Ebuzer AYDIN, Kaan KIRALİ, Sabit SARİKAYA, Murat Bülent RABUŞ, Mehmet DEDEMOĞLU, Yücel ÖZEN

A comparison between hiatal and thoracic clamping for rupturedabdominal aortic aneurysms

Amaç: Bu çalışmada rüptüre abdominal aortanevrizmalarında hiatal ve torakal klemplemeninameliyat sonrası morbidite ve mortalite üzerindekietkileri incelendi.Çalışmaplanı: Bu retrospektif çalışmaya kliniğimizdeMart 2005 - Haziran 2013 tarihleri arasında rüptüreabdominal aort anevrizmaları için açık tamir uygulanan47 hasta (35 erkek, 12 kadın) dahil edildi. Torakal vehiatal klempleme sırasıyla 26 (19 erkek, 7 kadın; ort.yaş 68.5±7.9) ve 21 (16 erkek, 5 kadın; ort. yaş 66.1±7.8)hastaya uygulandı. Ameliyat sonrası komplikasyonlarve mortalite iki grup arasında tek değişkenli ve çokdeğişkenli analizlerle değerlendirildi.Bul gu lar: Toplam mortalite %36.7 (n=18) idi ve ikigrup arasında anlamlı farklılık yoktu. Tek değişkenlianalizler ameliyat sonrası solunum komplikasyonları(p=0.59), renal yetmezlik (p=0.98), cell saver kullanımı(p=0.26) ve intestinal iskemi (p=0.08) açısından iki gruparasında anlamlı farklılık göstermedi. Hastanede kalışsüresi torakal klempleme grubunda daha uzun idi (p=0.01).Yaş ve klemp zamanı (>30 dakika) hastane mortalitesinianlamlı olarak artırdı.Sonuç: İnfrarenal klemplemenin uygun olmadığı hastalardaameliyat sonrası komplikasyonlar karşılaştırıldığındahiatal ve torakal klempleme birbirinden üstün değildi.Klemp süresi mümkün olduğunca kısa tutularak her ikiteknik güvenle uygulanabilir.

Rüptüre abdominal ao rt anev rizmalarında hiatal v e torakal klempleme nin karşılaştırılması

Background: This study aims to evaluate the effects ofhiatal and thoracic clamping on postoperative morbidityand mortality in the management of ruptured abdominalaortic aneurysms.Methods: This retrospective study included 47 patients(35 males, 12 females) who were performed open repairfor ruptured abdominal aortic aneurysms in our clinicbetween March 2005 and June 2013. Thoracic and hiatalclamping were performed in 26 (19 males, 7 females; meanage 68.5±8.0 years) and 21 (16 males, 5 females; meanage 66.1±7.8 years) patients, respectively. Postoperativecomplications and mortality were evaluated between the twogroups by univariate and multivariate statistical analyses.Results: Overall mortality was 36.7% (n=18) and there wasno significant difference between the two groups. Univariateanalyses showed no significant difference between the twogroups in terms of postoperative respiratory complications(p=0.59), renal failure (p=0.98), the use of cell saver(p=0.26), and intestinal ischemia (p=0.08). Duration ofhospital stay was longer in thoracic clamping group(p=0.01). Age and clamp time (>30 minutes) significantlyincreased hospital mortality.Conclusion: Hiatal and thoracic clamping were notsuperior to each other when postoperative complicationswere compared in patients for whom infrarenal clampingwas not feasible. Both techniques can be applied safely bykeeping the cross-clamp time as short as possible.

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