Alper ONK, İlker MATARACI, Mehmet TOKER, Ali FEDAKAR, Fuat BÜYÜKBAYRAK, Rahmi ZEYBEK, Ahmet ŞAŞMAZEL, Ercan EREN, Cengiz KÖKSAL, Mehmet AKSÜT

Abdominal aort anevrizmasında elektif ve acil cerrahi onarım

Amaç: Bu çalışmada son 10 yıllık periyotta acil ve elektif şartlarda kliniğimize başvuran ve cerrahi müdahale yapılan abdominal aort anevrizma (AAA)�ı olgularda elde edilen cerrahi sonuçlar değerlendirildi.Çalışma planı: Ocak 1998 - Ocak 2008 tarihleri arasında kliniğimize başvuran cerrahi sınırlardaki infradiyafragmatik AAA�ı toplam 190 hasta (27 kadın, 163 erkek; ort. yaş 64.9±7.8 yıl; dağılım 36-93 yıl) geriye dönük olarak değerlendirildi.Bulgular: Yüz doksan hastanın 163� elektif 27�i acil şartlarda ameliyat edildi. Elektif şartlarda ameliyat edilen üç hasta kaybedildi. Acil şartlarda getirilen sekiz hasta ameliyata hazırlık aşamasında, yoğun bakım şartlarında ya da ameliyata alınırken kaybedildi. Acil şartlarda ameliyata alınan 19 hastanın 10� kaybedildi, dokuzu ise şifa ile taburcu edildi. Elektif şartlarda ameliyata alınan hastalarda mortalite oranı %1.84 olmasına karşın, acil şartlarda ameliyata alınan hastalarda mortalite oranı %52 idi.Sonuç: Acil şartlar devreye girdiğinde ameliyat öncesi, sırası ve sonrası toplam mortalite oranı %66�a çıkmaktadır. Bu nedenle ulusal bir program geliştirilerek ileri yaş ve anevrizma gelişme riski yüksek kişilerde, tarama testleri yapılmalıdır. Bu yolla erken tanı konulabilmesi temin edilmeli ve acil şartlar devreye girmeden yerinde ve uygun müdahale planlanmalıdır.

Elective and emergency surgical repair in abdominal aortic aneurysms

Background: This study investigated the surgical outcomes of patients with abdominal aortic aneurysm (AAA) requiring emergency or elective intervention, admitted to our clinic during the last 10 years.Methods: One hundred and ninety patients (27 females, 163 males; mean age 64.9±7, 8 years; range 36 to 93 years) with infradiaphragmatic AAA requiring surgical intervention and admitted to our clinic between January 1998 and January 2008 were assessed retrospectively.Results: Of the 190 patients, 163 were electively operated while 27 presented emergently. Three of the electively operated patients died. Eight of the emergent patients died during the preparation phase in the intensive care unit or while being admitted to operating room. Of the nineteen patients operated on emergently, 10 died, and nine were discharged. The mortality rate for electively operated patients was 1.84%, while the mortality rate for patients who underwent emergency operations was 52%.Conclusion: Overall peri- and postoperative mortality increases by up to 66% in emergency situations. For this reason a national program and screening tests must be enhanced for people with a high risk of aneurysm development and advanced age. In this manner, early diagnosis can be achieved. For emergency conditions without circuit, an appropriate intervention must be designed.

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