JİNEKOLOJİK ONKOLOJİ CERRAHİ SONRASI EYER (SADDLE) EMBOLİSİ DÜŞÜNDÜREN AKUT BİLATERAL ALT EKSTREMİTE İSKEMİSİ: OLGU SUNUMU

Akut alt ekstremite iskemilerinin en sık nedeni ateroembolilerdir. Nadir de olsa aorta-iliyak tıkayıcı hastalık(Leriche Sendromu) daha proksimalden kaynaklanan embolizasyon sonucu akut bilateral alt ekstremiteiskemisi ile karşımıza gelebilir. Bu yazımızda jinekolojik onkoloji cerrahisi geçiren postoperatif dönemdeakut bilateral alt ekstremite iskemisi gelişen vakamızısunmayı amaçladık.50 yaşında bayan hasta endometrium kanseri nedeniyle jinekolojik onkoloji cerrahisi sonrası yirmi dördüncü saatte bilateral alt ekstremite iskemisi nedeniyle danışıldı. Bilgisayarlı tomografik anjiyo sonrasıabdominal aort total oklude idi ve acil cerrahi planlandı. Distal embolizasyonu ekarte etmek için bilateralana femoral arterden proximale ve distale embolektomi uygulandı. İşlem sonrası yeterli akım gelmemesiüzerine batın açıldı. Bifurkasyon öncesi abdominalaort ve her iki ana iliyak çapları normal çaplardan belirgin derecede küçüktü. Hastanemizde Y greft olmadığından dolayı her iki ana iliyak artere greft ile baypas yapıldı.Cerrahi sırasında vasküler yaralanması olan hastalarda postoperatif dönemde sık vasküler muayene geridönüşü olmayan komplikasyonların önlenmesi açısından gereklidir.

ACUTE BILATERAL LOWER EXTREMITY İSCHEMIA SUGGESTING SADDLE EMBOLISM, AFTER GYNECOLOGICAL ONCOLOGIC SURGERY : A CASE REPORT

Most common cause of acute lower extremity ischemia is atheroembolism. Although it is rare, aortic-iliac occlusive disease (Leriche Syndrome) may present with acute bilateral lower extremity ischemia resulting from proximal embolization. A 50-year-old female patient was consulted for bilateral lower extremity ischemia at the twenty-fourth hour after gynecologic oncology surgery for endometrium cancer. Patient was evaluated at clinic and determined bilateral lower extremity ischemia. After performing radiologic evaluation no flow obtained from aorta to distal vascular bed and emergency surgery planned. Bilateral proximal and distal embolectomy was performed at the same time, after no satisfactory achievement of retrograde and antegade flow, laporotomy was performed for further evaluation of proximal vasculature as a cause of ischemia. After the procedure did not come back enough backflow, laparotomy was performed. The distal abdominal aorta in the proximal of bifurcation and both major iliac diameters are significantly smaller than normal diameters. No flow was determined in small diametered distal abdominal aorta and bilateral iliac arteries and bilateral aorto-uni-iliac bypass was performed with 8mm ptfe-ringed graft because of, no Y graft in our hospital. In patients with vascular injuries during surgery, frequent vascular examination postoperatively is necessary to prevent non-reversible complications.

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