Hikmet Selçuk GEDİK, Kemal KORKMAZ, Hayati DENİZ

Periferik arter bypass cerrahisinde greft seçimi ve bu seçimin greft açıklığına katkısı

Amaç: Bu çalışmada, periferik bypass cerrahisinde seçilen greftlerle ilgili klinik sonuçlarımızı sunmayı amaçladık. Gereç ve yöntem: Çalışmaya Ağustos 2007- Ocak 2009 tarihleri arasında Kalp ve Damar Cerrahisi kliniğinde periferik arter bypass cerrahisi uygulanan 68 hasta alınmıştır. Hastaların % 81’i erkek (n=55), %19’u kadındı (n=13) ve yaşları ortalama 57±10 idi. Hastalardan 16 tanesine aorto-bifemoral bypass, 36 hastaya femoro-popliteal bypass, 7’sine femoro-femoral kros over bypass, 4’üne iliofemoro- popliteal bypass, 4’üne axillo-bifemoral bypass ve 1 hastaya aorto- femoral bypass yapıldı. Aterosklerotik alana ve yapılacak cerrahi tekniğe göre Safen ven, ringli politetrafloroetilen (PTFE) ve Dacron, ringsiz PTFE ve Dacron veya kompozit greft kullanıldı ve bir yıllık açıklık oranları karşılaştırıldı. Bulgular: Hastalar bir yıl boyunca klinik olarak ve doppler ultrasonografi ile değerlendirmeye alındı. Ringli PTFE ile axillo-femoral yapılan 1 hastada 3. ayda, femoro-popliteal bypass yapılan 1 hastada 6. ayda total oklüzyon görüldü. Ringli PTFE femoro-femorol cross over yapılan bir vakada, ringsiz PTFE kullanılan dört femoro-popliteal vakasında ve otojen safenven kullanılan bir femoropopliteal vakasında asemptomatik %20-50 stenoza yol açan daralmalar tespit edildi. Hastaların 31’ine diz üstü, 37’sine de diz ve diz altı bölgelere cerrahi girişim uygulandı. Diz üstü bölgede kullanılan sentetik greftler arasında ve sentetik greftlerle safen ven greftleri arasında açıklık oranı bakımından önemli bir fark görülmezken, diz ve diz altı bölgesinde safen ven greftinin diğer sentetik greftlere gör daha üstün olduğu görülmüştür.

Graft selection for the peripheral vascular by-pass surgery and its contribution to patency

Objectives: In this study, we aimed to present clinical results associated with graft selection in peripheral bypass surgery. Materials and methods: Between August 2007 and January 2009, 68 patients who underwent peripheral arterial bypass surgery in our cardiovascular department were included in this study. Eighty-one percent (n=55) of them were male and 19 % (n=13) of them were female, patients’ mean age was 57±10 years. We have performed aorto-bifemoral bypass to 16 patients, femoro-politeal bypass to 36 patients, femoro-femoral cross over bypass to 7 patients, ilio-femoro-politeal bypass to 4 patients, aorto- femoral bypass to1 patient and axillo-bifemoral bypass in 4 patients, respectively. Saphenous vein, stented or stentless polytetrafluoroethylene (PTFE) and Dacron grafts and composite grafts were used according to atherosclerotic area and surgical technique. Results: Above knee bypass procedure was performed in 31 patients and the remaining 7 patients required knee level or below knee bypass procedure. Comparing synthetic grafts and composit vein grafts above knee and below knee regions, revealed that there was no difference in above knee region, but in the below knee region autogenous saphenous vein graft was superior to synthetic grafts in patency rate. Conclusions: In this study, according to patency rate, there was no difference in above knee bypass procedures; but in the below knee bypass procedures, autogenous saphenous vein graft was found superior to synthetic grafts.

PDF

___

1. Fowkes FG, Murray GD, Butcher I,et al.Ankle brachial index combined with Framingham Risk Score to predict cardiovasculer events and mortality: a meta-analysis.Ankle Brachial Index Collaboration. JAMA 2008;300(2):197-208.
2. Haimovici H: Vascular Surgey, Principles and Technics.Montefiore Hospital and Medical Center Brox. New York,1996; 605-31.
3. Kunlin J: Le traitment de l’arterite obliterante par la greffeveniuse. Arch Mal Coeur 1949; 42(4):371-4.
4. Wesolewski Salvage L.R, et al: Rationale for the Development of the Gossamer small arterial prosthesis, Arch Surg1968; 97(7): 864-6.
5. Falco E, Celoria G, Nardini A: Femoro-popliteal bypass with reversed saphenous vein. Minerva-Chir 1999;50(8):883-8.
6. Macamley E.M, Samy AK, Cooper GG: Infrageniculate vein bypass greft for critical limb ischaemia. JR Coll Surg Edinb1996; 41(1):391-4.
7. Plecha EJ, Freischlag J.A, Seabrook GR. Femoropopliteal bypass revisted an analysis of 138 cases. Cardiovasc Surg 1996;12(2): 195–9.
8. Mc Collum C, kenchington G; PTFE or HUV for femoropopliteal bypass: a multicentre trial. Eur J Vasc Surgery 1991;5(4):435–43.
9. Samuel E.Wilson, Frank J. Robert W. Hoson II, et al: Vascular surgery principles and practice New York 1999.
10. Edwards WS. Progress in synthetic grafts development: An improved crimped graft of teflon surg. Surgery 1959;45(2):298-309.
11. Edwards WS: Arterial grafts of teflon in sawyer PN; Kaplitt( eds ):Vascular grafts. New York. Appleton, Crofts 1999.
12. Daenens K, Schepers S, Fourneau I, Houthoofd S, Nevelsteen A. Heparin-bonded ePTFE grafts compared with vein grafts in femoropopliteal and femorocrural bypasses: 1- and 2-year results. J Vasc Surg 2009; 49(5):1210-6.
13. Hirsch AT, Haskal ZJ, Hertzer NR, Bakal CW, Creager MA, Halperin JL, ACC/AHA Guidelines for the management of patients with peripheral arterial disease. Vasc Interv Radiol 2006; 17(9):1383-97.
14. Twine CP, McLain AD. Graft type for femoro-popliteal bypass surgery. Cohrane Database Sys Rev.2010 May 12 ;( 5):CD001487.
15. Conte MS. Challenges of distal bypass surgery in patients with diabetes: patient selection, techniques, and outcomes. J Vasc Surg 2010; 52(3):96-103.