Levent YILIK, Mert KESTELLİ, Cengiz ÖZBEK, Tayfun GÖKTOĞAN, Banu LAFCI, İbrahim ÖZSÖYLER, Bilgin EMRECAN, Ali GÜRBÜZ

Stanford tip A aort diseksiyonlarında aksiller arter kanülasyonu

Amaç: Bu çalışmada Stanford tip A aort diseksiyonlarında sağ aksiller arter kanülasyonu deneyim sonuçlarımız incelendi. Çalışma planı: Nisan 2001 ve Şubat 2005 tarihleri arasında ameliyat edilen 60 hasta (22 kadın, 38 erkek; ort. yaş 52.0±10.9; dağılım 23-73) çalışmaya alındı. İlk 19 hasta (%31.7) direkt olarak sağ aksiller arterin kanülasyonu yoluyla ve sonraki 41 hasta (%68.3) sağ aksiller artere yan greft anastomozu yapılarak, greftin kanülasyonu yoluyla ameliyat edildi. Hastalar kanülasyona bağlı gelişen komplikasyonlar ve ortaya çıkan nörolojik olay yönünden incelendi.Bulgular: Ortalama ameliyat sonrası hastanede kalış süresi 8.2±3.9 gündü. Aksiller arter direkt kanülasyon yapılan iki hastada (%10.5) kanülasyona bağlı aksiller arter diseksiyonu, birinde (%5.2) sağ üst ekstremite iskemisi gelişti. Yan greft kanülasyonu yapılan hastalarda cerrahi komplikasyon görülmedi. Nörolojik komplikasyon gelişme oranı direkt kanülasyon yapılan hastalarda daha fazla olmasına karşın istatistiksel olarak anlamlı bulunmadı. Ameliyat sonrası dönemde altı hasta kaybedildi.Sonuç: Aksiler arter kanülasyonu, Stanford tip A aort diseksiyonunda rutin kullanılması gereken düşük morbidite ve mortalite oranına sahip bir yöntemdir.

Our clinical experience of axillary artery cannulation in stanford type a aortic dissections

Background: In this study, our surgical experience on axillary artery cannulation in Stanford type A aortic dissection was evaluated. Methods: Sixty patients (22 females, 38 males; mean age 52.0±10.9; range 23 to 73 years) were in the study who had been operated between April 2001 and February 2005. The first 19 patients (31.7) were operated by using direct axillary artery cannulation whereas the other 41 patients (68.3%) were operated by cannulating the graft which was anastomosed to the axillary artery in an end to side fashion. The patients were evaluated according to the cannulation related complications and neurologic events.Results: Mean postoperative hospital stay was 8.2±3.9 days. Axillary artery dissection in two patients (10.5%) and right upper extremity ischemia in one patient (5.2%) were seen in the patients with direct axillary artery cannulation. No surgical complication was met in side graft cannulation. The difference was not statistically significant although neurologic complications were higher in direct cannulation. Six patients died in the postoperative period.Conclusion: Axillary artery cannulation is a technique that has low morbidty and mortality rates and should be routinely used in Stanford type A aortic dissections.

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