Mehmet BALKANAY, Denyan MANSUROĞLU, Kaan KIRALİ, Başar SAREYYÜPOĞLU, Erdal TURAN, Vedat ERENTUĞ, Deniz GÖKSEDEF, Cevat YAKUT, Gökhan İPEK, Bülent MUTLU, Suat Nail ÖMEROĞLU

Koroner bypass cerrahisinde radiyal arter kullanımının orta dönem anjiyografik sonuçları

Amaç: Koroner arter bypass cerrahisinde radiyal arter kullanımı son yıllarda önem kazanmıştır. Bu çalışmanın amacı, CABG ameliyatlarında kullanılan radiyal arterlerin orta dönem açıklık oranlarının anjiyografik olarak incelenmesidir. Materyal ve Metod: Kliniğimizde Haziran 1998 ve Haziran 2002 tarihleri arasında toplam 184 hastaya radiyal arter kullanılarak CABG operasyonu uygulandı. Hastaların on tanesi kadın, diğerleri erkek olup hastaların yaş ortalaması 47.9 ± 7.7 yıl (29-68) idi. Preoperatif ulnar kollateral sirkülasyonun değerlendirilmesi amacı ile tüm hastalarda modifiye Allen testi kullanıldı. Randomize seçilen 60 hastaya postoperatif ortalama 15 ± 1.3 ay sonra kontrol koroner anjiyografisi yapıldı. Bulgular: Erken mortalite bir hastada radiyal arter spazmına bağlı perioperatif miyokard enfarktüsü ve düşük kalp debisi nedeniyle gerçekleşti. Geç mortalite ise iki olguda (%1.1) gerçekleşti. Perioperatif miyokard enfarktüsü 5 olguda (%2.7) görüldü. Radial arter çıkartılan hiçbir hastada kol iskemisine rastlanmadı. Distal radiyal arter anastomozunun açıklık oranı %77.1 olarak bulundu. Sonuç: Radiyal arterin orta dönem açıklık oranını literatürden daha düşük bulmamıza rağmen, safen ven grefti ile karşılaştırıldığında daha yüksek orta dönem açıklık oranı nedeni ile CABG prosedürlerinde ikinci sıklıkta tercih edilebilecek arteriyel bir greft olduğunu düşünmekteyiz.

Use of radial artery in coronary artery bypass surgery: Midterm angiographic results

Background: Use of radial artery in coronary artery bypass grafting (CABG) has been popularized in recent years. The aim of this study was to evaluate the mid-term angiographic results of this conduit. Methods: In our institution, totally 184 patients underwent CABG operation using radial artery between June 1998 and June 2002. The mean age of the patients were 47.9 ± 7.7 years (range, 29 to 68 years), and ten patients were female. Modified Allen's test was used to evaluate the collateral circulation of ulnar artery for all patients. Sixty patients were randomized for control angiogram, and the mean time of the control angiographic evaluation was 15 ± 1.3 months. Results: There was one early mortality due to low cardiac output syndrome as a result of radial artery spasm and perioperative myocardial infarction. Late mortality was seen in two patients (1.1%) due to sudden death and low cardiac output syndrome followed by control angiography. Five patients (2.7%) had perioperative myocardial infarction. There was no hand ischemia in any patient. The patency rate of radial arteries was 77.1%. Conclusions: Although we found the patency rate lower than the literature, we suggest that the radial artery is the second choice as a conduit in CABG operations because of its mid-term patency is superior than saphenous vein grafts.

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