Murat SARGIN, Hakkı AYDOĞAN, Uğur FİLİZCAN, E. Ergin EREN, Bayer ÇINAR, Onur GÖKSEL, Veysel ŞAHİN, Çetemen Şebnem ALBEYOĞLU

Simultaneous coronary artery bypass grafting and peripheral revascularization in generalized atherosclerotic patients

Amaç: Koroner arter hastalığı ve periferik arter hastalığının birlikteliği anjiyografik olarak %37 ila %78 gibi yüksek bir orandadır. Karotis arter stenozu veya abdominal aort anevrizması ile koroner arter hastalığının birlikteliği daha sık rastlanan bir klinik durum olmasına karşın koroner bypass cerrahi uygulanan hastaların %4-15'inde ciddi semptomatik aortoiliyak oklüziv hastalığın eşlik ettiği görülmektedir. Bu çalışmada ciddi kalsifik asendan aortalı, kritik aortoiliyak oklüziv hastalığın eşlik ettiği düşük ejeksiyon fraksiyonlu ve/veya unstabil angina pektorisli komplike hasta grubunda uygulanan kombine cerrahi girişimin yakın dönem takip sonuçları incelendi.Çalışma planı: Ciddi koroner arter hastalığı ve birlikte kritik aortoiliyak oklüziv hastalığı olan 11 erkek hasta (ort. yaş 62.8) çalışmaya alındı. Hastalara kardiyak kateterizasyon, alt ekstremite arteriyel Doppler ultrasonografi, bilgisayarlı tomografi, manyetik rezonans anjiyografi uygulandı. Hastaların tamamına simultane çalışan kalpte koroner bypass ve ekstra anatomik periferik arteriyel revaskülarizasyon yapıldı.Bulgular: Ameliyat sonrası takip döneminde herhangi bir nörolojik, respiratuvar komplikasyon, kardiyak veya periferik iskemi gelişen olgu olmadı. Toplam takip süresi 3.4 yıldı, bir hasta periferik arteriyel greft oklüzyonu nedeniyle tekrar ameliyat edildi.Sonuç: Yüksek risk profiline sahip hastalarda kombine cerrahi yaklaşımın (ciddi kalsifik asendan aortanın manipülasyonundan kaçınılarak off pump koroner bypass cerrahi ve simultane ekstra anatomik periferik revaskülarizasyon) güvenli ve tercih edilir bir yöntem olduğu görüşündeyiz.

Yaygın aterosklerozisli hastalarda simultane koroner arter bypass ve periferik revaskülarizasyon

Background: Angiographically documented coexistence of coronary artery disease (CAD) and peripheric artery disease is as frequent as 37% to 78%. Although the coexistence of carotid artery stenosis or abdominal aortic aneurysm with CAD is a more common clinical situation, the prevalence of severe aortailiac occlusive disease (AIOD) has been reported as 4% and 15% in different series of patients undergoing coronary artery bypass operation. Short term follow-up results of the combined surgical interventions in a group of complicated patients with heavily calcified ascending aorta, simultaneous critical AIOD, low ejection fraction and/or unstable angina pectoris were evaluated in the present study.Methods: Eleven male patients (mean age 62.8), with severe CAD and coexisting critical AIOD were included in the study. All patients underwent cardiac catheterization, lower extremity arterial Doppler ultrasonography, abdominal computed tomography and magnetic resonance angiography. Simultaneous coronary bypass on the beating heart and extraanatomical peripheric arterial revascularization were performed to all patients.Results: There were no neurologic, respiratory complications, cardiac or peripheral ischemia in any of the cases in the postoperative follow-up period. The follow-up period was 3.4 years and only one patient has been reoperated due to an occluded graft.Conclusion: We conclude that in patients with a high risk profile, combined surgical approach consisting of offpump coronary bypass surgery and simultaneous extraanatomic peripheric revascularization, avoiding the manipulation of the heavily calcified ascending aorta, is a safe and preferrable approach.

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