{"id":564,"date":"2016-11-10T23:24:21","date_gmt":"2016-11-10T21:24:21","guid":{"rendered":"http:\/\/www.damartedavileri.com\/?p=564"},"modified":"2016-11-10T23:31:57","modified_gmt":"2016-11-10T21:31:57","slug":"buerger-hastaligi","status":"publish","type":"post","link":"https:\/\/www.damartedavileri.com\/en\/2016\/11\/buerger-hastaligi\/","title":{"rendered":"Tromboangiitis Obliterans (Buerger Hastal\u0131\u011f\u0131)"},"content":{"rendered":"
\"Buerger

Buerger Hastal\u0131\u011f\u0131<\/p><\/div>\n

Vask\u00fclitler i\u00e7erisinde s\u0131k olarak g\u00f6rd\u00fcklerimiz<\/strong>:<\/p>\n

Tromboangiitis obliterans (Buerger hastal\u0131\u011f\u0131)<\/strong><\/p>\n

En \u00e7ok kol ve bacaklardaki k\u00fc\u00e7\u00fck ve orta \u00e7apl\u0131 arterleri, venleri ve sinirleri etkileyen damar sertl\u0131g\u0131 olu\u015fturmadan iltihabi bir hastal\u0131kt\u0131r. Tromboangiitis obliteransl\u0131 ve ya burger bu hastal\u0131k ilk olarak 1879 y\u0131l\u0131nda tan\u0131mlanm\u0131\u015ft\u0131r.<\/p>\n

Burger hastal\u0131\u011f\u0131 baz\u0131 \u00f6nemli y\u00f6nleriyle di\u011fer vask\u00fclit hastal\u0131klar\u0131ndan ayr\u0131l\u0131r. Bu hastal\u0131kta ileri derece h\u00fccresel ve iltihapl\u0131 bir trombus vard\u0131r. Bu hastalarda sedimentasyon, CRP, serolojik test-ler ve otoantikorlar normal veya negatifken, arteryel intimada immun reaksiyon varl\u0131\u011f\u0131 g\u00f6sterilmi\u015ftir.<\/p>\n

Yap\u0131lan anjiografik incelemede, \u00f6zellikle proksimal arterler normal g\u00f6r\u00fcn\u00fcrken, k\u00fc\u00e7\u00fck arterlerde multipl t\u0131kanmalar oldu\u011fu, dirsekalt\u0131 arter alt ucunda, dizalt\u0131 arterlerde, hastal\u0131kl\u0131 olanlar\u0131n normallerin aras\u0131na serpi\u015ftirilmi\u015f gibi oldu\u011fu g\u00f6r\u00fclebilmektedir.<\/p>\n

Klinik seyrinde ayak ve bacakta “Flebitis migrans” (gezici filibit) tablosu tipiktir,akut donemde \u00e7ok h\u00fccreli inflamatuar tromb\u00fcsler vard\u0131r. Kronikle\u015ftik\u00e7e tromb\u00fcsler organize olur ve duvarda fibrozis geli\u015fir. Bu \u00f6zellikler arteriosklerozis veya vask\u00fclitislerden ay\u0131rmada faydal\u0131d\u0131r.<\/p>\n

Te\u015fhis:<\/strong><\/p>\n

\"Buerger<\/p>\n

Gezici filibitin olmas\u0131, ellerde de benzeri tutulum, istirahat a\u011fr\u0131s\u0131, sigara tiryakili\u011fi, ya\u015f\u0131n45 in civar\u0131nda olu\u015fu, gangren veya iskemi belirtileri, oto imm\u00fcn hastal\u0131k olmay\u0131\u015f\u0131, diabetes mellitus olmay\u0131\u015f\u0131, emboli nedeni olmay\u0131\u015f\u0131, dopler ultrasonografi tetkiki yard\u0131m\u0131yla bacak ve kol damarlar\u0131nda daralma ve t\u0131kanman\u0131n dereceleri veya anjiografik bulgular ve nadiren biyopsi ile yap\u0131labilir.<\/p>\n

Hastal\u0131\u011f\u0131n erken d\u00f6nemlerinde belirti ve bulgular\u0131 silik olup, s\u0131kl\u0131kla ayakta ba\u015flayan parmak yaralar\u0131, solukluk ve so\u011fukluk, uyu\u015fukluk, kar\u0131ncalanma ve yanma tarz\u0131nda \u015fikayetler g\u00f6r\u00fcl\u00fcr.<\/p>\n

Hastal\u0131k ilerledik\u00e7e, y\u00fcr\u00fcme ile artan istirahatla azalan bacak a\u011fr\u0131lar\u0131 yerle\u015fir. Hasta uzun s\u00fcreli y\u00fcr\u00fcy\u00fc\u015flerde, giderek artan a\u011fr\u0131 sebebiyle durmak ve dinlenmek zorunda kal\u0131r. S\u0131kl\u0131kla caddelerde, bu durma d\u00f6nemlerinde vitrinlere bak\u0131larak a\u011fr\u0131n\u0131n ge\u00e7mesi beklendi\u011finden, eskilerde bu duruma vitrin hastal\u0131\u011f\u0131 denilmi\u015ftir. \u0130leri d\u00f6nemlerde a\u011fr\u0131 sadece hareketle de\u011fil, istirahat d\u00f6nemlerinde bile hissedilmeye ba\u015flar.<\/p>\n

Yine \u00f6zellikle so\u011fuk su ve hava ile temasta el ve bacaklarda morarma, ayakta \u015fi\u015fme ve gangren ileri d\u00f6nemlerde g\u00f6r\u00fclen bulgulard\u0131r.<\/p>\n

Hastal\u0131\u011f\u0131n sigara ile ilgisi kesin olarak g\u00f6sterilmi\u015f olup, sigaray\u0131 b\u0131rakmayan hastalar, uzuv kayb\u0131na yol a\u00e7acak sonu\u00e7larla kar\u015f\u0131 kar\u015f\u0131yad\u0131r.<\/strong><\/p>\n

Tedavide gangren olmadan sigaray\u0131 b\u0131rakanlarda, %94 amputasyon gerekmemi\u015f, sigara i\u00e7enlerde en az %43 amputasyon yap\u0131lm\u0131\u015f.
\n<\/strong><\/p>\n

Tedavi:<\/strong><\/p>\n

1-Medikal:<\/strong><\/p>\n

Seyri tamamen durduran sigaray\u0131 b\u0131rakmakt\u0131r. Medikal tedavide ama\u00e7 vazodilatasyon yapmakt\u0131r. Prostoglandinlerin ke\u015ffi arterial hastal\u0131klarda \u00e7\u0131\u011f\u0131r a\u00e7m\u0131\u015ft\u0131r. Atardamar i\u00e7inden uyguland\u0131\u011f\u0131nda maximum vazodilatasyon yapar. Ve trombosit agregasyonunu engeller.<\/p>\n

En \u00f6nemli sava\u015f a\u011fr\u0131ya kar\u015f\u0131d\u0131r bu nedenle 1-2 haftal\u0131k epidural anestezi uygulanmas\u0131 a\u011fr\u0131y\u0131 azaltacakt\u0131r.<\/p>\n

Hiperbarik o2, ozon tedavisi, intraven\u00f6z oksijen tedavisi ve son zamanlarda d\u00fc\u015f\u00fck enerjili lazer tedavisi de hem a\u011fr\u0131n\u0131n azalt\u0131lmas\u0131nda,hem de \u00fclserlerin iyile\u015fmesinde yararl\u0131 olmaktad\u0131r.<\/p>\n

Son zamanlar\u0131n en iyi alternatif tedavisi; Buerger hasl\u0131\u011f\u0131nda damar i\u00e7i d\u00fc\u015f\u00fck enerjili lazer tedavisidir.<\/em><\/strong><\/a><\/p>\n

2-Cerrahi:<\/strong><\/p>\n

    \n
  1. Sempatektomi,<\/li>\n
  2. Arteriyel baypaslard\u0131r.<\/li>\n<\/ol>\n

    3-D\u00fc\u015f\u00fck Enerjili Lazer Tedavisi :<\/strong><\/p>\n

    \"Buerger<\/p>\n

    Periferik arter <\/strong>okloziv<\/strong> hastal\u0131klarda, burgerde, d\u00fc\u015f\u00fck yo\u011funluklu lazer terapisi hastal\u0131\u011f\u0131n derecesi yani akut ve kronikli\u011fine g\u00f6re sadece akut d\u00f6nemde a\u011fr\u0131, hassasiyet, trofik parmaklar veya ayak bile\u011fi tutulumu veya ayakta enfeksiyon ve istirahat a\u011fr\u0131s\u0131, dizalt\u0131nda damar t\u0131kan\u0131kl\u0131\u011f\u0131 veya diz\u00fcst\u00fcnde damar t\u0131kan\u0131kl\u0131\u011f\u0131n\u0131n derecelerine g\u00f6re d\u00fc\u015f\u00fck yo\u011funluklu lazerlerin dalga boylar\u0131 ve renkleri se\u00e7ilmektedir. Burger hastal\u0131\u011f\u0131nda lazer spinalkordun sinir h\u00fccrelerini i\u00e7ine alacak \u015fekilde ve buna ilaveten otomatik sinir sistemi ve gang\u0131lyonlar\u0131 da etkileyecek \u015fekilde se\u00e7ilmektedir.<\/p>\n

    Sempatik sinir liflerinin pregang\u0131l\u0131yon\u0131k motor noronlar\u0131, kord segmentleri T1 ve L2 aras\u0131ndan meydana gelmektedir. D\u00fc\u015f\u00fck yo\u011funluklu lazer tedavisi bu dokulara lokal olarak yay\u0131labilmektedir. Lazer anjio genezi situmulasyona ilaveten \u00f6nemli derecede antimfalamatuar ve aneljezik etkilerede sahiptir. D\u00fc\u015f\u00fck enerjili lazer dalga boylar\u0131na ve nufuz etti\u011fi dokulara g\u00f6re arter\u0131olleri etkileyerek damar a\u011f\u0131nda art\u0131\u015fa sebebiyet verir ve kolatarel arterleri geni\u015fleterek kan ak\u0131m\u0131n\u0131, oksijenizasyonu art\u0131rarak \u015fikayetleri tedavi etmektedir.<\/p>\n

    Tedavi bacaklar\u0131n yeterli iyile\u015fme g\u00f6sterdi\u011fi hissedilene kadar 10 g\u00fcn s\u00fcreyle yap\u0131lmaktad\u0131r. Burger hastalar\u0131n parma\u011f\u0131 \u00fczerindeki yaralar %70 oran\u0131nda azal\u0131r ve tedaviden 3 hafta sonra memnun edecek bir \u015fekilde iyile\u015fme g\u00f6stermektedir.<\/strong><\/p>\n

    4-Damar \u0130\u00e7i Oksijen Tedavisi :<\/strong><\/p>\n

    Oksijen v\u00fccudumuz i\u00e7in olduk\u00e7a gerekli bir yap\u0131d\u0131r.Ancak baz\u0131 durumlarda inflamatuar hastal\u0131klar da burger hastal\u0131\u011f\u0131,oto\u0131mon hastal\u0131klar,kardiyovask\u00fcler sistem hastal\u0131klar\u0131nda bozulmu\u015f sirkulasyona ba\u011fl\u0131 eksikli\u011fi g\u00f6r\u00fclebilir.<\/p>\n

    Damar i\u00e7i oksijen tedavinsiin avantajlar\u0131 aras\u0131nda ise kolay ve g\u00fcvenilir olmas\u0131 yan etkilerinin olmamas\u0131 ila\u00e7 kullan\u0131m\u0131n\u0131n say\u0131s\u0131n\u0131n d\u00fc\u015f\u00fcr\u00fclmesi s\u00f6ylenilebilir.<\/p>\n

    \u0130ntraven\u00f6z oksijen tedavisinde oksijen gaz\u0131 ,bir oksiven cihaz\u0131 yard\u0131m\u0131yla gaz\u0131 s\u0131v\u0131la\u015ft\u0131rarak damara verecek \u015fekle getirerek sistemi etkilemektedir.<\/p>\n

    intraven\u00f6z oksijen tedavisinde kan dola\u015f\u0131m\u0131n\u0131 uyaran plateletlerin agregasyonunu tutan hormon olan prostassilinin artan olu\u015fumu g\u00fc\u00e7l\u00fc vask\u00fcler dilatasyona \u00f6nc\u00fcl\u00fck eder.Bu hormon ince vask\u00fcler yap\u0131larda damar geni\u015flemelerine sebep olur.<\/p>\n

    Burger hastal\u0131\u011f\u0131nda bacaklardaki \u00f6dem ,\u00fclser, ven\u00f6z ve arteryel sistemde olu\u015fan gangrenlerden dolay\u0131, y\u00fczeyel dola\u015f\u0131m d\u00fczeni bozulmu\u015ftur.intravenoz oks\u0131jen tedavisinde direkt kana oksijen verilerek oksijen\u0131n bu dokularda nufuzu tedaviyi kolayla\u015ft\u0131rmaktad\u0131r<\/p>\n

    \u0130ntraven\u00f6z oksijen tedavisinde bu hastalarda prostassilin art\u0131\u015f\u0131nda ,eozinofil gran\u00fclleri kortikoitleri ,ACTH ,adrenalin ve lokotrien sentezini hibe eden arahidonik asit kaskadindan olu\u015fan bir formudur.Bu g\u00fc\u00e7l\u00fc antiflamatuar etki \u00fcretmektedir.Bozulmu\u015f m\u0131kro sirk\u00fclasyonu etkileyerek kollateral olu\u015fumunu art\u0131rmakta ve ince arteriolleri geni\u015fleterek etki sa\u011flamaktad\u0131r.<\/p>\n

    Tedaviden 3 ay sonra dopler ultrason tetkikinde dola\u015f\u0131m\u0131n ve bas\u0131nc\u0131n\u0131n artt\u0131\u011f\u0131 g\u00f6r\u00fclmektedir.<\/p>\n","protected":false},"excerpt":{"rendered":"

    Vask\u00fclitler i\u00e7erisinde s\u0131k olarak g\u00f6rd\u00fcklerimiz: Tromboangiitis obliterans (Buerger hastal\u0131\u011f\u0131) En \u00e7ok kol ve bacaklardaki k\u00fc\u00e7\u00fck ve orta \u00e7apl\u0131 arterleri, venleri ve sinirleri etkileyen damar sertl\u0131g\u0131 olu\u015fturmadan iltihabi bir hastal\u0131kt\u0131r. Tromboangiitis obliteransl\u0131 ve ya burger bu hastal\u0131k ilk olarak 1879 y\u0131l\u0131nda tan\u0131mlanm\u0131\u015ft\u0131r. Burger hastal\u0131\u011f\u0131 baz\u0131 \u00f6nemli y\u00f6nleriyle di\u011fer vask\u00fclit hastal\u0131klar\u0131ndan ayr\u0131l\u0131r. Bu hastal\u0131kta ileri derece h\u00fccresel […]<\/p>\n","protected":false},"author":5,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"class_list":["post-564","post","type-post","status-publish","format-standard","hentry","category-general"],"translation":{"provider":"WPGlobus","version":"3.0.0","language":"en","enabled_languages":["tr","en"],"languages":{"tr":{"title":true,"content":true,"excerpt":false},"en":{"title":false,"content":false,"excerpt":false}}},"yoast_head":"\nTromboangiitis Obliterans (Buerger Hastal\u0131\u011f\u0131) - Damar Tedavileri<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.damartedavileri.com\/2016\/11\/buerger-hastaligi\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Tromboangiitis Obliterans (Buerger Hastal\u0131\u011f\u0131) - 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