{"id":28,"date":"2010-08-24T10:19:01","date_gmt":"2010-08-24T07:19:01","guid":{"rendered":"http:\/\/caferabbasoglu.moldibi.com\/periferik-damar-hastal\/"},"modified":"2015-10-03T15:50:08","modified_gmt":"2015-10-03T12:50:08","slug":"periferik-damar-hastaligi","status":"publish","type":"page","link":"https:\/\/www.caferabbasoglu.com\/en\/periferik-damar-hastaligi\/","title":{"rendered":"Periferik damar hastal\u0131\u011f\u0131"},"content":{"rendered":"<h2>Periferik damar hastal\u0131\u011f\u0131 nedir?<\/h2>\n<p><img decoding=\"async\" class=\"alignleft lazyload\" data-src=\"\/wp-content\/uploads\/old_site_images\/stories\/IMG_3986.jpg\" alt=\"\" src=\"data:image\/gif;base64,R0lGODlhAQABAAAAACH5BAEKAAEALAAAAAABAAEAAAICTAEAOw==\" style=\"--smush-placeholder-width: 214px; --smush-placeholder-aspect-ratio: 214\/142;\" \/>Periferik damar hastal\u0131\u011f\u0131, kalp ve beyin d\u0131\u015f\u0131ndaki t\u00fcm kan damarlar\u0131n\u0131n(atardamar) hastal\u0131klar\u0131n\u0131 ifade eder. En s\u0131k neden ateroskleroz yani damar sertli\u011fidir. Genelde 50 ya\u015f \u00fczerindeki erkeklerin %5-15 inde \u015fikayete yol a\u00e7mayan damar hastal\u0131\u011f\u0131 bulunur. Bu sessiz damar hastal\u0131\u011f\u0131 s\u0131kl\u0131kla kalpte koroner damar hastal\u0131\u011f\u0131 ve \u015fah damar hastal\u0131\u011f\u0131na ba\u011fl\u0131 ciddi sorunlar nedeniyle risk ta\u015f\u0131r.<\/p>\n<p>Bacak damar hastal\u0131klar\u0131nda en yayg\u0131n \u015fikayet, y\u00fcr\u00fcmek, ko\u015fmak, merdiven \u00e7\u0131kmakla meydana gelen ve dinlenma ile ge\u00e7en a\u011fr\u0131d\u0131r. Zamanla a\u011fr\u0131 istirahatte de olu\u015fur. Sonras\u0131nda ise iyile\u015fmeyen yaralar ve kangren g\u00f6r\u00fcl\u00fcr.<\/p>\n<h2>Ateroskleroz (damar sertli\u011fi) nedir ?<\/h2>\n<p><img decoding=\"async\" class=\"alignleft lazyload\" data-src=\"\/wp-content\/uploads\/old_site_images\/stories\/22122008328.jpg\" alt=\"22122008328\" width=\"259\" height=\"194\" src=\"data:image\/gif;base64,R0lGODlhAQABAAAAACH5BAEKAAEALAAAAAABAAEAAAICTAEAOw==\" style=\"--smush-placeholder-width: 259px; --smush-placeholder-aspect-ratio: 259\/194;\" \/>Ateroskleroz, kolesterol k\u00fctlelerinin atardamar duvarlar\u0131na yap\u0131\u015fmas\u0131 ile meydana gelen ilerleyici bir hadisedir. Yap\u0131\u015fan bu kolesterol plaklar\u0131 damar duvarlar\u0131n\u0131n sertle\u015fmesine ve damar i\u00e7erisindeki bo\u015flu\u011fun daralmas\u0131na neden olur. Ateroskleroz insan v\u00fccudunda erken ya\u015flarda olu\u015fmaya ba\u015flar. E\u011fer hafif d\u00fczeyde ise yada damar ciddi oranda daralmam\u0131\u015fsa, ateroskleroz hi\u00e7bir belirti vermez.<\/p>\n<p>\u0130leri ateroskleroz sonucu daralm\u0131\u015f arterler nedeniyle pek\u00e7ok farkl\u0131 organda hastal\u0131k meydana gelebilir. \u00d6rne\u011fin, koroner arterlerin (kalp kaslar\u0131n\u0131 besleyen arterler) ileri aterosklerozu kalp krizine yol a\u00e7abilir. \u015eah damar\u0131n\u0131n ve beyin damarlar\u0131n\u0131n ileri aterosklerozu fel\u00e7lere neden olabilir. Bacak arterlerinin ileri aterosklerozu ise y\u00fcr\u00fcrken veya egzersiz ile bacak a\u011fr\u0131s\u0131na (klodikasyon), yara iyile\u015fmesinde gecikmelere ve bacak \u00fclserlerine (a\u00e7\u0131k yara) neden olabilir.<\/p>\n<h2>Ateroskleroz bacak a\u011fr\u0131na nas\u0131l sebep olur?:<\/h2>\n<p><img decoding=\"async\" class=\"alignleft lazyload\" data-src=\"\/wp-content\/uploads\/old_site_images\/stories\/22122008329.jpg\" alt=\"22122008329\" width=\"259\" height=\"194\" src=\"data:image\/gif;base64,R0lGODlhAQABAAAAACH5BAEKAAEALAAAAAABAAEAAAICTAEAOw==\" style=\"--smush-placeholder-width: 259px; --smush-placeholder-aspect-ratio: 259\/194;\" \/>1. Egzersiz gibi oksijen ihtiyac\u0131n\u0131n artt\u0131\u011f\u0131 anlarda dokulara g\u00f6nderilen kan ve oksijen miktar\u0131nda h\u0131zla art\u0131\u015f olmas\u0131 gerekirken, ateroskleroz nedeniyle daralm\u0131\u015f olan damarda bu art\u0131\u015f olmaz.<\/p>\n<p>2. Bir arterin (atardamar) tromb\u00fcs veya emboli (kan p\u0131ht\u0131lar\u0131) nedeniyle t\u0131kanmas\u0131 dokuda ani olarak oksijen azl\u0131\u011f\u0131 ve beslenme bozuklu\u011funa yol a\u00e7ar.<\/p>\n<p>&nbsp;<\/p>\n<h2>Kladikasyn nedir?<\/h2>\n<p>Bacaklar\u0131n tekli veya \u00e7oklu kas gruplar\u0131nda istirahatle ortaya \u00e7\u0131kan ve egzersizle kaybolan uyu\u015fma,a\u011fr\u0131, g\u00fc\u00e7s\u00fczl\u00fck,kramp ve s\u0131z\u0131 olarak tarif edilen bir tablodur.neden olan darl\u0131k ilerledik\u00e7e bulgular\u0131n yeri ve karakteri de\u011fi\u015febilir.yoku\u015f yukar\u0131\u00e7\u0131kma ve inme, h\u0131zl\u0131 y\u00fcr\u00fcmede y\u00fcr\u00fcy\u00fc\u015f mesafesi ve s\u00fcresi k\u0131sal\u0131r. Kladikasyo aniden ba\u015flarsa p\u0131ht\u0131 nedeniyle damar\u0131n aniden t\u0131kand\u0131\u011f\u0131 d\u00fc\u015f\u00fcn\u00fcl\u00fcr. \u0130stirahatle genelde 5- 10 dk da a\u011fr\u0131 azal\u0131r.<\/p>\n<h2>Kollateral nedir?<\/h2>\n<p>Bazen, bir arterdeki ciddi t\u0131kan\u0131kl\u0131\u011fa ra\u011fmen, bu arterin besledi\u011fi dokuda a\u011fr\u0131 meydana gelmez.. Bu durumda ilgili dokuyu ya birden fazla damar beslemektedir yada o dokuyu besleyen bir kollateral dola\u015f\u0131m mevcuttur. Bir arter i\u00e7erisindeki a\u00e7\u0131kl\u0131k darald\u0131\u011f\u0131nda ilgili alana oksijenlenmi\u015f kan\u0131 ta\u015f\u0131mak \u00fczere kollateral dola\u015f\u0131m geli\u015febilir.<\/p>\n<p><img decoding=\"async\" style=\"--smush-placeholder-width: 389px; --smush-placeholder-aspect-ratio: 389\/292;margin-right: 5px;\" data-src=\"\/wp-content\/uploads\/old_site_images\/stories\/periferik__baypass_srasnda.jpg\" alt=\"periferik__baypass_srasnda\" width=\"389\" height=\"292\" src=\"data:image\/gif;base64,R0lGODlhAQABAAAAACH5BAEKAAEALAAAAAABAAEAAAICTAEAOw==\" class=\"lazyload\" \/><em><br \/>\nDr. Cafer Abbaso\u011flu Hocas\u0131 Prof.Dr.Mustafa \u00d6z ile Periferik Damar By-Pass Cerrahisinde G\u00f6r\u00fclmekteler<\/em><\/p>\n<p>Kollateral dola\u015f\u0131m ince arterlerden olu\u015fmakta olup genel kan\u0131ya g\u00f6re d\u00fczenli egzersiz bu kollaterallerin geli\u015fimini artt\u0131rmaktad\u0131r. \u0130yi kollateral geli\u015fmi\u015f ki\u015filerde ciddi bir arter t\u0131kan\u0131kl\u0131\u011f\u0131na ra\u011fmen bacaklarda y\u00fcr\u00fcme ile meydana gelen a\u011fr\u0131 (klodikasyon) g\u00f6r\u00fclmeyebilir.<\/p>\n<h3>Bu risk fakt\u00f6rleri \u015funlard\u0131r:<\/h3>\n<ul>\n<li>LDL kolesterol (k\u00f6t\u00fc kolesterol) ve trigliserit d\u00fczeylerinin kanda y\u00fcksek olmas\u0131<\/li>\n<li>HDL kolesterol (iyi kolesterol) d\u00fczeylerinin kanda d\u00fc\u015f\u00fck olmas\u0131<\/li>\n<li>Sigara kullan\u0131m\u0131<\/li>\n<li>Diabetes mellitus (\u015feker hastal\u0131\u011f\u0131)<\/li>\n<li>Y\u00fcksek kan bas\u0131nc\u0131 (hipertansiyon) veya ailede hipertansiyon \u00f6yk\u00fcs\u00fc<\/li>\n<li>Ailede ateroskleroza (damar sertli\u011fi) ba\u011fl\u0131 hastal\u0131k \u00f6yk\u00fcs\u00fc<\/li>\n<li>Kronik b\u00f6brek yetersizli\u011fi<\/li>\n<li>A\u015f\u0131r\u0131 kilo veya obesite<\/li>\n<\/ul>\n<h2>Periferik damar hastal\u0131\u011f\u0131 nas\u0131l te\u015fhis edilir?<\/h2>\n<p><strong>Muayene:<\/strong><\/p>\n<p>&#8211; kollar veya bacaklarda nab\u0131zlar\u0131n zay\u0131f al\u0131nmas\u0131 yada hi\u00e7 al\u0131nmamas\u0131<\/p>\n<p>&#8211; kollar ve bacaklar aras\u0131nda tansiyon fark\u0131<\/p>\n<p>&#8211; cilt rengi ve t\u0131rnaklarda de\u011fi\u015fiklikler bulunmaktad\u0131r.<\/p>\n<p><strong>g\u00f6r\u00fcnt\u00fcleme testleri <\/strong><\/p>\n<ul>\n<li>Doppler Ultrason<\/li>\n<li>Duplex Ultrason<\/li>\n<li>Klasik anjiografi (R\u00f6ntgen \u0131\u015f\u0131nlar\u0131 olan X-Ray ile)<\/li>\n<li>BT Anjiografi (Bilgisayarl\u0131 tomografi ile)<\/li>\n<li>MR Anjiografi (Manyetik Rezonans g\u00f6r\u00fcnt\u00fcleme ile)<\/li>\n<\/ul>\n<h2>Periferik damar hastal\u0131\u011f\u0131nda tedavi y\u00f6ntemleri<\/h2>\n<p><img decoding=\"async\" class=\"alignleft lazyload\" data-src=\"\/wp-content\/uploads\/old_site_images\/stories\/IMG_3986.jpg\" alt=\"IMG_3986\" width=\"383\" height=\"256\" src=\"data:image\/gif;base64,R0lGODlhAQABAAAAACH5BAEKAAEALAAAAAABAAEAAAICTAEAOw==\" style=\"--smush-placeholder-width: 383px; --smush-placeholder-aspect-ratio: 383\/256;\" \/>Periferik damar hastal\u0131\u011f\u0131n\u0131n tedavisindeki ama\u00e7lar \u015funlard\u0131r:<\/p>\n<p>1. Y\u00fcr\u00fcme ile meydana gelen bacak a\u011fr\u0131s\u0131n\u0131n ortadan kald\u0131r\u0131lmas\u0131<\/p>\n<p>2. Klodikasyon ba\u015flay\u0131ncaya kadar olan y\u00fcr\u00fcme mesafesinin artt\u0131r\u0131larak egzersiz kapasitesinin artt\u0131r\u0131lmas\u0131.<\/p>\n<p>3. Ayaklarda a\u00e7\u0131k yara, gangren veya ayak veya baca\u011f\u0131n kesilmesine neden olabilecek olan ciddi damar t\u0131kan\u0131kl\u0131\u011f\u0131n\u0131n \u00f6nlenmesi.<\/p>\n<p>Periferik damar hastal\u0131\u011f\u0131n\u0131n tedavileri aras\u0131nda ya\u015fam ve beslenme \u015feklinin de\u011fi\u015ftirilmesi, d\u00fczenli egzersiz, ila\u00e7 tedavisi, anjioplasti (ameliyats\u0131z baz\u0131 i\u015flemler) ve cerrahi tedavi y\u00f6ntemleri bulunmaktad\u0131r.<\/p>\n<h3>Ya\u015fam ve beslenme \u015feklinin de\u011fi\u015ftirilmesi:<\/h3>\n<ul>\n<li>Sigaran\u0131n b\u0131rak\u0131lmas\u0131, periferik damar hastal\u0131\u011f\u0131n\u0131n daha fazla ilerlemesini durdurarak, istirahat a\u011fr\u0131s\u0131n\u0131n olu\u015fmas\u0131n\u0131 veya ayak veya baca\u011f\u0131n kesilmesi gereksinimini \u00f6nler.<\/li>\n<li>Sa\u011fl\u0131kl\u0131 bir diyet, kandaki kolesterol ve di\u011fer ya\u011f d\u00fczeylerinin d\u00fc\u015f\u00fcr\u00fclmesi ve kan bas\u0131nc\u0131n\u0131n kontrol alt\u0131nda tutulmas\u0131na yard\u0131mc\u0131 olur.<\/li>\n<li>\u015eeker hastal\u0131\u011f\u0131n\u0131n kontrol alt\u0131nda tutulmas\u0131.<\/li>\n<\/ul>\n<h3>D\u00fczenli egzersiz:<\/h3>\n<p>Uygun egzersiz, hem kaslar\u0131n oksijeni daha etkin olarak kullanabilmesi i\u00e7in yard\u0131mc\u0131 olmakta hem de kollateral dola\u015f\u0131m\u0131n (t\u0131kan\u0131kl\u0131k \u00f6tesine do\u011fru geli\u015fmi\u015f k\u00fc\u00e7\u00fck atardamar dallar\u0131ndan olu\u015fan yeni damar a\u011f\u0131) geli\u015fmesini h\u0131zland\u0131rmaktad\u0131r.<\/p>\n<h3>\u0130la\u00e7 tedavisi:<\/h3>\n<p>Baz\u0131 insanlar i\u00e7in ya\u015fam ve beslenme \u015feklinin de\u011fi\u015ftirilmesi, periferik damar hastal\u0131\u011f\u0131n\u0131n \u00f6nlenmesi i\u00e7in yeterli olmakta iken di\u011fer bir k\u0131sm\u0131nda ila\u00e7 tedavisi veya ameliyat gerektirebilecek kadar ileri hastal\u0131k geli\u015fmi\u015f olabilir. Periferik damar hastal\u0131\u011f\u0131n\u0131n tedavisinde kullan\u0131lan ila\u00e7lar \u015funlard\u0131r:<\/p>\n<ul>\n<li><strong>Antiplatelet ila\u00e7lar<\/strong><\/li>\n<\/ul>\n<p>Bu ila\u00e7lar kanda p\u0131ht\u0131la\u015fmay\u0131 sa\u011flayan kan elemanlar\u0131n\u0131n birbirlerine ve damar duvar\u0131na yap\u0131\u015farak kan p\u0131ht\u0131s\u0131 olu\u015fturmas\u0131n\u0131 \u00f6nlemektedir. Antiplatelet ila\u00e7lar ayn\u0131 zamanda anjioplasti veya periferik bypass operasyonlar\u0131 sonras\u0131nda da damarlar\u0131n yeniden t\u0131kanmas\u0131n\u0131 \u00f6nlemek i\u00e7in kullan\u0131lmaktad\u0131r.<\/p>\n<ul>\n<li><strong> Antikoag\u00fclan ila\u00e7lar<\/strong><\/li>\n<\/ul>\n<p>Bu ila\u00e7lar kan\u0131n p\u0131ht\u0131la\u015fmas\u0131n\u0131 \u00f6nlemektedir. Antikoag\u00fclanlar, kan p\u0131ht\u0131s\u0131 olu\u015fturma riski \u00e7ok y\u00fcksek olan baz\u0131 hastalara verilmektedir.<\/p>\n<ul>\n<li><strong>Kolesterol d\u00fc\u015f\u00fcr\u00fcc\u00fc ila\u00e7lar<\/strong><\/li>\n<\/ul>\n<p>Statinlerin aterosklerozu olan hastalarda kalp krizi ve fel\u00e7 geli\u015fim riskini azaltmaya y\u00f6nelik yard\u0131mc\u0131 rolleri bulunmaktad\u0131r. Periferik damar hastal\u0131\u011f\u0131 olan bireylerde diyet veya ila\u00e7lar\u0131n yard\u0131m\u0131 ile kan LDL kolesterol d\u00fczeyinin 100 mg\/dl\u2019nin alt\u0131na indirilmesi \u00f6nerilmektedir.<\/p>\n<ul>\n<li><strong>Cilostazol etken maddeli ila\u00e7lar<\/strong><\/li>\n<\/ul>\n<p>Kollar ve bacaklara kan ta\u015f\u0131yan atardamarlarda meydana getirdi\u011fi geni\u015fleme ile bu organlara daha fazla oksijenlenmi\u015f kan ula\u015fmas\u0131na yard\u0131mc\u0131 olmaktad\u0131r. Ya\u015fam ve beslenme \u015feklinin de\u011fi\u015ftirilmesine ra\u011fmen periferik damar hastal\u0131\u011f\u0131 ilerlemeye devam eden hastalara \u00f6nerilebilir<\/p>\n<ul>\n<li><strong>Pentoxifylline etken maddeli ila\u00e7lar<\/strong><\/li>\n<\/ul>\n<p>Kollar ve bacaklara giden kan\u0131n ak\u0131\u015fkanl\u0131\u011f\u0131n\u0131 artt\u0131rarak daha iyi kan ak\u0131m\u0131 sa\u011flamaya yard\u0131mc\u0131 olmaktad\u0131r. Bu ila\u00e7lar\u0131n periferik damar hastal\u0131\u011f\u0131 olan bireylerde y\u00fcr\u00fcme mesafesini artt\u0131rd\u0131\u011f\u0131 g\u00f6sterilmi\u015ftir.<\/p>\n<ul>\n<li><strong>Hipertansiyonu kontrol eden ila\u00e7lar<\/strong><\/li>\n<\/ul>\n<p>Periferik damar hastal\u0131\u011f\u0131nda y\u00fcksek tansiyonun kontrol alt\u0131nda tutulmas\u0131 kalp krizi, fel\u00e7ler ve aort disseksiyonu gibi damar duvar\u0131n\u0131n bozulmas\u0131 ile seyreden \u00f6l\u00fcmc\u00fcl hastal\u0131klar\u0131n geli\u015fim riskini azaltmaktad\u0131r.<\/p>\n<ul>\n<li><strong>Homosistein d\u00fczeyini d\u00fc\u015f\u00fcrmeye yard\u0131mc\u0131 ila\u00e7lar<\/strong><\/li>\n<\/ul>\n<p>Artm\u0131\u015f homosistein d\u00fczeylerinin ateroskleroz (damar sertli\u011fi) ile ili\u015fkili oldu\u011fu g\u00f6sterilmi\u015ftir. G\u00fcnl\u00fck al\u0131nan bir multivitamin (folik asit i\u00e7eren) homosistein d\u00fczeylerini d\u00fc\u015f\u00fcrmeye yard\u0131mc\u0131 olmaktad\u0131r.<\/p>\n<div id=\"attachment_209\" style=\"width: 234px\" class=\"wp-caption alignleft\"><a href=\"http:\/\/caferabbasoglu.moldibi.com\/wp-content\/uploads\/2010\/08\/periferik_anjiyo.jpg\"><img decoding=\"async\" aria-describedby=\"caption-attachment-209\" class=\"size-medium wp-image-209 lazyload\" data-src=\"http:\/\/caferabbasoglu.moldibi.com\/wp-content\/uploads\/2010\/08\/periferik_anjiyo-224x300.jpg\" alt=\"Periferik damar hastal\u0131\u011f\u0131n\u0131n te\u015fhisinde en \u00f6nemli te\u015fhis y\u00f6ntemi anjiyografidir\" width=\"224\" height=\"300\" data-srcset=\"https:\/\/www.caferabbasoglu.com\/wp-content\/uploads\/2010\/08\/periferik_anjiyo-224x300.jpg 224w, https:\/\/www.caferabbasoglu.com\/wp-content\/uploads\/2010\/08\/periferik_anjiyo.jpg 640w\" data-sizes=\"(max-width: 224px) 100vw, 224px\" src=\"data:image\/gif;base64,R0lGODlhAQABAAAAACH5BAEKAAEALAAAAAABAAEAAAICTAEAOw==\" style=\"--smush-placeholder-width: 224px; --smush-placeholder-aspect-ratio: 224\/300;\" \/><\/a><p id=\"caption-attachment-209\" class=\"wp-caption-text\">Periferik damar hastal\u0131\u011f\u0131n\u0131n te\u015fhisinde en \u00f6nemli te\u015fhis y\u00f6ntemi anjiyografidir<\/p><\/div>\n<p><strong>Anjioplasti:<\/strong><\/p>\n<p>Anjioplasti genellikle daralm\u0131\u015f ve bazen de tamamen t\u0131kanm\u0131\u015f arterlerin (atardamar) geni\u015fletilmesi veya a\u00e7\u0131lmas\u0131 i\u00e7in kullan\u0131lan, cerrahi olmayan bir i\u015flemdir. Bu i\u015flem ile damarlara balon ile geni\u015fletme i\u015flemleri yap\u0131labilmekte ve kal\u0131c\u0131 stentler konulabilmektedir.<\/p>\n<p>&nbsp;<\/p>\n<h3>Cerrahi tedavi y\u00f6ntemleri:<\/h3>\n<p>Periferik damar hastal\u0131\u011f\u0131n\u0131n tedavisi i\u00e7in uygulanan cerrahi tedavi y\u00f6ntemleri aras\u0131nda periferik bypass i\u015flemleri ve endarterektomi bulunmaktad\u0131r. bypass cerrahisi, v\u00fccudunuzdan al\u0131nan bir toplardamar veya sentetik bir damar ile t\u0131kal\u0131 alan\u0131n \u00f6ncesinden sonras\u0131na olu\u015fturulan yan bir yol ile kan ak\u0131\u015f\u0131n\u0131n yeniden temin edilmesini sa\u011flamaktad\u0131r. Endarterektomi i\u015fleminde ise kol veya bacaklara giden damar i\u00e7erisinde t\u0131kan\u0131kl\u0131\u011fa neden olan plak tabakas\u0131 temizlenmektedir.<\/p>\n<h3>Periferik damar hastal\u0131kar\u0131na neden olan di\u011fer nedenler:<\/h3>\n<p><strong>Vask\u00fclitler:<\/strong><\/p>\n<p>Vask\u00fclit, damar duvar\u0131n\u0131n inflamasyonu sonucu geli\u015fen, s\u0131k g\u00f6r\u00fclmeyen ama \u00f6zellikle baz\u0131 tiplerinde erken tan\u0131nmaz ve etkin bir \u015fekilde tedavi edilmez ise \u00f6l\u00fcmc\u00fcl olabilen hastal\u0131klard\u0131r. Tek bir organ tutulu\u015flu, s\u0131kl\u0131kla deriye yerle\u015fik ve benign seyirli (lokalize vask\u00fclit) olabilece\u011fi gibi, yayg\u0131n ve t\u00fcm sistemleri tutabilen ve ya\u015fam\u0131 tehdit eden formlarda da (sistemik nekrotizan vask\u00fclit) kendisini g\u00f6sterebilir. Klinik belirtileri \u00e7ok y\u00f6nl\u00fc ve de\u011fi\u015fken olup, inflamatuar yan\u0131t\u0131n \u015fiddet ve do\u011fas\u0131na, ve hedef organ y\u0131k\u0131m\u0131n\u0131n derece ve da\u011f\u0131l\u0131m\u0131na ba\u011fl\u0131d\u0131r. Bu hastal\u0131klar\u0131n ba\u015far\u0131l\u0131 tedavisi, istenmeyen inflamatuar yan\u0131t\u0131n bask\u0131lanmas\u0131 ile ila\u00e7 toksisitesi ve immun-bask\u0131lanma komplikasyonlar\u0131ndan hastay\u0131 koruma aras\u0131ndaki dengeyi sa\u011flayarak ger\u00e7ekle\u015ftirilebilir<\/p>\n<p>Herhangi bir hastal\u0131\u011fa ba\u011fl\u0131 olmayan vask\u00fclitlere \u201cPrimer Vask\u00fclitler\u201d, sistemik lupus eritematozus, romatoid artrit gibi ba\u015fka bir hastal\u0131\u011fa ba\u011fl\u0131 olarak geli\u015fen vask\u00fclitlere \u201cSekonder Vask\u00fclitler\u201d denir. Burada Chapel Hill Konsens\u00fcs Konferans\u0131\u2019nda yap\u0131lan sistemik vask\u00fclit s\u0131n\u0131flamas\u0131 kullan\u0131lacakt\u0131r. Bu s\u0131n\u0131flamada tutulan damar boyutuna g\u00f6re \u00fc\u00e7 b\u00fcy\u00fck grup vard\u0131r.<\/p>\n<p><a href=\"http:\/\/caferabbasoglu.moldibi.com\/wp-content\/uploads\/2010\/08\/lazer_4.jpg\"><img decoding=\"async\" class=\"size-medium wp-image-206 alignleft lazyload\" data-src=\"http:\/\/caferabbasoglu.moldibi.com\/wp-content\/uploads\/2010\/08\/lazer_4-300x169.jpg\" alt=\"lazer_4\" width=\"300\" height=\"169\" data-srcset=\"https:\/\/www.caferabbasoglu.com\/wp-content\/uploads\/2010\/08\/lazer_4-300x169.jpg 300w, https:\/\/www.caferabbasoglu.com\/wp-content\/uploads\/2010\/08\/lazer_4.jpg 1024w\" data-sizes=\"(max-width: 300px) 100vw, 300px\" src=\"data:image\/gif;base64,R0lGODlhAQABAAAAACH5BAEKAAEALAAAAAABAAEAAAICTAEAOw==\" style=\"--smush-placeholder-width: 300px; --smush-placeholder-aspect-ratio: 300\/169;\" \/><\/a><\/p>\n<p><strong><em>Son zamanlarda d\u00fc\u015f\u00fck enerjili lazer tedavisi kalp damar hastal\u0131klar\u0131nda \u00f6zellikler atardamar t\u0131kan\u0131kl\u0131\u011f\u0131 olan hastalarda en son ve en iyi tedavi y\u00f6ntemidir.<\/em><\/strong><\/p>\n<h3>Chapel Hill Konsens\u00fcs Konferans\u0131na g\u00f6re Sistemik Vask\u00fclit S\u0131n\u0131flamas\u0131<\/h3>\n<p><i><strong>1-primer vask\u00fclitler:<\/strong><\/i><\/p>\n<p><em>-B\u00fcy\u00fck Damar Vask\u00fcliti<\/em><br \/>\nDev H\u00fccreli (Temporal) Arterit<br \/>\nTakayasu Arteriti<\/p>\n<p><em>-Orta B\u00fcy\u00fckl\u00fckte Damar Vask\u00fcliti<\/em><br \/>\nPoliarteritis Nodosa (Klasik PAN)<br \/>\nKawasaki Hastal\u0131\u011f\u0131<\/p>\n<p><em>-K\u00fc\u00e7\u00fck Damar Vask\u00fcliti<\/em><br \/>\nWegener Gran\u00fclomatozu<br \/>\nChurg-Strauss Sendromu<br \/>\nMikroskopik Polianjiitis (Poliarteritis)<br \/>\nHenoch-Sch\u00f6nlein Purpuras\u0131<br \/>\nEsansiyel Kriyoglob\u00fclinemik Vask\u00fclit<br \/>\nKutan\u00f6z L\u00f6kositoklastik Vask\u00fclit<\/p>\n<p>-\u00c7e\u015fitli patolojiler:<\/p>\n<p>Beh\u00e7et sendromu<\/p>\n<p>Buerger hastal\u0131\u011f\u0131<\/p>\n<p>Kwasaki hastal\u0131\u011f\u0131<\/p>\n<p><i><strong>2-sekonder vask\u00fclitler:<\/strong><\/i><\/p>\n<p>SLE,romatoid artrit,sj\u00f6gren sendromu,skleroderma<\/p>\n<p>Antifosfolipid antikor sendromu<\/p>\n<p>Esansiyel mikst kriyoglobulinemi<\/p>\n<p>Malignite ile ilgili vask\u00fclit,a\u015f\u0131r\u0131 duyarl\u0131l\u0131k vask\u00fcliti,<\/p>\n<p>Ate\u015f, halsizlik, yorgunluk, gece terlemesi, artralji gibi semptom ve bulgular, vask\u00fclitlerin hemen hemen t\u00fcm\u00fcnde saptanabilir. Bununla birlikte sistemlerin etkilenmeleri, vask\u00fclitler aras\u0131nda farkl\u0131l\u0131klar g\u00f6sterebilmektedir. Hipertansiyon ise poliarteritis nodosa gibi baz\u0131 vask\u00fclitlerde belirgin klinik bulgulardan ve klasifikasyon kriterlerinden biri iken baz\u0131lar\u0131nda daha az oranda g\u00f6zlenmektedir.<\/p>\n<p><strong>Vask\u00fclitler i\u00e7erisinde s\u0131k olarak g\u00f6rd\u00fcklerimiz:<\/strong><\/p>\n<p><strong>Tromboangiitis obliterans (Buerger hastal\u0131\u011f\u0131)<\/strong> en \u00e7ok kol ve bacaklardaki k\u00fc\u00e7\u00fck ve orta \u00e7apl\u0131 arterleri, venleri ve sinirleri etkileyen nonaterosklerotik segmental enflamatuar bir hastal\u0131kt\u0131r.<\/p>\n<p>Tromboangiitis obliteransl\u0131 bir hasta ilk olarak 1879 y\u0131l\u0131nda Von Winiwarter taraf\u0131ndan tan\u0131mlanm\u0131\u015ft\u0131r. Bundan 29 y\u0131l sonra Leo Buerger ampute edilmi\u015f 11 ekstremitede patolojik bulgular\u0131n kesin ve ayr\u0131nt\u0131l\u0131 tarifini yapm\u0131\u015ft\u0131r.<br \/>\nTromboangiitis obliterans baz\u0131 \u00f6nemli y\u00f6nleriyle di\u011fer vask\u00fclit formlar\u0131ndan ayr\u0131l\u0131r.<br \/>\nPatolojik olarak, ileri derecede sell\u00fcler ve enflamatuar bir trombus vard\u0131r. Damar duvar\u0131 nispeten korunmu\u015ftur.<br \/>\nBu hastalarda sedimentasyon, CRP, serolojik test-ler (imm\u00fcne kompleksler, kompleman, kriyoglobu-lin) ve otoantikorlar (antin\u00fckleer antikorlar, roma-toid fakt\u00f6r) normal veya negatifken arteriyel intimada immun reaksiyon varl\u0131\u011f\u0131 g\u00f6sterilmi\u015ftir. Arter duvar\u0131ndaki kollajen I ve III e kar\u015f\u0131 artm\u0131\u015f h\u00fccresel duyarl\u0131l\u0131\u011f\u0131, normal ve arteriosklerozisli insanlardan ay\u0131r\u0131c\u0131 tan\u0131da kullan\u0131labilir. Eichhorn ve arkada\u015flar\u0131 Buerger in aktif evresinde 7 hastada, serum anti-endotel antikorlar\u0131nda artma (ortalama 1857 U, nor-mal 30 ki\u015fide 126\u00fc, remisyonda olanlarda 461 U.) g\u00f6stermi\u015flerdir.<\/p>\n<p>Bu hastalar\u0131n (klinik olarak) hastal\u0131ks\u0131z gibi duran ekstremitelerine, &#8220;Sodium nitroprusside&#8221; gibi endotele ba\u011f\u0131ml\u0131 olmadan vazodilat\u00f6r etki yapan ajanlar verildi\u011finde vazorelaksasyon normal olmas\u0131na ra\u011fmen (endotele ba\u011f\u0131ml\u0131) etkili &#8220;Acetyl-Choline&#8221; intra arteriyel verildi\u011finde; &#8220;Pletysmog-raphy&#8221; ile \u00f6l\u00e7\u00fclen relaksasyon normale g\u00f6re d\u00fc\u015f\u00fck olmakta, yap\u0131lan arteriografik incelemede, k\u00fc\u00e7\u00fck arterlerde multipl t\u0131kanmalar oldu\u011fu, \u00f6zellikle proksimal arterler normal g\u00f6r\u00fcn\u00fcrken, brakial arter distalinde, infrapopliteal arterlerde, hastal\u0131kl\u0131 olanla-r\u0131n normallerin aras\u0131na serpi\u015ftirilmi\u015f gibi oldu\u011fu g\u00f6r\u00fclebilmektedir. Klinik seyrinde ayak ve bacakta &#8220;Flebitis migrans&#8221; tablosu tipiktir, patolojilerinde akut fazlar\u0131nda \u00e7ok h\u00fccreli inflamatuar tromb\u00fcsler vard\u0131r. Kronikle\u015ftik\u00e7e tromb\u00fcsler organize olur ve duvarda fibrozis geli\u015fir. Ancak internal elastik lamina pek \u00e7o\u011funda korunmu\u015ftur. Bu \u00f6zellikler arteriosklerozis veya vask\u00fclitislerden ay\u0131rmada faydal\u0131d\u0131r.<br \/>\nAllen testi yap\u0131lmas\u0131 gen\u00e7 tiryakilerde, ellerdeki dola\u015f\u0131m\u0131 ayd\u0131nlat\u0131r ve ayaklarda trofik de\u011fi\u015fikliklerin ba\u015flang\u0131c\u0131nda bile bu test sonucu anormaldir. Te\u015f-his: flebitis migrans olmas\u0131, ellerde de benzeri tutu-lum, istirahat a\u011fr\u0131s\u0131, sigara tiryakili\u011fi, ya\u015f\u0131n45 in \u00fczerinde 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, arteriografik bulgular ve nadiren biyopsi ile yap\u0131labilir.<\/p>\n<p>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<p>Hastal\u0131k ilerledik\u00e7e, y\u00fcr\u00fcme ile artan istirahatle azalan bacak a\u011fr\u0131lar\u0131 yerle\u015fir. Hasta uzun s\u00fcreli y\u00fcr\u00fcy\u00fc\u015flerde, giderek artan a\u011fr\u0131sebebiyle 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, klasik t\u0131p kitaplar\u0131na bu durum vitrin belirtisi olarak ge\u00e7mi\u015ftir. \u0130leri d\u00f6nemlerde a\u011fr\u0131 sadece hareketle de\u011fil, istirahat d\u00f6nemlerinde bile hissedilmeye ba\u015flar.<\/p>\n<p>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<p>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.<\/p>\n<p>Hastal\u0131\u011f\u0131n te\u015fhisi i\u00e7in Doppler ultrasonografi ile damarlardaki kan ak\u0131m seviyesi ve daralma g\u00f6sterilir, damar i\u00e7ine kontras madde verilerek \u00e7ekilen filmlerle te\u015fhis kesinle\u015ftirilir.<\/p>\n<p>Tedavide gangren olmadan sigaray\u0131 b\u0131rakanlarda, %94 amputasyon gerekmemi\u015f, sigara i\u00e7enlerde en az %43 amputasyon yap\u0131lm\u0131\u015f.<\/p>\n<h3>Tedavi:<\/h3>\n<p><strong>Medikal:<\/strong> 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.intraarteriyal uyguland\u0131\u011f\u0131nda maximum vazodilatasyon yapar. Ve trombosit agregasyonunu engeller.prostoglandinin iskemik \u00fclser tedavisindeki yeri hala tart\u0131\u015fmal\u0131d\u0131r.yap\u0131lan bir \u00e7al\u0131\u015fmada \u00fclserli hastalar\u0131n %31 ini iyile\u015ftirmi\u015f, di\u011ferlerinde herhangi bir etki g\u00f6r\u00fclmemi\u015f.<\/p>\n<p>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<p>Hiperbarik o2tedavisi de hem a\u011fr\u0131n\u0131n azalt\u0131lmas\u0131nda,hem de \u00fclserlerin iyile\u015fmesinde yararl\u0131 olabilmektedir.<\/p>\n<p><a href=\"http:\/\/caferabbasoglu.moldibi.com\/wp-content\/uploads\/2010\/08\/lazer_3.jpg\"><img decoding=\"async\" class=\"size-medium wp-image-205 alignleft lazyload\" data-src=\"http:\/\/caferabbasoglu.moldibi.com\/wp-content\/uploads\/2010\/08\/lazer_3-300x225.jpg\" alt=\"lazer_3\" width=\"300\" height=\"225\" data-srcset=\"https:\/\/www.caferabbasoglu.com\/wp-content\/uploads\/2010\/08\/lazer_3-300x225.jpg 300w, https:\/\/www.caferabbasoglu.com\/wp-content\/uploads\/2010\/08\/lazer_3.jpg 1024w\" data-sizes=\"(max-width: 300px) 100vw, 300px\" src=\"data:image\/gif;base64,R0lGODlhAQABAAAAACH5BAEKAAEALAAAAAABAAEAAAICTAEAOw==\" style=\"--smush-placeholder-width: 300px; --smush-placeholder-aspect-ratio: 300\/225;\" \/><\/a><\/p>\n<p><strong><em><a href=\"\/dusuk-enerjili-lazer-tedavisi\">Son zamanlar\u0131n en iyi alternatif tedavisi; Buerger hasl\u0131\u011f\u0131nda damar i\u00e7i d\u00fc\u015f\u00fck enerjili lazer tedavisidir.<\/a><\/em><\/strong><\/p>\n<p><strong>Cerrahi:<\/strong> Sempatektomi<\/p>\n<p>Arteriyel baypass<\/p>\n<h2>Skleroderma<\/h2>\n<p>\u0130lk kez 18. y\u00fczy\u0131lda tarif edilmi\u015f olan, nadir g\u00f6r\u00fclen kronik bir ba\u011f dokusu hastal\u0131\u011f\u0131d\u0131r. Ba\u011f dokusu eklemlerin etraf\u0131nda, damarlarda, i\u00e7 organlarda ve ciltte bulunan, destek sa\u011flayan bir dokudur. Bilinen ilk skleroderma hastas\u0131na, 1754 y\u0131l\u0131nda Napoli\u2019de Dr. Carlo Curzio taraf\u0131ndan tan\u0131 konulmu\u015ftur.30-50ya\u015f aras\u0131nda kad\u0131nlarda daha s\u0131k g\u00f6r\u00fclmektedir. hastal\u0131\u011f\u0131n en belirgin \u00f6zelli\u011finin fibrozis oldu\u011funu bilinmektdir. Zaten skleroderma kelimesi de Yunanca\u2019da \u201csert cilt\u201d anlam\u0131na gelir ve cildin kollajen birikimi nedeniyle kal\u0131nla\u015fmas\u0131n\u0131 ifade eder. Fakat sklerodermal\u0131 hastalar\u0131n sorunu sadece ciltte sertle\u015fme de\u011fildir, v\u00fccudun \u00e7e\u015fitli organlar\u0131na ait rahats\u0131zl\u0131klar da olabilir. Bu nedenle skleroderma hastal\u0131\u011f\u0131na sistemik (v\u00fccudun bir\u00e7ok organ\u0131n\u0131 ilgilendirebilen) sklerozis de (sertle\u015fme) denmektedir. Hastal\u0131\u011f\u0131n tamamen iyile\u015fmesini sa\u011flayan tedavi hen\u00fcz m\u00fcmk\u00fcn olmamakla birlikte, uygun tedavi ve bak\u0131m ile sklerodermal\u0131 hastalar\u0131n \u00e7o\u011funda, normale yak\u0131n ya\u015fam s\u00fcrmeleri sa\u011flanabilmektedir.<\/p>\n<p>Sklerodermada mikrovask\u00fcler tutulumun yayg\u0131n oldu\u011fu, makrovask\u00fcler tutulumun ise \u00e7ok nadir oldu\u011fu bilinmekteydi.ancak son yap\u0131lan \u00e7al\u0131\u015fmalarda makrovask\u00fcler tutulumun da artan oranda g\u00f6r\u00fcld\u00fc\u011f\u00fc saptanm\u0131\u015ft\u0131r.serebrovask\u00fcler, koroner ve periferal arteriyal hastal\u0131\u011f\u0131n da artan s\u0131kl\u0131kta g\u00f6r\u00fcld\u00fc\u011f\u00fc saptanm\u0131\u015f..(rheumatology 2008,47(5) 578-583). Sklerodermal\u0131 hastalarda lipoprotein a,oksidize LDL, inflamasyon, vazospazm ve endotelyal disfonksiyon di\u011fer hastalara g\u00f6re daha fazla g\u00f6r\u00fclmektedir.<\/p>\n<p>\u0130mm\u00fcn aktivasyon ve vask\u00fclopati (endotelyal hiperaktivasyon) sonucu fibroblastik aktivasyon ve ESM yap\u0131m\u0131nda art\u0131\u015f ve ESM degradasyonunda azalma, skleroderma patogenezinin temel \u00f6zellikleri oldu\u011fu bilinmesine kar\u015f\u0131n<sup>,<\/sup> skleroderman\u0131n patogenezi tam olarak ayd\u0131nlat\u0131lamam\u0131\u015ft\u0131r.<\/p>\n<p>Vask\u00fclopati ile ili\u015fkili RF ve kapilleroskopik anormallikler skleroderman\u0131n \u00f6nc\u00fcl bulgular\u0131ndand\u0131r ve preklinik d\u00f6nemde bile saptanabilmektedir. Bu durum, vask\u00fclopatinin skleroderma patogenezindeki \u00f6nemini ortaya koymaktad\u0131r. Vask\u00fclopati, endotelyal hasar sonucu, inflamatuar h\u00fccrelerin adezyonuna ve migrasyonuna neden olmaktad\u0131r ve fibrointimal proliferasyon ve epizodik vazospazmlar ile karakterizedir. Bu proliferasyonun nedeni net olarak bilinmemektedir, ancak dokularda iskemi ile sonu\u00e7lanmaktad\u0131r.<\/p>\n<p>Sklerodermal\u0131 hastalar\u0131n \u00e7o\u011funda dijital arter stenozu ve okl\u00fczyonu g\u00f6r\u00fclmektedir.s\u0131kl\u0131kla 2. ve 5. palmar arterlerde, ulnar arter ve s\u00fcperficial palmar arkta g\u00f6r\u00fclmektedir. Sonu\u00e7 olarak digiltal iskemi,\u00fclser ve amputasyon sklerodermada g\u00f6r\u00fclen ve korkulan problemlerdir.<\/p>\n<p>Kardik tutulum s\u0131kt\u0131r (%30-50). Perikardit, ritm problemleri, myokardit, koroner arter hastal\u0131\u011f\u0131 \u015feklinde g\u00f6r\u00fclebilir.<\/p>\n<p><a href=\"http:\/\/caferabbasoglu.moldibi.com\/wp-content\/uploads\/2010\/08\/burger_3.jpg\"><img decoding=\"async\" class=\"wp-image-203 size-medium alignleft lazyload\" data-src=\"http:\/\/caferabbasoglu.moldibi.com\/wp-content\/uploads\/2010\/08\/burger_3-300x300.jpg\" alt=\"burger_3\" width=\"300\" height=\"300\" data-srcset=\"https:\/\/www.caferabbasoglu.com\/wp-content\/uploads\/2010\/08\/burger_3-300x300.jpg 300w, https:\/\/www.caferabbasoglu.com\/wp-content\/uploads\/2010\/08\/burger_3-150x150.jpg 150w, https:\/\/www.caferabbasoglu.com\/wp-content\/uploads\/2010\/08\/burger_3.jpg 1024w\" data-sizes=\"(max-width: 300px) 100vw, 300px\" src=\"data:image\/gif;base64,R0lGODlhAQABAAAAACH5BAEKAAEALAAAAAABAAEAAAICTAEAOw==\" style=\"--smush-placeholder-width: 300px; --smush-placeholder-aspect-ratio: 300\/300;\" \/><\/a><\/p>\n<p><strong>Periferik vask\u00fcler sistem tutulumunda tedavi:<\/strong> Vask\u00fcler sistem tutulumunda tedavideki temel hedefler RF s\u0131kl\u0131\u011f\u0131n\u0131 azaltmak, iskemik-\u00fclsere lezyonlar\u0131n iyile\u015fmesini h\u0131zland\u0131rmak ve progresif t\u0131kay\u0131c\u0131 damar hasar\u0131n\u0131 yava\u015flatmakt\u0131r. RF olan hastalar\u0131n so\u011fuk, stres ve sigara kullan\u0131m\u0131ndan ka\u00e7\u0131nmalar\u0131, ekstremitelerini s\u0131cak tutmalar\u0131 ve gerekmedik\u00e7e vazospastik ila\u00e7 kullanmamalar\u0131 gerekmektedir. RF tedavisinde dihidropiridin grubu kalsiyum kanal blokerleri (KKB), ACE inhibit\u00f6rleri ve anjiotensin resept\u00f6r blokerleri gibi vazodilatat\u00f6r ila\u00e7lar\u0131n yararl\u0131 olduklar\u0131 kan\u0131tlanm\u0131\u015ft\u0131r. KKB, bu ama\u00e7la en s\u0131k kullan\u0131lan vazodilatat\u00f6rlerdir. Ancak, yararlar\u0131 s\u0131n\u0131rl\u0131d\u0131r ve palpitasyon, hipotansiyon gibi yan etkileri bulunmaktad\u0131r. ACE inhibit\u00f6rlerinin etkinli\u011fini ara\u015ft\u0131ran yeterli \u00e7al\u0131\u015fma bulunmamaktad\u0131r. Yukar\u0131daki tedavi ajanlar\u0131 ile yak\u0131nmalar\u0131n kontrol alt\u0131na al\u0131namad\u0131\u011f\u0131 veya kontrendikasyonlar nedeniyle kullan\u0131lamad\u0131\u011f\u0131 durumlarda \u03b1-resept\u00f6r blokerleri, fosfodiesteraz tip 5 (PDE-5) inhibit\u00f6rleri, fluoksetin gibi seratonin geri al\u0131n\u0131m inhibit\u00f6rleri, topikal nitrogliserin veya intraven\u00f6z (iv) prostaglandin analoglar\u0131 kullan\u0131labilmektedir<\/p>\n<p>Ya\u015fam \u015fekli de\u011fi\u015fikli\u011fi \u00f6nerileri ve vazodilatat\u00f6r ila\u00e7lar\u0131n kullan\u0131m\u0131na kar\u015f\u0131n yak\u0131nmalar\u0131 devam eden hastalarda, sempatektomi di\u011fer bir tedavi se\u00e7ene\u011fidir. \u015eiddetli RF olanlarda, iskemik parmak \u00fclserleri \u00f6nemli bir sorundur. Dijital \u00fclserler nedeniyle ba\u015fvuran hastalarda ve klasik tedavi y\u00f6ntemlerine diren\u00e7li RF varl\u0131\u011f\u0131nda, klasik tedavi yakla\u015f\u0131mlar\u0131na ek olarak, iv iloprost kullan\u0131labilmektedir.<\/p>\n<p><a href=\"http:\/\/caferabbasoglu.moldibi.com\/wp-content\/uploads\/2010\/08\/burger_1.jpg\"><img decoding=\"async\" class=\"wp-image-202 size-medium alignleft lazyload\" data-src=\"http:\/\/caferabbasoglu.moldibi.com\/wp-content\/uploads\/2010\/08\/burger_1-300x225.jpg\" alt=\"burger_1\" width=\"300\" height=\"225\" data-srcset=\"https:\/\/www.caferabbasoglu.com\/wp-content\/uploads\/2010\/08\/burger_1-300x225.jpg 300w, https:\/\/www.caferabbasoglu.com\/wp-content\/uploads\/2010\/08\/burger_1.jpg 1024w\" data-sizes=\"(max-width: 300px) 100vw, 300px\" src=\"data:image\/gif;base64,R0lGODlhAQABAAAAACH5BAEKAAEALAAAAAABAAEAAAICTAEAOw==\" style=\"--smush-placeholder-width: 300px; --smush-placeholder-aspect-ratio: 300\/225;\" \/><\/a><\/p>\n<p><strong><em><a href=\"\/dusuk-enerjili-lazer-tedavisi\/\">G\u00fcn\u00fcm\u00fcz\u00fcn en iyi alternatif<\/a>\u00a0<a href=\"\/dusuk-enerjili-lazer-tedavisi\/\">Skleroderma tedavisi; Damar i\u00e7i d\u00fc\u015f\u00fck enerjili lazer tedavisidir.<\/a><\/em><\/strong><\/p>\n<h3><\/h3>\n<h3><\/h3>\n<h3><\/h3>\n<h3>Beh\u00e7et Hastal\u0131\u011f\u0131<\/h3>\n<p>(BH) ilk kez 1937 y\u0131l\u0131nda Ord. Prof. Dr. Hulusi Beh\u00e7et taraf\u0131ndan, tekrarlayan oral aft, genital \u00fclser ve hipopyonlu iridosiklit \u00fc\u00e7l\u00fc kompleksi olarak tan\u0131mlanm\u0131\u015ft\u0131r. Ge\u00e7en zaman i\u00e7inde, BH\u2019n\u0131n her boydan arter ve venleri tutabilen ve \u00f6zellikle ven\u00f6z tromboz e\u011filimiyle seyreden \u00f6zel bir sistemik vask\u00fclit oldu\u011fu anla\u015f\u0131lm\u0131\u015ft\u0131r. \u0130lk tan\u0131mlanan bulgulara ek olarak, deri, lokomotor system, merkezi sinir sistemi, solunum sistemi ve gastrointestinal sistem tutulu\u015fu da olabilece\u011fi g\u00f6sterilmi\u015ftir. Etyolojisi ve patogenezi tam olarak bilinmemekle birlikte, yayg\u0131n olarak kabul edilen hipotez; hastal\u0131\u011f\u0131n, genetik olarak duyarl\u0131 bireylerde \u00e7evresel fakt\u00f6rlerin (s\u0131kl\u0131kla enfeksiy\u00f6z ajanlar\u0131n) tetikledi\u011fi yo\u011fun immun-arac\u0131l\u0131 inflamatuar yan\u0131t sonucu ortaya \u00e7\u0131kt\u0131\u011f\u0131d\u0131r. Hastal\u0131\u011f\u0131n co\u011frafi da\u011f\u0131l\u0131m\u0131, tarihsel \u201c\u0130pek yolu\u201d \u00fczerindeki \u00fclkelerde yo\u011funla\u015fm\u0131\u015ft\u0131r. Hastal\u0131\u011f\u0131n, HLA-B51 ile ili\u015fkisi, \u00f6zellikle T\u00fcrk, Japon ve Akdeniz k\u00f6kenlilerde belirgindir, ancak, Bat\u0131 Avrupa\u2019da ili\u015fki zay\u0131ft\u0131r. Paterji testi i\u00e7in de, HLA-B51 i\u00e7in ge\u00e7erli olan ayn\u0131 b\u00f6lgesel farkl\u0131l\u0131klar ge\u00e7erlidir. Klinik bulgular\u0131n s\u0131kl\u0131\u011f\u0131 ve tipi de, b\u00f6lgesel, etnik farkl\u0131l\u0131klar g\u00f6sterir. T\u00fcrklerde gastrointestinal tutulum nadir bir bulgu iken, Japonya\u2019da olduk\u00e7a s\u0131kt\u0131r.<\/p>\n<p>En s\u0131k g\u00f6r\u00fclenler y\u00fczeyel tromboflebit ve derin ven trombozudur. Bunlar\u0131 vena kava inferior ve suprahepatik venlerin tutulumu izler. Tromboembolizm p\u0131ht\u0131n\u0131n damar duvar\u0131na yap\u0131\u015f\u0131k olmas\u0131 nedeniyle pek g\u00f6z\u00fckmez. En s\u0131k g\u00f6r\u00fclen arteriyel tutulum anevrizma olup bunu arteriyel t\u0131kan\u0131klar izler. Pulmoner arter anevrizmas\u0131 en \u00f6ld\u00fcr\u00fcc\u00fc komplikasyondur. Gen\u00e7 ve erkek Beh\u00e7et hastalar\u0131 damar tutulumuna daha e\u011filimlidirler. ishal hastal\u0131\u011f\u0131n en \u00f6nemli belirtileridir.<\/p>\n<p><img decoding=\"async\" style=\"--smush-placeholder-width: 300px; --smush-placeholder-aspect-ratio: 300\/169;float: left;\" data-src=\"\/wp-content\/uploads\/images\/flibit.jpg\" alt=\"\" src=\"data:image\/gif;base64,R0lGODlhAQABAAAAACH5BAEKAAEALAAAAAABAAEAAAICTAEAOw==\" class=\"lazyload\" \/> Semptomlar\u0131n tekrarlay\u0131c\u0131 olmas\u0131 ve hastal\u0131\u011f\u0131n zaman zaman alevlenme ve yat\u0131\u015fmalar g\u00f6stermesi tipiktir. BH, \u00f6zellikle gen\u00e7 erkek hastalarda daha \u015fiddetli seyreden ve ya\u015f ilerledik\u00e7e klinik aktivitenin yat\u0131\u015fma e\u011filimi g\u00f6sterdi\u011fi bir hastal\u0131kt\u0131r. BH&#8217;n\u0131n tedavisi genelde ampirik olup, inflamasyonu bask\u0131lamaya y\u00f6neliktir. BH tedavisi klinik bulgulara ve organ tutulu\u015funun ciddiyetine g\u00f6re yap\u0131l\u0131r.<\/p>\n<p><strong>Raynaud (Reyno) Fenomeni<\/strong> so\u011fukta \u00f6zellikle ellerde sararma, morarma ve k\u0131zarma ile karakterize bir lokal arteriel dola\u015f\u0131m bozuklu\u011fudur Bu bulgular Raynaud i\u00e7in karakteristiktir ve tan\u0131 i\u00e7in ba\u015fka bir tahlile gerek yoktur, fakat Doppler ile de teyid edilebilirse de pratikte pek kullan\u0131lmamaktad\u0131r.<\/p>\n<p>Bu bulgular tek ba\u015f\u0131na mevcutsa hastal\u0131k Raynaud &#8220;Fenomeni&#8221; ad\u0131n\u0131 al\u0131r Ba\u015fka bir hastal\u0131k da e\u015flik ediyorsa, buna da Raynaud &#8220;Sendromu&#8221; denir Sendromda \u00f6zellikle ba\u011f dokusu hastal\u0131klar\u0131 (romatizmal hastal\u0131klar) (skleroderma, SLE, ara sendrom, dermatomyozit-polimyozit,romatoid artrit) e\u015flik eder En s\u0131k (%90) e\u015flik eden hastal\u0131k skleroderma&#8217;d\u0131r<\/p>\n<p>Olay sadece fenomen ise korkacak bir\u015fey yoktur, tedavisi de yoktur; sadece so\u011fuktan korunmak gerekir Bu hastalar\u0131n \u0131l\u0131man iklimde ya\u015famas\u0131 gerekmektedir Sendrom ise (e\u015flik eden romatizmal hastal\u0131\u011f\u0131n) mutlaka tedavisinin yap\u0131lmas\u0131 gerekir<\/p>\n<p><img decoding=\"async\" style=\"--smush-placeholder-width: 300px; --smush-placeholder-aspect-ratio: 300\/169;width: 300px; height: 169px; float: left;\" data-src=\"\/wp-content\/uploads\/images\/flibit.jpg\" alt=\"\" src=\"data:image\/gif;base64,R0lGODlhAQABAAAAACH5BAEKAAEALAAAAAABAAEAAAICTAEAOw==\" class=\"lazyload\" \/> Sendrom olup olmad\u0131\u011f\u0131n\u0131 anlamak i\u00e7in de e\u015flik eden bir romatizmal hastal\u0131\u011f\u0131n olup olmad\u0131\u011f\u0131n\u0131n tahlillerle ara\u015ft\u0131r\u0131lmas\u0131 gerekmektedir Bu hastal\u0131kta so\u011fuktan ka\u00e7\u0131nmal\u0131, stresten m\u00fcmk\u00fcn oldu\u011funca uzak durmal\u0131d\u0131r, sigara kullanmamal\u0131d\u0131r<\/p>\n<p>Raynaud hastal\u0131\u011f\u0131, el ve ayak parmaklar\u0131, burun ve kulaklardaki damarlar\u0131 etkileyen bir hastal\u0131kt\u0131r. S\u00f6z\u00fc edilen b\u00f6lgelerdeki damarlarda ani daralmayla ortaya \u00e7\u0131kan ataklarla seyreder. Tek ba\u015f\u0131na bir hastal\u0131k olabilece\u011fi gibi, ba\u015fka hastal\u0131klara da e\u015flik edebilir, bu durumda \u201cRaynaud sendromu\u201d olarak adland\u0131r\u0131l\u0131r. Raynoud sendromu en s\u0131k ba\u011f doku hastal\u0131klar\u0131 ile birlikte olu\u015fur. Bu hastal\u0131klar, damar duvar\u0131nda kal\u0131nla\u015fmaya yol a\u00e7arak damarlar\u0131n \u00e7ok \u00e7abuk b\u00fcz\u00fclmesine neden olurlar. Atardamar bozukluklar\u0131, baz\u0131 tansiyon ve migren ila\u00e7lar\u0131 Raynaud sendromuna yol a\u00e7abilir.<\/p>\n<p>Toplumda g\u00f6r\u00fclme s\u0131kl\u0131\u011f\u0131 %5-10 aras\u0131ndad\u0131r ve en \u00e7ok 15-40 ya\u015f aras\u0131 kad\u0131nlarda ortaya \u00e7\u0131kar. So\u011fuk iklimli yerlerde g\u00f6r\u00fclme s\u0131kl\u0131\u011f\u0131 artar. Hastalarda ataklar \u00e7o\u011funlukla so\u011fu\u011fa maruz kalmakla bazen de stresle ortaya \u00e7\u0131kar. Genellikle el ve ayak parmaklar\u0131 etkilenir. Ancak bazen burun, dudaklar ve kulaklarda da belirtiler olu\u015fur.<\/p>\n<p>Normalde so\u011fukla kar\u015f\u0131la\u015f\u0131ld\u0131\u011f\u0131nda, v\u00fccut, \u0131s\u0131s\u0131n\u0131 koruyabilmek i\u00e7in \u0131s\u0131 kayb\u0131n\u0131 azaltmaya \u00e7al\u0131\u015f\u0131r. Bunun i\u00e7in y\u00fczeydeki damarlar b\u00fcz\u00fcl\u00fcr. Raynaud hastal\u0131\u011f\u0131 olanlarda bu yan\u0131t \u00e7ok ani ve \u015fiddetlidir. Ve sonu\u00e7 olarak v\u00fccudun u\u00e7 noktalar\u0131 olan el ve ayaklara kan ak\u0131\u015f\u0131 ciddi bi\u00e7imde azal\u0131r.<\/p>\n<p><img decoding=\"async\" style=\"--smush-placeholder-width: 300px; --smush-placeholder-aspect-ratio: 300\/169;float: left;\" data-src=\"\/wp-content\/uploads\/images\/flibit3.jpg\" alt=\"\" src=\"data:image\/gif;base64,R0lGODlhAQABAAAAACH5BAEKAAEALAAAAAABAAEAAAICTAEAOw==\" class=\"lazyload\" \/> Atak ba\u015flad\u0131\u011f\u0131nda el ve ayak parmaklar\u0131nda \u00f6nce beyazla\u015fma ard\u0131ndan morarma ve k\u0131zar\u0131kl\u0131k olu\u015fur. Ancak t\u00fcm hastalarda bu klasik s\u0131radaki renk de\u011fi\u015fikli\u011fi olu\u015fmayabilir. Beyazla\u015fma parmaklardaki k\u00fc\u00e7\u00fck atardamarlar\u0131n ani kapanmas\u0131na morarma damarlar kapand\u0131\u011f\u0131 i\u00e7in oksijenden zengin kan\u0131n dokulara ula\u015famamas\u0131na ba\u011fl\u0131d\u0131r. Bu s\u0131rada parmaklarda hissizle\u015fme ortaya \u00e7\u0131kabilir. Damarlar a\u00e7\u0131l\u0131p kan ak\u0131\u015f\u0131 d\u00fczelince renk k\u0131rm\u0131z\u0131ya d\u00f6ner. Atak ge\u00e7tikten sonra parmaklarda kar\u0131ncalanma hissi olabilir. Ataklar\u0131n uzunlu\u011fu birka\u00e7 dakikadan birka\u00e7 saate kadar de\u011fi\u015febilir. Tekrarlayan ataklarla doku beslenmesi bozuldu\u011fu i\u00e7in parmak u\u00e7lar\u0131nda ciltte \u00fclser ve gangrenler olu\u015fabilir.<\/p>\n<blockquote><p><a href=\"\/dusuk-enerjili-lazer-tedavisi\/\">G\u00fcn\u00fcm\u00fcz\u00fcn en iyi alternatif <\/a><a href=\"\/dusuk-enerjili-lazer-tedavisi\/\">Skleroderma tedavisi; Damar i\u00e7i d\u00fc\u015f\u00fck enerjili lazer tedavisidir.<\/a><\/p><\/blockquote>\n<p><a href=\"http:\/\/caferabbasoglu.moldibi.com\/wp-content\/uploads\/2010\/08\/lazer_1.jpg\"><img decoding=\"async\" class=\"size-medium wp-image-204 alignleft lazyload\" data-src=\"http:\/\/caferabbasoglu.moldibi.com\/wp-content\/uploads\/2010\/08\/lazer_1-228x300.jpg\" alt=\"lazer_1\" width=\"228\" height=\"300\" data-srcset=\"https:\/\/www.caferabbasoglu.com\/wp-content\/uploads\/2010\/08\/lazer_1-228x300.jpg 228w, https:\/\/www.caferabbasoglu.com\/wp-content\/uploads\/2010\/08\/lazer_1-778x1024.jpg 778w, https:\/\/www.caferabbasoglu.com\/wp-content\/uploads\/2010\/08\/lazer_1.jpg 1024w\" data-sizes=\"(max-width: 228px) 100vw, 228px\" src=\"data:image\/gif;base64,R0lGODlhAQABAAAAACH5BAEKAAEALAAAAAABAAEAAAICTAEAOw==\" style=\"--smush-placeholder-width: 228px; --smush-placeholder-aspect-ratio: 228\/300;\" \/><\/a><\/p>\n<p><strong>Takayasu arteriti:<\/strong> ilk kez 1908 y\u0131l\u0131nda Japon g\u00f6z hekimi Takayasu taraf\u0131ndan tan\u0131mlanan, aorta ve b\u00fcy\u00fck dallar\u0131n\u0131 tutan etiyolojisi tam olarak bilinmeyen kronik inflamatuar bir hastal\u0131kt\u0131r. Anatomo-patolojik olarak d\u00f6rt alt gruba ayr\u0131lm\u0131\u015ft\u0131r. Tip 1 aortik arkusu ve dallar\u0131n\u0131, Tip 2 aortik arkustan uzak olarak torako-abdominal aorta ve dallar\u0131n\u0131 (\u00f6zellikle renal ve mezenterik arteri); Tip 3 her iki b\u00f6lgeyi, Tip 4 ise di\u011fer tiplerden herhangi birisine ilave olarak pulmoner arteri tutar.<\/p>\n<p>Takayasu arteritinin klinik seyri, akut-alevli ve kronik d\u00f6nemde farkl\u0131l\u0131k g\u00f6sterir. Akut d\u00f6nemde sistemik belirtiler, kronik d\u00f6nemde ise sinsi seyredebilen iskemik-destr\u00fcktif bulgular \u00f6n plandad\u0131r. Bu bulgular, %85 oran\u0131nda stenoz, %2 oran\u0131nda dilatasyon; %13 olguda ise stenoz ve dilatasyonla birliktedir. Kronik d\u00f6neme, yayg\u0131n inflamatuar reaksiyon bulgular\u0131, arkus aorta sendromu, inen aort sendromu, renovaskuler hipertansiyon sendromu, kronik abdominal visseral iskemi, aorta-iliak sendrom, koroner arter sendromu, aort yetersizli\u011fi, pulmoner arter sendromu ve aort anevrizmas\u0131n\u0131n e\u015flik etti\u011fi alt klinik gruplar belirlenmi\u015ftir.<\/p>\n<p>Takayasu arteritinin tedavisi, medikal ve cerrahi olarak iki gruba ayr\u0131l\u0131r medikal tedavide steroid, siklofosfamid ve metotreksat \u00f6nerilen ila\u00e7lard\u0131r. Cerrahi tedavi ise medikal tedaviye cevap vermeyen ve semptomatik renovask\u00fcler hipertansiyon, serebral iskemi, aortik veya arteriyel anevrizma, aortik regurjitasyon ve koroner iskemi ile seyreden olgulara uygulanan koroner arter cerrahisi olarak planlan\u0131r. Klinik subgruplara g\u00f6re perk\u00fctan transl\u00fcminal anjioplasti dahil olmak \u00fczere kombine tedavi yakla\u015f\u0131mlar\u0131 da uygulanabilir.<\/p>\n<p>Takayasu arteritinin tedavisi, medikal ve cerrahi olarak iki gruba ayr\u0131l\u0131r. Medikal tedavide steroid, siklofosfamid ve metotreksat \u00f6nerilen ila\u00e7lard\u0131r. Cerrahi tedavi ise medikal tedaviye cevap vermeyen ve semptomatik renovask\u00fcler hipertansiyon, serebral iskemi, aortik veya arteriyel anevrizma, aortik regurjitasyon ve koroner iskemi ile seyreden olgulara uygulanan koroner arter cerrahisi olarak planlan\u0131r. Klinik subgruplara g\u00f6re perk\u00fctan transl\u00fcminal anjioplasti dahil olmak \u00fczere kombine tedavi yakla\u015f\u0131mlar\u0131 da uygulanabilir.<\/p>\n<p>Takayasu arteritinin tedavisi, medikal ve cerrahi olarak iki gruba ayr\u0131l\u0131r. Medikal tedavide steroid, siklofosfamid ve metotreksat \u00f6nerilen ila\u00e7lard\u0131r. Cerrahi tedavi ise medikal tedaviye cevap vermeyen ve semptomatik renovask\u00fcler hipertansiyon, serebral iskemi, aortik veya arteriyel anevrizma, aortik regurjitasyon ve koroner iskemi ile seyreden olgulara uygulanan koroner arter cerrahisi olarak planlan\u0131r. Klinik subgruplara g\u00f6re perk\u00fctan transl\u00fcminal anjioplasti dahil olmak \u00fczere kombine tedavi yakla\u015f\u0131mlar\u0131 da uygulanabilir.Tedavinin amac\u0131 atak s\u0131kl\u0131\u011f\u0131n\u0131 ve \u015fiddetini azaltmak dolay\u0131s\u0131 ile kal\u0131c\u0131 doku hasar\u0131n\u0131 engellemektir. Baz\u0131 basit \u00f6nlemlerle atak s\u0131kl\u0131\u011f\u0131 ve \u015fiddeti azalt\u0131labilir. En \u00f6nemli nokta so\u011fuktan korunmakt\u0131r. Yaln\u0131zca el ve ayaklar\u0131n de\u011fil t\u00fcm v\u00fccudun so\u011fuktan korunmas\u0131 gereklidir. V\u00fccut \u0131s\u0131s\u0131n\u0131n b\u00fcy\u00fck oranda kafa derisinden de kaybedildi\u011fi i\u00e7in eldiven ve \u00e7oraplar\u0131n yan\u0131 s\u0131ra \u015fapka kullan\u0131m\u0131 da \u00f6nemlidir.alar\u0131n sigaradan uzak durmas\u0131 gereklidir. \u00c7\u00fcnk\u00fc nikotin ataklar\u0131 tetikleyebilir. Stres y\u00f6netimi ile ilgili profesyonel yard\u0131m al\u0131nmas\u0131 faydal\u0131 olabilir.lsiyum kanal blokerleridir. Damar duvar\u0131ndaki d\u00fcz kaslar\u0131n gev\u015femesini sa\u011flayarak damarlar\u0131 geni\u015fletirler. Damarlarda daralmaya yol a\u00e7an norepinefrin hormonunun aktivitesine z\u0131t y\u00f6nde etki g\u00f6steren alfa blokerler tedavide kullan\u0131lan di\u011fer bir ila\u00e7 grubudur. Di\u011fer dama geni\u015fletici ila\u00e7 gruplar\u0131 da tedavide denenebilmektedir. Parmak u\u00e7lar\u0131nda yaralar\u0131n olu\u015ftu\u011fu ciddi hastalarda damarlarda daralmay\u0131 sa\u011flayan sempatik sinir aktivitesini engellemeye y\u00f6nelik cerrahi y\u00f6ntemler uygulanabilir.(sempatik sinir blokaj\u0131 ya da sempatektomi) Primer raynaud hastal\u0131\u011f\u0131 tedaviye daha iyi yan\u0131t verirken Raynaud sendromunun tedavisi daha g\u00fc\u00e7t\u00fcr.<\/p>\n<p>\u0130skemi, aorta-iliak sendrom, koroner arter sendromu, aort yetersizli\u011fi, pulmoner arter sendromu ve aort anevrizmas\u0131n\u0131n e\u015flik etti\u011fi alt klinik gruplar belirlenmi\u015ftir.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Periferik damar hastal\u0131\u011f\u0131 nedir? Periferik damar hastal\u0131\u011f\u0131, kalp ve beyin d\u0131\u015f\u0131ndaki t\u00fcm kan damarlar\u0131n\u0131n(atardamar) hastal\u0131klar\u0131n\u0131 ifade eder. En s\u0131k neden ateroskleroz yani damar sertli\u011fidir. Genelde 50 ya\u015f \u00fczerindeki erkeklerin %5-15 inde \u015fikayete yol a\u00e7mayan damar hastal\u0131\u011f\u0131 bulunur. Bu sessiz damar hastal\u0131\u011f\u0131 s\u0131kl\u0131kla kalpte koroner damar hastal\u0131\u011f\u0131 ve \u015fah damar hastal\u0131\u011f\u0131na ba\u011fl\u0131 ciddi sorunlar nedeniyle risk [&hellip;]<\/p>\n","protected":false},"author":5,"featured_media":0,"parent":0,"menu_order":16,"comment_status":"closed","ping_status":"closed","template":"","meta":{"two_page_speed":[],"footnotes":""},"class_list":["post-28","page","type-page","status-publish","hentry"],"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":"<!-- This site is optimized with the Yoast SEO plugin v24.9 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Periferik damar hastal\u0131\u011f\u0131 - Opr.Dr.Cafer Abbaso\u011flu<\/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.caferabbasoglu.com\/periferik-damar-hastaligi\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Periferik damar hastal\u0131\u011f\u0131 - 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