Cemalettin AYDIN, Ünal AYDIN, Halil BAŞEL, Hasan EKİM, Dolunay ODABAŞI, Ayşenur DOSTBİL

Management of popliteal artery injuries

Amaç. Kardiyovasküler cerrahide periferik vasküler yaralanmalar büyük bir sorun oluşturur. Popliteal arter yaralanmaları ise tüm ekstremite arter yaralanmalarının %5-19’unu oluşturur. Cerrahi tekniklerdeki ilerlemelere rağmen ampütasyon oranı halen yüksektir. Çalışmamızın amacı popliteal arter yaralanmalarıyla ilgili deneyimlerimizi gözden geçirmektir. Yöntem. Ana Bilim Dalımızda Mayıs 1999 ile Mart 2009 tarihleri arasında popliteal arter yaralanması nedeniyle opere edilen 41 olgu retrospektif olarak incelenmiştir. Yaralanma nedeni 11 olguda kesici delici alet, 23 olguda ateşli silah ve 7 olguda künt travma idi. Mümkünse primer vasküler onarım tercih edildi. Aksi halde greft interpozisyonu uygulandı. Bulgular. Çalışma grubumuzun 33’ü erkek ve 8’i kadın olup, yaşları 18 ile 56 arasında değişmekte ve ortalama yaşta 28,1±6,4 idi. Olguların büyük çoğunluğu penetre travmaya maruz kalmıştı. Arteriyal yaralanması olan 21 olguda uç uca anastomoz, 13 olguda safen ven greftiyle interpozisyon, 4 olguda lateral arteriorafi, 2 olguda ringli PTFE greft ile interpozisyon ve 1 olguda yama plasti uygulandı. Aynı zamanda popliteal ven yaralanması da olan 19 olgunun, 5’inde uç uca anastomoz, 7’sinde lateral venorafi, 6’sında safen ven greft interpozisyonu ve 1’inde PTFE greft interpozisyonu uygulanarak venöz onarım da yapıldı. Sonuç. Ektremitenin kurtarılmasında arteriyal onarımın zaman geçirilmeden yapılması önemli bir faktör olmakla birlikte, popliteal arter yaralanmalarında tam motor kayıp olan olgularda bile sabit benekli cilt görünümü yoksa iskemi süresine bakılmaksızın vasküler onarım düşünülmelidir.

Popliteal arter yaralanmalarının tedavisi

Aim. Peripheral vascular injuries constitute a major problem in cardiovascular surgery. Popliteal artery injuries account for between 5 and 19% of extremity arterial injuries. Despite improvements in surgical techniques of peripheral vascular injuries, a high amputation risk is still seen. The aim of this study was to review our experience in the management of popliteal artery injuries. Method. We studied retrospectively a number of 41 patients with popliteal artery injuries in our department between May 1999 and March 2009. Injuries were related to stab wound in 11 patients, gunshots in 23, and blunt trauma in 7. Primary vascular repair was preferred where possible; if not possible the interposition graft was used. Result. The study group consisted of 33 males and 8 females, ranging in age from 18 years to 56 years with a mean age of 28.1±6.4 years. Penetrating trauma was the cause of a high proportion of cases. Arterial repair techniques performed were end-to-end anastomosis in 21 popliteal arterial injuries, saphenous vein graft interposition in 13, lateral arteriorrhaphy in 4, ringed PTFE graft interposition in 2, and patch plasty in 1. There were 19 patients with associated popliteal vein injury, of which 5 cases had end-to-end anastomosis, 7 had lateral venorrhaphy, 6 had vein graft interposition, and 1 had PTFE graft interposition. Conclusion. Although prompt arterial repair appears to be a critical factor that improves the extremity salvage rate, even in popliteal arterial injury with complete motor deficit without mottling, vascular repair should be considered regardless of ischemic time.

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