İlker KİRİŞ, ŞENOL GÜLMEN, Emre DOĞAN, Hüseyin OKUTAN

Karotis endarterektomi sırasında ‘Y’ şeklinde patchplasti yapılan ve atipik yerleşimli hipoglossus sinirine cerrahi travmanın önlendiği bir olgu

Beş yıl önce sol karotis endarterektomi operasyonu yapılmış olan altmış yedi yaşında erkek hasta baş dönmesi yakınması ile kliniğimize başvurdu. Doppler ultrasonografi ve intraarteriyel digital substracted anjiyografi sağ internal karotis arterde %90 darlığı açığa çıkardı. Sağ karotis endarterektomi operasyonu sırasında common, eksternal ve internal karotis artere ulaşıldığında, nervus hipoglossusun beklenen anatomik lokalizasyonundan daha aşağıda olduğu ve bulbus karotisi çaprazladığı görüldü. Atipik yerleşimli nervus hipoglossus korunarak common karotis arterde arteriyotomi yapıldı. Arteriyotomi distale doğru ilerletildiğinde yoğun aterosklerotik plağın hem internal hem de eksternal karotis artere uzandığı tespit edildi. Common karotis arterden başlatılan arteriyotomi ve endarterektomi planı hem eksternal hem de internal karotis artere uzatıldı. Y şeklindeki ince duvarlı bir polytetrafluoroethylene yama hazırlandı. Yamanın proksimal ucu common karotis artere, distaldeki uçları da eksternal ve internal karotis arterlere dikilerek patch plasti tamamlandı. Hasta onuncu ayında sorunsuz izlenmektedir.

A case in whom Y-shaped patchplasty was done and surgical trauma to atypically placed nervus hypoglossus was avoided during carotid endarterectomy

A 67-year-old man who underwent left carotid endarterectomy five years ago admitted to our clinic with complaint of dizziness. Doppler ultrasonography and intraarterial digital substracted angiography revealed 90 % stenosis in the right internal carotid artery. During right carotid endarterectomy operation, following exposure of common, external and internal carotid arteries, nervus hypoglossus was found to be placed lower than its expected anatomic localisation, crossing the carotid bulb. An arteriotomy in the common carotid artery was done by preserving atypically placed nervus hypoglossus. When arteriotomy was extended distally, a heavy aterosclerotic plaque was found to extend to both external and internal carotid arteries. The arteriotomy and endarterectomy planes that were started in common carotid arteries were extended to both external and internal carotid arteries. A Y-shaped, thin wall polytetrafluoroethylene patch was prepared. Proximal end of the patch was sutured to common carotid artery and the patchplasty was completed by suturing the distal ends of the patch to external and internal carotid arteries. The patient remains in good health in his postoperative tenth month. (Pam Med J 2009;2(1):31-34).

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