Tek taraflı karotis endarterektomi cerrahisi yapılan hastalarda preoperatif risk faktörleri ve operasyon sonuçlarının araştırılması

Amaç: Bu çalışmada, tek taraflı karotis endarterektomi operasyonu yapılan hastalarda preoperatif risk faktörleri ile operasyon sonuçları arasındaki ilişki literatür sonuçları eşliğinde karşılaştırıldı. Yöntem: Çalışmaya İstanbul Dr. Siyami Ersek Göğüs Kalp ve Damar Cerrahisi Eğitim ve Araştırma Hastanesinde 2007- 2009 yılları arasında tek taraflı karotis endarterektomi operasyonu yapılan 223 hasta dâhil edildi. Hastaların yaş ortalaması 68.13 ± 5,25 ve %29,5’ i (n=66) kadın, %70,5’i (n=157) erkek idi. Hastaların %43,5’ünde (n=97) hipertansiyon, %61,2’sinde (n=136) ise diabetes mellitus mevcuttu. Sigara kullanımı hikâyesi %76,1 (n=170) hastada mevcut iken, hastaların %29,3’sinde (n=65) hiperlipidemi mevcut idi. Hastaların %5,4’ünde (n=12) operasyon öncesinde geçirilmiş stroke öyküsü bulunurken , %10,8’inde (n=24) uzamış nörolojik defisit hikâyesi ve %6,8’inde (n=15) geçirilmiş geçici iskemik atak bulunmaktaydı. Bulgular: Postoperatif dönemde karotis endarterektomi yapılan hastalar 3 ana başlık altında takip edildi. Bunlar; erken nörolojik komplikasyonlar, erken kardiyak aritmiler ve diğer komplikasyonlardır ( multiple organ yetmezliği, respiratuar problemler ve hipertansiyon). Erken nörolojik komplikasyonlar yönünden hastalar stroke geçirme, geçici iskemik atak (TIA) ve uzamış reversible iskemik hastalık (URID) atağı geçirme sıklığı takip edildi. Bu grupta postoperatif dönemde stroke geçiren hastaların oranı %2,2 (n=5) iken, TIA ya da URID geçiren hastaların oranı %4,1 (n=9) olarak bulundu. Sonuç: Karotis arter endarterektomi sonrası mortalite ve morbiditenin azaltılması preoperatif risklerin iyi bir şekilde analiz edilmesi ve iyi bir preoperatif hazırlık evresi ile mümkündür. Karotis arter endarterektomi cerrahisindeki risklerin ve komplikasyonların azaltılmasında ise preoperatif, intraoperatif ve postoperatif olarak kardiyovasküler cerrahlara büyük bir görev ve sorumluluk düşmektedir.

A study of preoperative risk factors and postoperative results in patients who have undergone unilateral carotid endarterectomy

Objective: In this study, the relationship between preoperative risk factors and operative outcomes in patientsundergoing unilateral carotid endarterectomy was compared in the light of literature reviews.Method: 223 patients who underwent unilateral carotid endarterectomy in Dr.Siyami Ersek Breast Heart and VascularSurgery Training and Research Hospital in the years between 2007 and 2009 were included in the study. The mean ageof the patients was 68.13 ± 5,25 and 29,5% of them were women (n=66) while 70,5% of them were men (n=157).43.5% of patients (n=97) had hypertension and 61.2% of patients (n = 136) had diabetes mellitus. 76.1% of patients (n =170) had a history of smoking while 29.3% of patients (n = 65) had hyperlipidemia. In 5.4% (n = 12) of patientsexperienced perioperative stroke, 10.8% (n = 24) of patients had a history of prolonged neurologic disease and 6.8% (n= 15) of patients had experienced transient ischemic attacks.Results: Patients undergoing carotid endarterectomy in the postoperative period were followed under 3 main headings:early neurologic complications, early cardiac arrhythmias and other complications (multiple organ failure, respiratoryproblems and hypertension). Early neurologic complications in patients were followed by the frequency of stroke,transient ischemic attack (TIA), and prolonged reversible ischemic neurological disease (PRIND). In this group, the rateof stroke patients in the postoperative period was 2.2% (n = 5) while the rate of TIA or PRIND patients was 4.1% (n =9).Conclusions: Reducing mortality and morbidity after carotid artery endarterectomy is possible with a good analysis ofpreoperative risks and a good preoperative preparation. Cardiovascular surgeons have a great role and responsibility toreduce the risk and complications of carotid artery endarterectomy in preoperative, intraoperative and postoperativeperiods.

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