İrfan ESER, Abdullah ERDOĞAN, Tarık TÜRK, Abid DEMİRCAN, Uğur GÜRSES

Prostetik vasküler greft cinsleri ve uzun dönem sonuçları

Amaç: Anevrizma veya stenotik aterosklerotik hastalıkların bypass prosedürü ile tedavisinde kullanılan prostetik vasküler greftlerin cinsleri ve uygulama pozisyonlarına göre uzun dönem sonuçlarının retrospektif olarak değerlendirilmesi amacıyla bu çalışma düzenlenmiştir. Materyal ve Metod: 1990-2000 yılları arasında Dacron ve Polytetrafluoroethylene (PTFE) greft kullanılan toplanı 316 hasta çalışmaya dahil edildi. Hastaların 8 tanesi (%2.5) kadın, 308 tanesi (%97.5) erkek ve yaş ortalaması 61$pm$9.2 yıl (28-72 yıl) idi. Prostetik greftlerin 134 ianesi (%42.5) Dacron ve 182 tanesi (%57.5) PTFE idi. Hastaların 105 tanesine (%33.2) anevrizma, 211 tanesine (%66.8) stenoz veya oklüzyon nedeni ile greft uygulanmıştı. Greftin cinsi ve uygulama pozisyonuna göre geç dönemde, postoperatif ilk bir aydan sonra görülen komplikasyonlar araştırıldı. Uzun dönemde grell cinsi ve uygulama pozisyonuna göre oklüzyon oranları karşılaştırıldı. Bulgular: Hastaların tümü en az 2 yıl olmak üzere ortalama 6 ± 3.1 yıl (2-12 yıl) izlendi. Peroperatif olarak toplam 3 hasta (%0.9) kaybedildi. Dacron greft kullanılan hastaların 18 tanesinde (%13.4) greft oklüzyonu, 11 tanesinde (%8.2) greft enfeksiyonu görüldü. PTFE greft kullanılan hastaların 12 tanesinde (%6.6) greft oklüzyonu ve 11 tanesinde de (%6) greft enfeksiyonu görüldü. Sekonder oklüzyon oranları Dacron greft kullanılan hastalarda %38.8 iken, PTFE greft kullanılan hastalarda %16.6 olarak bulundu. Primer ve sekunder oklüzyonlar en sık femoro-popliteal ve ekstra-anatomik (femoro-femoral) pozisyonda uygulanan Dacron greltlerde görüldü. Bu greftlerin postoperatif 5 yıl içinde sırası ile 4 (%80) ve 2 (%66.6) tanesinin oklüde olduğu tespit edildi (p < 0.05). Benzer şekilde greft enfeksiyon oranlarının da Dacron greftlerde daha sık olduğu (%8.2) belirlendi (p < 0.05). Sonuç: Ekstra-analomik ve femoro-popliteal bypass prosedürlerinde primer ve sekunder oklüzyon oranlan ve greft enfeksiyon oranları araştırıldığında PTFE vasküler greftlerin Dacron greftlere göre istatistiksel olarak anlamlı derecede üstün oldukları tespit edilmiştir.

The types of prosthetic vascular grafts and their long-term outcome

Background: To evaluate retrospectively the long-term results of prosthetic vascular bypass grafts used for treatment aneurysms or atherosclerotic occlusive disease regarding the replacement localization and graft type. Methods: A total of 316 patients, who had undergone Dacron or Polytetrafluoroethylene (PTFE) bypass grafting from 1990 to 2000 were enrolled in (he study. Of those, 8 (2.5%) were female, 308 patients (97.5%) were male and mean age was 61$pm$ 9.2 years (range 28 to 72 years). One hundred and thirty-four prosthetic grafts (42.5%) were Dacron and 182 (57.5%) were PTFE. The bypass procedure was performed because of aneurysms in 105 patients (33.2%)) and atherosclerotic occlusive disease in 211 patients (66.7%). The occlusion and infection rates (1 month after postoperatively) were investigated with regard to the graft type and replacement localization. Results: All of the patients were followed up for an average of 6$pm$ 3.1 years (range 2 to 12 years). Three patients (0.9%)) died perioperatively. Among the patients who underwent Dacron grafting 18 (13.4%) had graft occlusion, and 11 (8.2%) had graft infection. Whereas, 12 (6.6%)) of the patients who underwent PTFE grafting had graft occlusion and 11 (6%) had graft infection. In Dacron group, occlusion and reoperation rate was 18 (13.4%) and graft infection rate was 11 (8.2%), and in PTFE group, the graft occlusion rate was 12 (6.5%) and infection rate was 11 (6%). The patients who had femoro-poplileal and extra-anatomic (femoro-femoral) bypass Dacron grafting had occlusions, 4 (80%) and 2 (66%) respectively (j> < 0.05). Conclusion: Long-term occlusion and graft infection rate are less encountered in the patients who had PTFE bypass grafting compared to the ones who had Dacron grafting. Especially, secondary occlusion rate are significantly less seen in the femoro-popliteal and extra-anatomicfemoro-femoral position.

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1. Haimovici H. An historic overview of vascular surgery: Past record and new trends-a vision for the 1990s. In: Haimovici H, ed. Vascular Surgery. Masschusetts: Blackwell Science, 1996:1-7.
2. Dotter CT, Judkins MP. Transluminal treatment of arteriosclerotic obstruction. Description of a new technic and a preliminary report of its application 1964. Radiology 1989;172:904-20.
3. Kempczinski FR. Vascular conduits: An overview. In :Rutherford RB, ed. Vascular Surgery. Philadelphia: WB Saunders Company, 2000:527-31.
4. Pringle JH. Two cases of vein grafting for the meintanence of a direct arterial circulation. Lancet 1913;1:1975.
5. Voorhess AB Jr, Jaretzki A III, Blakemore AH. The use of tubes constructed from vinyon ‘N’ cloth in bridging arterial defects. Ann Surg 1952;135:332.
6. Brewster DC. Prosthetic grafts. In: Rutherford RB, ed. Vascular Surgery. Philadelphia: WB Saunders Company, 2000:559-79.
7. Sauvage LR. Biologic behavior of grafts in arterial system. In: Haimovici H, ed. Vascular Surgery. Massachusetts: Blackwell Science, 1996:159-88.
8. Urayama H, Katada S, Kasashima F, Tanaka Y, Kawasuji K, Watanabe Y. Plasminogen activators, matrix metalloproteinases and their inhibitors in implanted vascular prostheses. Eur J Vasc Endovasc Surg 2000;20:501-7.
9. Tai NR, Salacinski HJ, Edwards A, Hamilton G, Seifalian AM. Compliance properties of conduits used in vascular reconstruction. Br J Surg 2000;87:1516-24.
10. Pasquinelli G, Freyrie A, Preda P, Curti T, D’Addato M, Laschi R. Healing of prosthetic arterial grafts. Scanning Microsc 1990;4:351-62.
11. Brothers TE, Graham LM, Till GO. Systemic effects of prosthetic vascular graft implantation. Surgery 1988;104:375-82.
12. Vohra R, Thomson GJ, Carr HM, Sharma H. Comparison of different vascular prostheses and matrices in relation to endothelial seeding. Br J Surg 1991;78:417-20.
13. Tiwari A, Salacinski H, Seifalian AM, Hamilton G. New prostheses for use in bypass grafts with special emphasis on polyurethanes. Cardiovasc Surg 2002;10:191-7.
14. Bergamini TM, Towne JB, Bandyk DF, Seabrook GR, Schmitt DD. Experience with in situ saphenous vein bypasses during 1981 to 1989: Determinant factors of longterm potency. J Vasc Surg 1991;13:137-47.
15. Ruckert RI, Settmacher U, Kruger U, Scholz H. Femorodistal PTFE bypass grafting for severe limb ischaemia: Results of a prospective clinical study using a new distal anastomotic technique. Eur J Vasc Endovasc Surg 2000;20:51-6.
16. Abbott WM. Prosthetic above-knee femoral-popliteal bypass: Indications and choice of graft. Semin Vasc Surg 1997;10:3-7.
17. Patterson RB, Fowl RJ, Kempezinski RF, Gewitz R, Shukla R. Preferential use of PTFE for above-knee femoropopliteal bypass grafts. Ann Vasc Surg 1990;4:338-43.
18. Prendiville EJ, Yeager A, O’Donnell TF, et al. Long-term results with above-knee popliteal expanded polytetrafluoroethylene graft. J Vasc Surg 1990;11:517-24.
19. Haimovici H. Vascular sutures and anastomoses. In: Haimovici H, ed. Vascular Surgery. Masschusetts: Blackwell Science, 1996:239-49.
20. Rutherford RB. Basic vascular surgical techniques. In: Rutherford RB, ed. Vascular Surgery. Philadelphia: WB Saunders Company, 2000:476-93.