektedir.<\/p>\n\n\n\n<p><strong>Hipertansiyon&nbsp;<\/strong>en yayg\u0131n kardiyovask\u00fcler risk fakt\u00f6r\u00fcd\u00fcr.&nbsp;Bu hastalarda kan bas\u0131nc\u0131n\u0131 kontrol alt\u0131na almak i\u00e7in ACE inhibit\u00f6rleri ve anjiyotensin resept\u00f6r blokerleri \u00f6nerilmektedir.<\/p>\n\n\n\n<p><strong>Sigara i\u00e7mek ve di\u011fer t\u00fct\u00fcn<\/strong>&nbsp;kullan\u0131m\u0131 bi\u00e7imleri,&nbsp;periferik arter hastal\u0131\u011f\u0131 geli\u015fiminde g\u00fc\u00e7l\u00fc ve doza ba\u011f\u0131ml\u0131 bir risk fakt\u00f6r\u00fcd\u00fcr. Sigaray\u0131 b\u0131rakmak, hastal\u0131\u011f\u0131n ilerlemesini ve uzuv kayb\u0131 riskini azalt\u0131r.<\/p>\n\n\n\n<p><strong>Diyabet,<\/strong>&nbsp;periferik arter hastal\u0131\u011f\u0131&nbsp;geli\u015fimini h\u0131zland\u0131ran \u00f6nemli bir risk fakt\u00f6r\u00fcd\u00fcr. Diyabetik hastalarda, ya\u015fam tarz\u0131 de\u011fi\u015fikliklerini ve kilo kontrol\u00fcn\u00fc i\u00e7eren tedavi planlamas\u0131 yap\u0131lmal\u0131d\u0131r.<\/p>\n\n\n\n<p><strong>Vitamin takviyesi<\/strong>&nbsp;B-kompleks veya D vitamini gibi takviyelerin, periferik arter hastal\u0131\u011f\u0131 riskini azaltmada etkili oldu\u011funa dair g\u00fc\u00e7l\u00fc kan\u0131tlar bulunmamaktad\u0131r (7).<\/p>\n\n\n\n<p><strong>Kaynaklar<\/strong><\/p>\n\n\n\n<ol class=\"wp-block-list\">\n<li><a href=\"https:\/\/www.merckmanuals.com\/home\/authors\/jones-schuyler\">William Schuyler Jones<\/a>.\u00a0Peripheral Artery Disease.\u00a0Duke University Health System. Reviewed\/Revised\u00a0Jul 2025.\u00a0<a href=\"https:\/\/www.merckmanuals.com\/home\/heart-and-blood-vessel-disorders\/peripheral-artery-disorders\/overview-of-peripheral-artery-disorders\">https:\/\/www.merckmanuals.com\/home\/heart-and-blood-vessel-disorders\/peripheral-artery-disorders\/overview-of-peripheral-artery-disorders<\/a><\/li>\n\n\n\n<li>Aboyans, V., Ricco, J. B., Bartelink, M. E. L., et al. (2018). 2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases.\u00a0European Heart Journal, 39(9), 763\u2013816.\u00a0<a href=\"https:\/\/doi.org\/10.1093\/eurheartj\/ehx095\">https:\/\/doi.org\/10.1093\/eurheartj\/ehx095<\/a><\/li>\n\n\n\n<li><a href=\"\/\/4E792A08-6514-40EC-894A-D06EFAD34118#!\/search\/Schmitt%20Volker_H.\/%7B%22type\">Volker H. Schmitt<\/a>\u00a0at all. Sarkopeni. 75 Ya\u015f ve \u00dczeri Periferik Arter Hastal\u0131\u011f\u0131 Olan Hastanede Yatan Hastalarda Klinik Sonucu Etkiler. Vask\u00fcler Cerrahi Y\u0131ll\u0131klar\u0131, 2025-01-01, Cilt 110, Sayfalar 54-65.<\/li>\n\n\n\n<li>McDermott, M. M., Mehta, S., &amp; Ahn, H. (2021). Atypical and Asymptomatic Presentations of Peripheral Artery Disease in Older Adults.\u00a0JAMA, 325(21), 2195\u20132206.<\/li>\n\n\n\n<li>\u0130hsan ALUR \u0130, Y.\u0130.AL\u0130HANO\u011eLU, Ali Baran BUDAK A.B at all., A Huge Aneurysm of Popliteal Arteriovenous Fistula Occured Secondary to Trauma:CaseReport. DamarCerDerg2013;22(1). doi: 10.9739\/uvcd.2012-32965<\/li>\n\n\n\n<li>Norgren, L., Hiatt, W. R., Dormandy, J. A., et al. (2007). Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II).\u00a0Journal of Vascular Surgery, 45(Suppl S), S5\u2013S67<\/li>\n\n\n\n<li>Heather L. Gornik, Herbert D. Aronow, Philip P. Goodney at all.\u00a02024 ACC\/AHA\/AACVPR\/APMA\/ABC\/SCAI\/ SVM\/SVN\/SVS\/SIR\/VESS Guideline for the Management of Lower Extremity Peripheral Artery Disease: A Report of the American College of Cardiology\/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2024;149:e1313\u2013e1410. DOI: 10.1161\/CIR.0000000000001251\u00a0<\/li>\n\n\n\n<li>Hirsch, A. T., Haskal, Z. J., Hertzer, N. R., et al. (2006). ACC\/AHA Guidelines for the Management of Patients With Peripheral Arterial Disease.\u00a0Journal of the American College of Cardiology, 47(6), 1239\u20131312.<\/li>\n\n\n\n<li>Olin, J. W., &amp; Sealove, B. A. (2010). Peripheral artery disease: current insight into the disease and its diagnosis and management.\u00a0Mayo Clinic Proceedings, 85(7), 678\u2013692.<\/li>\n\n\n\n<li>Li S, King BN, Velasco N, Kumar Y, Gupta N. Cystic adventitial disease-case series and review of literature. Ann Transl Med. 2017 Aug;5(16):327. doi: 10.21037\/atm.2017.05.04. PMID: 28861424; PMCID: PMC5566729.<\/li>\n\n\n\n<li>Fields C. Calciphylaxis and M\u00f6nckberg\u2019s Arteriosclerosis in a Diabetic Patient.\u00a0Journal for Vascular Ultrasound. 2020;44(2):83-88. doi:<a href=\"https:\/\/doi.org\/10.1177\/1544316720923478\">10.1177\/1544316720923478<\/a><\/li>\n\n\n\n<li>K\u00f6ksal C. \u0130ntermittan klodikasyon. In: Bozkurt AK, editor. Periferik arter ve ven hastal\u0131klar\u0131 ulusal tedavi k\u0131lavuzu. \u0130stanbul: Bay\u00e7\u0131nar T\u0131bbi Yay\u0131nc\u0131l\u0131k; 2016. p. 12\u201326.<\/li>\n\n\n\n<li>Bokhari MR, Bokhari SRA. Renal Artery Stenosis. [Updated 2023 Jul 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-.\u00a0Available from:\u00a0<a href=\"https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK430718\/?utm_source=chatgpt.com\">https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK430718\/?utm_source=chatgpt.com<\/a><\/li>\n\n\n\n<li>Kele\u015fo\u011flu \u015e, &#8220;periferik arter hastal\u0131klar\u0131,&#8221; \u0131n temel kardiyoloji ve pratik \u00e7\u00f6z\u00fcmler, Ankara: Nobel Yay\u0131nevi, 2020, pp.1-328.\u00a0\u00a0\u00a0<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"<p>Yazar: Do\u00e7.Dr. Tanzer Korkmaz Edit\u00f6r: Do\u00e7.Dr. Rana Di\u015fel Periferik arter hastal\u0131\u011f\u0131, g\u00f6vde, \u00fcst ve alt ekstremiteler ile beyin, mezenter ve b\u00f6brek gibi&hellip;<\/p>\n","protected":false},"author":1185,"featured_media":720,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"inline_featured_image":false,"_lmt_disableupdate":"","_lmt_disable":"","footnotes":""},"categories":[1,10014],"tags":[10020,10018,10061],"class_list":["post-719","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-genel","category-akademik-blog-yazisi","tag-acil-tip","tag-geriatri","tag-periferik-arter-hastaligi"],"acf":[],"_links":{"self":[{"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/posts\/719","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/users\/1185"}],"replies":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/comments?post=719"}],"version-history":[{"count":0,"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/posts\/719\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/media\/720"}],"wp:attachment":[{"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/media?parent=719"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/categories?post=719"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/tags?post=719"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}