Bayram YILMAZKAYA, Sami GÜRKAHRAMAN, Alaa HİJAZİ, Murat ERCİŞLİ, Deniz DEMİR, Aytekin YEŞİLAY

Kombine karotid endarterektomi ve koroner baypas cerrahisinde deneyimlerimiz

Giriş: Karotid arter stenozu ve koroner arter hastalığı birlikteliğinde kombine şekilde tek anestezi seansında karotid endarterektomi ve koroner baypas yaptığımız hastaların sonuçlarını incelemek ve deneyimlerimizi sunmaktırHastalar ve Yöntem: Kombine şekilde karotid endarterektomi ve koroner baypas yapılan 38 hasta retrospektif olarak incelendi. Digital substraksiyon anjiyografi veya bilgisayarlı tomografik anjiografi % 70 ve üzerindeki darlıklar ameliyat yapıldı. Yaş ortalaması 69 ± 8,5 yıldı. Hastalardan vertigo 21 (% 55,3), senkop 10 (% 26,3), karotid üfürüm 16 (% 42.1), geçici iskemik atak öyküsü 12 (% 31,6) hastada vardı. On yedi (% 44.7) hastada herhangi bir semptom yoktu. Önce karotid endarterektomi sonra sentetik yamayla anjiyoplasti yapıldı. Bütün hastalarda intraluminal şant kullanıldı. Daha sonra kardiyopulmoner baypas altında koroner baypas yapıldı. Proksimal anastomozlar, kros klemp eşliğinde yapıldı. Bulgular: Bir hasta düşük debi nedeni ile hastanede kaybedildi (% 2,6). Hastaların yoğun bakımda ventilasyon süresü 7 ± 1,5 saat, kalış süresi 16,9 ± 7,4 saat, hastanede kalış süresi 6,6 ± 2,9 gündü. Postoperatif dönemde hiçbir hastada serebrovasküler olay olmadı. Sonuç: Anlamlı karotid arter stenozu ve koroner arter hastalığı olan hastalarda, kombine şekilde aynı seansta karotid endarterektomi ve koroner baypas intraluminal şant kullanılarak düşük morbidite ve mortalite oranlarıyla güvenle yapılabilir.

Anahtar Kelimeler:

Endarterektomi, Karotis Arter, Koroner Bypass

Surgical experiences in concomitant carotid endarterectomy and coronary artery bypass surgery

Introduction: We aimed to investigate the results of concomitant carotid endarterectomy and coronary artery bypass grafting operations in patients with coronary artery disease and carotid artery stenosis. Patients and Methods: 38 consecutive patients who were operated on concomitantly were included in this study. Digital substraction angiography or computerized tomoghraphic angiography was performed for the patients and stenosis 70 % or higher were accepted for operation. The mean age was 69 ± 8,5. There was a history of vertigo in 21 (55.3 %), syncope in 10 (26.3 %), carotid souffle in 16 (42.1 %), and transient ischemic attack in 12 (31.6 %) patients. 17 (44,7 %) patients were asymptomatic. Carotid endarterectomy was performed first and patch angioplasty was performed with synthetic patch. Then, intraluminal shunt was used for all patients. Coronary artery bypass grafting was performed under cardiopulmonary bypass. Proximal anastomosis were fashioned under single cross clamp. Results: Hospital deaths occured in one patient due to low cardiac output. The mean length of intensive care unit stay was 16.9 ± 7.4 hours, ventilatıon period 7 ± 1,5 hours and mean length of hospital stay was 6.6 ± 2.9 days. Conclusion: Concomitant carotid endarterectomy and coronary artery bypass grafting operations can be safely performed with using intraluminal shunt in patients with significant carotid artery stenosis and coronary artery disease.

Keywords:

Endarterctomy, carotid Artery, Coronery Bypass,

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ISSN: 2149-2972
Yayın Aralığı: Yılda 3 Sayı
Başlangıç: 1990
Yayıncı: Sağlık Bilimleri Üniversitesi, Kartal Koşuyolu Yüksek İhtisas Eğitim ve Araştırma Hastanesi