Fırat DURNA, Serkan GİRGİN, Mohammed ALSHALALDEH, Bilgin EMRECAN

Paramedian retroperitoneal approach for revascularization of aortoiliac occlusive disease

Amaç: Bu çalışmada paramedian insizyon veretroperitoneal yaklaşım ile aortoiliyak tıkayıcı hastalığıntek taraflı ve iki taraflı revaskülarizasyonu incelendi. Çalışmaplanı:Ocak 2005 - Aralık 2012 tarihleri arasında74 hastaya (67 erkek, 7 kadın; ort. yaş 61.6±9.5 yıl;dağılım 24-79 yıl) aortoiliyak tıkayıcı hastalık nedeniyleparamedian insizyon ve retroperitoneal yaklaşım ilecerrahi revaskülarizasyon [aortofemoral baypas (n=40),iliyofemoral baypas (n=14), aortoiliyak baypas (n=2)ve aortobifemoral baypas (n=18)] yapıldı. Tek taraflıaortoiliyak revaskülarizasyon yapılan hastaların verileri,iki taraflı aortoiliyak revaskülarizasyon yapılan hastalarile karşılaştırıldı. Hastaların ameliyat öncesi özellikleri veameliyat sırası verileri incelendi. Bul gu lar: Üç hasta (%3.9) miyokard enfarktüsü ve pulmonerkomplikasyonlar nedeniyle ameliyat sonrası kaybedildi.Ameliyat sırası komplikasyon gözlenmedi. Takiben altıhastaya yeniden cerrahi yapıldı: iki hastaya karşı tarafekstremiteye akut distal emboli, iki hastaya distal anastomozkaçağı ve iki hastaya da lokal distal yara yeri enfeksiyonunedeniyle. Bu hastalar başarılı bir şekilde tedavi edildi.Hastalar antitrombosit tedavisi ile hastaneden taburcu edildi.Yoğun bakımda kalma süresi, oral gıdaya kadar geçenzaman, ameliyat öncesi ve ameliyat sonrası hemoglobindüzeyleri, hematokrit düzeyleri, kreatinin düzeyleri vetransfüzyon ihtiyaçları açısından tek taraflı ve iki taraflırevaskülarizasyon hastalarında anlamlı bir fark bulunmadı. So nuç: Deneyimlerimize göre, paramedian insizyonile retroperitoneal aortoiliyak yaklaşımın az sayıdakomplikasyonu ve kabul edilebilir sonuçları vardır.

Aortoiliyak tıkayıcı hastalık revaskülarizasyonunda paramedian retroperitoneal yaklaşım

Background: This study aims to examine unilateral andbilateral revascularization of aortoiliac occlusive diseasevia paramedian incision and retroperitoneal approach. Methods: Between January 2005 and December 2012, 74patients (67 males, 7 females; mean age 61.6±9.5 years;range 24 to 79 years) underwent surgical revascularizationfor aortoiliac occlusive disease via paramedian incisionand retroperitoneal approach [aortofemoral bypass (n=40),iliofemoral bypass (n=14), aortoiliac bypass (n=2) andaortobifemoral bypass (18)]. Data of the patients forunilateral aortoiliac revascularization were comparedwith those for bilateral aortoiliac revascularization. Thepreoperative characteristics and perioperative data of thepatients were analyzed. Results: Three patients (3.9%) died postoperatively due tomyocardial infarction and pulmonary complications. Nointraoperative complications occurred. Six patients requiredsubsequent reoperation: two for acute distal embolism tothe contralateral limb, two for distal anastomosis leakage,and two for local distal wound infection. These patientswere successfully treated. The patients were dischargedfrom the hospital on antiplatelet therapy. There was nosignificant difference in the length of intensive care unitstay, time to oral intake, preoperative and postoperativehemoglobin levels, hematocrit levels, creatinin levels, andneed for transfusion between the unilateral and bilateralrevascularization patients. Conclusion: Based on our experience, the retroperitonealaortoiliac approach with a paramedian incision has fewcomplications and reasonable outcomes.

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