Onur GÜRER, Yavuz ENÇ, Fikri YAPICI, Bayer ÇINAR, Mesut KÖSEM, Özge SEZERMAN

Karotiko-Aksiller / subklavyan bypass greft uygulanan subklavyan steal sendromu olgularımızda orta dönem sonuçlarımız

Amaç: Subklavyan steal sendromu insidansı sanıldığından daha yüksek oranda olup, semptomatik olgularda çeşitli cerrahi tekniklerle tam iyileşme sağlanabilir. Materyal ve Metod: Bu çalışmada, 5 yılını tamamlamış ve karotiko-aksiller veya karotiko-subklavyan bypass yöntemi ile opere edilmiş 25 subklavyan steal sendromlu olgudaki komplikasyonlar, mortalite ve patensi oranlarının retrospektif analizi yapılmıştır. Bulgular: Bir olguda (%4) erken oklüzyon ve yine 1 olguda (%4) geç greft oklüzyonu gerçekleşti. Erken oklüzyon, embolektomi ile tedavi edildi. Geç greft oklüzyonu ise reopere edilmeden takibe alındı. Total kümülatif 5 yıllık patensi oranı %96 olarak gerçekleşti. Mortalite oranları ilk otuz günde %4 ve 5. yılda gene %4 oldu. Postoperatif komplikasyonlar 1 olguda (%4) operasyon bölgesinde hematom, 1 olguda (%4) sol hemiparezi, 1 olguda (%4) üst ekstremiteye periferik embolizasyon olarak gerçekleşti. Geç dönemde ise 1 olgu (%4) greft enfeksiyonu nedeni ile reopere edildi. Sonuç: Subklavyan steal sendromunda karotiko-aksiller veya karotiko-subklavyan bypass, uygun cerrahi endikasyonlarda ve tecrübeli cerrahlar tarafından, kabul edilir morbidite ve mortalite ile uygulanabilir.

Mid-term results of subclavian steal syndromes operated by carotico-Axillary / subclavian bypass grafts

Background: The incidance of subclavian syndrome is higher than accepted and absolute cure is achived by surgical procedures in semptomatic patients. Methods: In this study, the complications, mortality and patency rates of 25 cases trented with carotico-axillary or caratico-subklavian bybass techniques were retrospectively analyzed after 5 year follow up period. Results: In one patient (4%) early and in one patient (4%) late graft occlusion were seen. The early graft occlusion was treated by emergency embolectomy, but late graft occlusion was not reoperated and followed up periodically. Total cumulative patency rate at 5 year was 96%. The 30 day and 5-year mortality rates were 4%, retrospectively. In one case (4%) hematoma of the surgical field, in one (4%) left hemiparesthesis and in another case (4%) upper extremity embolism were seen as early postoperative complications. In late postoperative period, one case (4%) was reoperated due to late graft infection. Conclusions: Based on our results, carotico-axillary/subclavian bypass grafts can be performed with an acceptable morbidity and mortality when done by surgeon in considerable indications.

PDF

___

1. Daves J, Treger A. Vertebral grand larceny. Circulation 1964;29:91-3.
2. Gerber N. Congenital atresia of the subclavian artery producing "subclavian steal syndrome". Amer J Dis Child 1967;113:709-13.
3. Lochaya S, Kaplan B, Shaffer AB. Pseudocoarctation of the aorta with bicuspid aortic valve and kinked left subclavian artery, a possible cause of subclavian steal. Amer Heart H 1967;73:369-74.
4. Marshall WG Jr, Miller EC, Kouchoukos NT. The coronary-subclavian steal syndrome: Report of a case and recommendations for prevention and management. Ann Thorac Surg 1988;46:93-6.
5. Olsen CO, Dunton RF, Maggs PR, Lahey SJ. Review of coronary-subclavian steal following internal mammary artery-coronary artery bypass surgery. Ann Thorac Surg 1988;46:675-8.
6. Sanisoğlu Ü, Akpınar B, Güden M, Sağbaş E, Karaman K. Koroner-subklavian steal sendromu: 3 olgu nedeniyle. Türk Göğüs Kalp Damar Cerr Derg 1999;7:341-3.
7. Fields WS, Lemak HA. Joint Study of Extracranial Arterial Occlusion, VII. subclavian steal-a review of 168 cases. JAMA1972;222:1139-43.
8. Russell RW. Green M. Mechanism of transient cerebral ischaemia. Br Med J 1971;1:646-7.
9. Vogt DP, Hertzer NR, O'Hara PJ, Beven EG. Brachiocephalic arterial reconstruction. Ann Surg 1982;196:541-52.
10 . Kachel R, St Basche S, Heerklotz I, Grossmann K, Endler S. Percutaneus transluminal angioplasty (PTA) of supraaortik arteries especially the internal carotid artery. Neuroradiology 1991;33:191-4.
11. Selby JB, Matsumoto AH, Tegtmeyer CJ, et al. Balloon angioplasty above the aortic arch: Immediate and longterm results. Am J Roentgenol 1993;160:631-5.
12. Motarjeme A, Gordon GI. Percutaneous transluminal angioplasty of the brachiocephalic vessels: Guidelines for therapy. Int Angiol 1993;12:260-9.
13. Hebrang A, Maskovic J, Tomac B. Percutaneous transluminal angioplasty of the subclavian arteries: Longterm results in 52 patients. Am J Roentgenol 1991;156:1091-4.
14. Rodriguez-Lopez JA, Werner A, Martinez R, Torruella LJ, Ray LI, Dietrich EB. Stenting for atherosclerotic occlusive disease of the subclavian artery. Ann Vasc Surg 1999;13:254-60.
15. Aburahma A F, Robinson PA, Jennings TG. Carotidsubclavian bypass grafting with polytetrafluoroethylene grafts for symptomatic subclavian artery stenosis or occlusion: A20-year experience. J Vasc Surg 2000;32:411 - 9 .
16. Vitti MJ, Thompson BW, Read RC, et al. Carotidsubclavian bypass: A twenty Ðtwo year experience. J Vasc Surg 1994;20:411-8.
17. Lord RS, Ehrenfeld WK. Carotid-subclavian bypass: A hemodynamic study. Surgery 1969;66:521-6.
18. Cook CH, Stemmer EA, Connolly JE. Effect of peripheral resistance on carotid blood flow after carotid-subclavian bypass. Arch Surg 1972;105:9-13.
19. Swayngim DM Jr, Avellone JC. Hemodynamic consequences of axillo-axillary bypass. J Cardiovasc Surg 1982;23:65-8.
20. Dietrich EB, Koopot R, Kinard SA, Futral JE. Treatment of microemboli of the upper extremity. Surg Gyn Obstet 1979;148:584-7.
21. Kretschmer G, Teleky B, Marosi L, et al. Obliterations of the proximal subclavian artery: To bypass or to anastomose? J Cardiovasc Surg 1991;32:334-9.
22. Rosenthal D, Ellison RG Jr, Clark MD, et al. Axilloaxillary bypass: Is it worthwhile? J Cardiovasc Surg 1988;29:191-5.
23. Lotina S, Davidovic L, Maksimovic Z, Djukanovic B, Sindjelic R, Sagic D. Femoro-axillary bypass in the treatment of subclavian steal syndrome. Srp Arh Celok Lek 1990;118:317-9.
24. Law MM, Colburn MD, Moore WS, Quinones-Baldrich WJ, Machleder HI, Gelabert HA. Carotid-subclavian bypass for brachiocephalic occlusive disease. Stroke 1995;26:1565-71.