Ulusoy Nilgün BOZBUĞA, Kaan KIRALİ, Erdal TURAN, Vedat ERENTUĞ, Deniz GÖKSEDEF, Esat AKINCI, Cevat YAKUT, Hasan Basri ERDOĞAN, Yücel ÖZEN, Suat Nail ÖMEROĞLU

Ekstra-anatomik bypass girişimleri

Amaç: Ekstremite revaskülarizasyonunda ekstra-anatomik bypass girişimleri riskli hasta gruplarında tercih edilebilen uygulamalardır. Bu çalışmada ekstra-anatomik bypass girişimlerimizin klinik sonuçlan irdelenmiştir. Materyal ve Metod: 1985 ile 2002 tarihleri arasında kliniğimizde 22 hastaya ekstra-anatomik bypass girişimi uygulandı. Hastaların 20 tanesi (%90.9) erkek, iki tanesi (%9.1) kadın idi. Hastaların ortalama yaşı 46.4 ± 4.8 yıl (17-69) idi. Onüç olguda (%59.1) alt ekstremiteye, dokuz olguda (%40.9) üst ekstremiteye yönelik revaskülarizasyon yapıldı. Alt ekstremiteye yönelik olarak dokuz olguda femoro-femoral bypass, iki olguda subklavyo-femoral bypass, bir olguda aksillo-femoro-femoral bypass, bir olguda sol iliyo-sağ femoral bypass uygulandı. Üst ekstremiteye yönelik olarak dört olguda subklavyo-subklavyan, üç olguda karotiko-subklavyan, iki olguda aorto-aksiller bypass uygulandı. Hastalarda dokuz PTFE, beş Dakron, sekiz "reverse" safen ven greft kullanıldı. Bulgular: Hastane mortalitesi görülmedi. Erken postoperatif dönemde üç (%13.5) komplikasyon kaydedildi. Geç mortalite bir hasta ile %4.5 idi ve mortalite nedeni serebrovasküler olay idi. Geç dönem morbidite bir olguda gelişen greft trombozu idi. Sonuç: Ekstra-anatomik bypass girişimleri düşük mortalite ve morbidite oranlarıyla riskli hasta grubunda tercih edilebilecek alternatif cerrahi yaklaşım şeklidir.

Extra-anatomic bypass procedures

Background: Extra-anatomic revascularization can be an alternative for limb salvage in high risk patients. We reviewed our clinical results of the extra-anatomic bypass procedures. Methods: Between 1985 and 2002, 22 patients underwent extra-anatomic bypass operations. Twenty patients (90.9%) were male and two patients (9.1%) were female with the mean age 46.4$pm$ 4.8 years (range, 17 to 69 years). Thirteen extra-anatomic bypass revascularizations (59.1%) were performed for lower extremities, and nine revascularizations (40.9%) were performed for upper extremities. Nine cases underwent femoro-femoral bypass, two cases underwent subclavio-femoral bypass, one case underwent axillo-femoro-femoral bypass, one case underwent left ilio-right femoral bypass. Four cases underwent subclavio-subclavian bypass, three cases underwent carotico-subclavian bypass, and two cases underwent aorto-axillary bypass. Nine patients recieved PTFE, five patients Dacron, eight patients reversed saphenous grafts. Results: There was no operative mortality. The early morbidity was 13.5% with three cases. The late mortality was 4.5% with one patient due to cerebrovascular accident, and the late morbidity rate was 4.5% with one patient that suffered from late-term graft infection. Conclusions: Extra-anatomic bypass procedures as alternative surgical approaches can be performed with low mortality and morbidity rates especially in patients with high risk.

PDF

___

1. Freeman NE, Leeds FH. Operations on large arteries. Calif Med 1952;77:229-39.
2. Kolbakır F, Keçeligil T, İriz E ve ark. Ekstraanatomik bypass uygulamaları: 23 vakanın takdimi. Damar Cer Derg 1999:8;116-9.
3. Rutherford RB, Patt A, Pearce WH. Extra-anatomic bypass: A closer view. J Vasc Surg 1987;5:437-46.
4. Dick LS, Brief DK, Alpert J, et al. A 12 year experience with femoro-femoral crossover grafts. Arch Surg 1980;115:1359-65.
5. Elmacı T, Alpagut U, Barlas S ve ark. Anatomik vasküler cerrahi rekonstrüksiyona alternatif cerrahi yaklaşım şekli: Ekstraanatomik bypass prosedürleri. Damar Cer Derg 2001:10;74-8.
6. Walker PJ, Harris JP, May J. Combined percutaneous transluminal angioplasty and extraanatomic bypass for symptomatic unilateral iliac artery occlusion with contrlateral iliac artery stenosis. Ann Vasc Surg 1991;5:209-17.
7. Perler BA, Williams GM. Does donor iliac artery percutaneous transluminal angioplasty or stent placement influence the results of femorofemoral bypass? Analysis of 70 consecutive cases with long term follow up. J Vasc Surg 1996;24:363-70.
8. Shah RM, Peer RM, Upson JF, Ricotta JJ. Donor iliac artery angioplasty and crossover femorofemoral bypass. Am J Surg 1992;164:295-8.
9. Gürer O, Yapıcı F, Çınar B ve ark. Femoro-femoral ekstraanatomik bypass greft olgularımızda orta dönem sonuçlarımız. Damar Cer Derg 2002:11;21-7.
10. Webster WM, Downs L, Yonas H, et al. The effect of arm exercise on regional cerebral blood flow in the subclavian steal syndrome. Am J Surg 1994;168:91-3.
11. Crawford ES, Stowe CL, Powers RW Jr. Occlusion of the innominate, common carotid and subclavian arteries: Long-term results of surgical treatment. Surgery 1993;94:781-9.
12. Bozkurt AK, Beþirli K, Tüzün H, Sayýn AG, Erdoðan G. Karotikosubclavian ve karotikobrakial revaskülarizasyon. Damar Cer Derg 1997:6;31-3.
13. Law MM, Colburn MD, Moore WS, et al. Carotidsubclavian bypass for brachiocephalic occlusive disease: Choice of conduit and long-term follow-up. Stroke 1995;26:1565-71.
14. Vitti MJ, Thompson BW, Read RC, et al. Carotidsubclavian bypass: A twenty-two-year experience. J Vasc Surg 1994;20:411-8.
15. Perler BA, Williams GM. Carotid-subclavian bypass: A decade of experience. J Vasc Surg 1990;12:716-23.
16. Kretschmer G, Teleky B, Marosi L, et al. Obliterations of the proximal subclavian artery: To bypass or to anastomose? J Cardiol Surg 1991;32:334-9.