Femoro-femoral ekstra-anatomik bypass: 18 olgunun analizi

Amaç: Tek taraflı aorto-iliak tıkanıklıklara yaklaşımda, özellikle yüksek riskli yaşlı hastalarda, klasik vasküler bypass prosedürlerinin uygulanamadığı durumlarda, anatomik lokalizasyondaki vasküler kaynağın uygunsuzluğu ya da bu yaklaşımın yaratacağı risk varlığında ekstra-anatomik femoro-femoral bypass alternatif bir cerrahi yöntem olarak seçilebilir. Gereç ve yöntem: Ocak 1997-Nisan 2002 yılları arasında Alsancak Devlet Hastanesi Kalp ve Damar Cerrahisi Kliniğinde alt ekstremite revaskülarizasyonu amacıyla 18 hastaya femoro-femoral (F-F) bypass greftleme gerçekleştirildi. Yaş ortalaması 64 olup tüm olgular erkekti. Hastaların hepsi yüksek cerrahi risk taşımaktaydı. Dört olguda F-F bypass uygulamasına ek olarak femoro-distal bypass prosedürü de uygulandı. Hastaların hepsi epidural anestezi ile ameliyat edildi. Tüm olgularda 8 mm'lik ringli polytetrafluoroethylene greft materyali kullanıldı. Bulgular: Olgular 9 ay ile 5 yıl (ortalama 3.1 yıl) süreyle izlendi. Olgular ortalama 6.8 gün sonra taburcu edildi. Erken postoperatif dönemde hiçbir olguda revizyon girişimi gerekli olmadı. Grade III prostat kanserli bir olguda vasküler girişimin 3. ayında uygulanan radyoterapi sonrası greft üzerinde gelişen deri nekrozu ve greftin cilt dışına çıkması nedeniyle, patent olmasına karşın reoperasyona alınarak grefti çıkarıldı. Bir olgu 11. ayda 2. kez geçirdiği yaygın anterolateral miyokard enfarktüsü nedeniyle eksutus oldu. Diğer 16 olgunun izlemleri süresince greftlerinin patent olduğu tespit edildi. Sonuç: Bu dizideki düşük mortalite ve morbidite değerleri, özellikle yüksek riskli olgularda oluşan tek taraflı aorto-iliak tikayıcı hastalıkta titiz bir anestezi ve cerrahi uygulama ile yapılan ekstra-anatomik F-F bypassın iyi bir alternatif yaklaşım, olduğunu göstermektedir.

Anahtar Kelimeler:

Arteriyel tıkayıcı hastalıklar, Greft oklüzyonu, vasküler, Femoral arter, Kan damarı protezleri, Aort hastalıkları

Our femoro-femoral extraanatomic bypass procedures

Objective: Extra-anatomic femoro-femoral bypass is an alternative method for unilateral aorto-iliac occlusions, especially in elderly patients with high risk and that classical vasculary bypass can't be performed or inconvenient vascular origin in anatomic localization or the risk due to this approach. Material and method: At Alsancak State Hospital, Cardiovascular surgery clinic, femoro-femoral (F-F) bypass grafting was performed in 18 patients for lower extremity revascularization between 1997 January and 2002 April. All cases were men with a mean age of 64 years. All patients had high surgical risk. Additional to F-F bypass in 4 patients also femoro-distal bypass was performed. All were operated with epidural anesthesia. In all cases 8 mm. ringed polytetrafluoroethylene graft Femoro-femoral ekstra-anatomik bypass material was used. Results: Patients were followed for 9 months to 5 years (mean 3.1 years). Mean hospital stay was 6.8 days. No revision procedure was necessary in early postoperative period. In a patient with grade III prostate cancer, radiotherapy was performed at the third month of vascular procedure and skin necrosis was developed on the graft and graft was removed with reoperation although it was patent. One patient was died due to second anterolateral myocardial infarctus at 11th month. Other 16 cases had patent grafts during follow-up. Conclusion: Low morbidity and mortality in this series, showedthatextra-anatomic F-F bypass procedure is a good alternative in unilateral aorto-iliac occlusive disease in patients with high risk.

Keywords:

Arterial Occlusive Diseases, Graft Occlusion, Vascular, Femoral Artery, Blood Vessel Prosthesis, Aortic Diseases,

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