Kerim ÇAĞLI, Murat BAYAZIT, Oğuz TAŞDEMİR, Özer KANDEMİR, Mahmut Mustafa ULAŞ, Erol ŞENER, Hilmi TOKMAKOĞLU

İnfrapopliteal arterlere yapılan bypass cerrahisinin ekstremite kurtarılmasındaki önemi

Amaç: Bu çalışmada infrapopliteal arteriyel revaskülarizasyon cerrahisinin uzun dönem sonuçları bildirilerek alt ekstremite kurtarılmasında bypass cerrahisinin önemi irdelendi. Materyal ve Metod: Kliniğimizde 1991 ile 2001 yılları arasında ekstremite kurtarma amaçlı infrapopliteal bölgeye cerrahi girişim yapılan 72 hasta incelendi. Fontain sınıflamasına göre hastaların 48'i üçüncü evrede, 24'ü dördüncü evrede idi. Uzun dönem açıklıklarını ve ekstremitenin son durumunu değerlendirmede renkli doppler ultrasonografi ve anjiyografi tetkikleri ile fizik muayene yöntemleri kullanıldı. Bulgular: Hastalar 21.3 ± 15.9 ay (1-60 ay) süreyle izlendi. Bu sürede kümülatif greft açıklık oranı %42, ekstremite kurtarılma oranı %51 idi. Safen ven grefti kullanma tekniklerinden revers ve in situ arasında patens açısından fark yokken (p > 0.05), transloke teknikte patens oranları oldukça düşük bulundu (p < 0.05). Sonuç: İnfrapopliteal arterlere yapılan bypass operasyonları, uzun dönem sonuçlarının iyi olması ve ekstremite kurtarılma oranlarındaki yüksekliği nedeniyle oldukça yararlıdır. Bu cerrahinin özenle seçilecek hastalara uygulanması yaşam kalitesini artıracaktır.

The importance of bypass surgery for infrapopliteal arteries in limb salvage

Background: In this study, the long-term results of the infrapopliteal arterial revascularization were documented and also the importance of bypass surgery for saving the lower extremity was examined. Methods: Seventy two patients who underwent the infrapopliteal surgery for saving the lower extremity between 1991 and 2001 were examined retrospectively. According to Fontaine classification forty eight of these patients were at the third class, and twenty four of them were at the fourth class. To determine the long-term patency and the last position of the extremity, we used color doppler ultrasound, angiographic technics and physical examination. Results: The patients were followed for 21.3 ± 15.9 months (range 1 to 60 months). The cumulative patency of grafts was 42%, the average limb salvage rate was 51% during the following period. By using the techniques of saphenous vein grafting, there was no difference between the patency of reverse and in situ techniques (p > 0.05), but we found that the patency of translocated technique was very low (p < 0.05). Conclusions: The infrapopliteal artery bypass operations are very useful, because the long-term results are very well and the limb salvage rate is very high. Prefering this bypass surgery for the patients who are chosen extraoptinacily will increase the quality of life.

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