CÜNEYT ERİŞ, Arif GÜCÜ, Sinan DEMİRTAŞ, Gündüz YÜMÜN, ŞENOL YAVUZ

Ciddi karotis bifürkasyon lezyonunda endarterektomi ve safen ven ile Y' patchplasti tekniği

Arterioskleroz nedeni tam olarak bilinmemekle birlikte en sık koroner ve karotis arterleri etkilemekte, akım özelliklerinden dolayı ise en sık damar ostiumları ve bifurkasyon düzeylerinde görülmektedir. Arteriyel bifurkasyon bölgesindeki lezyonlar tedavi eden hekim için problemdir, çünkü hem cerrahi hem de invazif girişimler esnasında ayrı bir tecrübe ve daha uzun işlem süresi gerektirir. Karotid arter cerrahisinde patchplasti uygulanmasının perioperatif ve geç dönem restenozları ve dolayısı ile de tek taraflı inme riskini azalttığı düşünülmektedir. Yama materyali olarak sentetik (polytetrafluoroethylene [PTFE], Dacron) ve otolog (Safen ven, juguler ven) materyaller kullanılmaktadır. Biz burada; karotis bifürkasyon bölgesine endarterektomi ve Y şeklinde safen patch ile anjiyoplasti yaptığımız bir vakayı sunduk. Literatürde yaptığımız araş- tırmalar neticesinde, bu tarz safen venden hazırlanmış Y şeklinde patch ile yapılmış karotis patchplastiye rastlamadık. Sadece sentetik materyalden hazırlanmış Yşeklinde patch, bir olguda karotis arterde kullanılmıştır. Sunduğumuz teknik literatürde ilk olması nedeniyle orijinal olmakla beraber hem hazırlaması ve uygulaması kolay hem de sonuç olarak yüz güldürücüdür.

Endarterectomy and saphenous vein Y patchplasty technique for severe carotid artery bifurcation lesion

Arteriosclerosis, is mostly affect coronary and carotid arteries especially the ostium and bifurcation due to the nature of the flow. Arterial bifurcation lesions cause dilemma for the treating physician during both surgical and invasive procedures because they require a higher clinical experience and longer processing time. In carotid artery surgery, it is accepted that patchplasty prevents perioperative and postoperative restenosis, and as a result of this, it reduces the incidence of ipsilateral stroke. In the present time synthetic patch materials (PTFE, Dacron) and autologous patch materials (saphenous and jugular veins) are used. We report a case of carotid endarterectomy and Y shaped saphenous patchplasty to the carotid bifurcation. According to our research in the literature, we didnt find any case with Y shaped saphenous vein patch. There was only one Y shaped carotid patchplasty case by using PTFE material. Our original technic is advantageous in terms of easy preparation and application as well as its successful outcome.

PDF

___

1. Blaser T, Hofmann K, Buerger T, et al. Risk of stroke, transient ischemic attack, and vessel occlusion before endarterectomy in patients with symptomatic severe carotid stenosis. Stroke 2002;33:1057-1062.
2. Maekinnon AD, Jerrard-Dunne P, Sitzer M, et al. Rates and determinants of site-specific progression of carotid artery intima-media thickness: the carotid atherosclerosis progression study. Stroke 2004;35:2150-2154.
3. Mayo SW, Eldrup-Jorgensen J, Lucas FL, et al. Carotid endarterectomy after NASCET and ACAS: a statewide study. North American Symptomatic Carotid Endarterectomy Trial. Asymptomatic Carotid Artery Stenosis Study. J Vasc Surg 1998;27:1017-1022.
4. Bayazıt M. Karotis endarterektomi: teknik ayrıntılar. Türkiye Klinikleri J Surg Med Sci 2005;1:26-36.
5. Üstünsoy H, Kazas H, Celkan A, Kayıran C. Strok sonrası karotis endarterektomi zamanlaması. T Klin Kalp-Damar Cerrahisi 2002;3:57-60.
6. Bond R, Rerkasem K, AbuRahma AF, Rothwell PM. Systematic review of randomized controlled trials of patch angioplasty versus primary closure and different types of patch materials during carotid endarterectomy. J Vasc Surg 2004;40:1126-1135.
7. Meerwaldt R, Lansink KWW, Blomme AM, Fritschy WM. Prospective randomised study of carotid endarterectomy with FluoropassivTM thin wall carotid patch versus venous patch. Eur J Vasc Endovasc Surg 2008;36:45-52.
8. Barnett HJ, Taylor DW, Eliasziw M, et al. Benefit of carotid endarterectomy in patients with symptomatic moderate or severe stenosis. N Engl J Med 1998;339:1415-1425.
9. Hobson RW II, Weiss DG, Fields WS, et al. Efficacy of carotid endarterectomy for asymptomatic carotid stenosis. The Veterans Affairs Cooperative Study Group. N Engl J Med 1993;328:221-227.
10. European Carotid Surgery Trial Investigators. Randomised trial of endarterectomy for recently symptomatic carotid stenosis: final results of the MRC European Carotid Surgery Trial (ECST). Lancet 1998;351:1379-1387.
11. Executive Committee for the Asymptomatic Carotid Atherosclerosis Study. Endarterectomy for asymptomatic carotid artery stenosis. JAMA 1995;273:1421-1428.
12. North American Symptomatic Carotid Endarterectomy Trial Collaborators. Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. N Engl J Med 1991;325:445-453.
13. Kalko Y, Aydın U, Bayrak Y, et al. Carotid endarterectomy under local anesthesia: single institutional experience. Interact Cardiovasc Thorac Surg 2006;5:570-573.
14. Fode NC, Sundt TM Jr, Robertson JT, et al. Multicenter retrospective review of results and complications of carotid endarterectomy in 1981. Stroke 1986;17:370-376.
15. Verhoeven BAN, Pasterkamp G, De Vries JPPM, et al. Closure of arteriotomy after carotid endarterectomy: patch type is related to intraoperative microemboli and restenosis rate. J Vasc Surg 2005;42:1082-1088.
16. Gonzalez-Fajardo JA, Perez JL, Mateo AM. Saphenous vein patch versus polytetrafluoroethylene patch after carotid endarterectomy. J Cardiovasc Surg (Torino) 1994;35:523- 528.
17. Moore WS, Kempczinski RF, Nelson JJ, Toole JF. Recurrent carotid stenosis: results of the asymptomatic carotid atherosclerosis study. Stroke 1998;29:2018-2025.
18. AbuRahma AF, Choueiri MA. Cranial and cervical nerve injuries after repeat carotid endarterectomy. J Vasc Surg 2000;32:649-654.
19. Gasparis AP, Ricotta L, Cuadra SA, et al. High-risk carotid endarterectomy: fact or fiction. J Vasc Surg 2003;37:40-46.
20. Hans SS, Shah S, Hans B. Carotid endarterectomy for high plaques. Am J Surg 1989;157:431-434.
21. Kiriş İ, Gülmen Ş,Doğan E, Okutan H. A case in whom Yshaped patchplasty was done and surgical trauma to a typically placed nervus hypoglossus was avoided during carotid endarterectomy. Pamukkale Medical Journal 2009;2:31-34.
22. McIntyre KE Jr, Ely RL, Malone JM, Bernhard VM, Goldstone J. External carotid artery reconstruction: its role in the treatment of cerebral ischemia. Am J Surg 1985;150:58-64.
23. Boontje AH. External carotid artery revascularization: indications, operative techniques and results. J Cardiovasc Surg 1992;33:315-318.