Yavuz ENÇ, Erol KURÇ, Bayer ÇINAR, Mesut KÖSEM, Ergin EREN, Onur GÖKSEL, İlhan ÖZTEKİN, Sertaç ÇİÇEK, İhsan BAKIR

Subklavyan arterin tıkayıcı hastalığı: Koroner ve subklavyan çalma sendromu

Amaç: Bu çalışma, subklavyan arterin oklüziv hastalıklarında politetrafluroetilen (PTFE) greftlerle uygulanan karotiko-subklayan bypass operasyonlarının kısa ve uzun dönem sonuçlarını tespit etmek için yapıldı.Materyal ve Metod: Ocak 1990 ve Ocak 2003 arasında tanısı subklavyan çalma sendromu (54) ve koroner çalma sendromu (12) olan ve karotiko-subklavyan bypass uygulanan 66 hastanın bilgileri retrospektif olarak incelendi. Erken ve geç sonuçlar analiz edildi. Kümülatif açıklık ve tüm yaşamda kalım hızları yaşam-tablosu yöntemiyle incelendi.Bulgular: İntraoperatif ölüm görülmedi, ancak 30-gün takiplerde bir hasta kaybedildi. Ortalama 96 aylık (6-44 ay) takiplerde 13 hasta kaybedildi. 1., 3., 5. ve 10. yıllarda primer açıklık oranları %98, %91, %83 ve %47 olarak bulundu. Aynı dönemlerde yaşamda kalım ise %100, %95, %93 ve %38 şeklindeydi.Sonuç: PTFE greftlerle karotiko-subklavyan bypasslar güvenilir, efektif ve kalıcı sonuçlar sunmaktadır. Rejyonel anestezi ile yapılabilirliği ayrıca kolaylık sağlar.

Occlusive disease of subclavian artery: Subclavian and coronary steal syndrome

Backgrounds: This review was conducted to analyze the long-term results of carotid-subclavian bypass with polytetrafluoroethylene (PTFE) grafts used for occlusive subclavian artery disease. Methods: In this retrospective study, the medical records of 66 (54 for subclavian steal syndrome and 12 for coronary steal syndrome) patients undergone carotid-subclavian bypass between January 1990 and January 2003 were reviewed. Early (operative mortality and morbidity) and late results cumulative patency and overall survival rates were analyzed with life-table method.Results: There was no intraoperative mortality and one case of mortality in 30-day follow-up. Only one peri-operative cerebrovascular accident was observed. Over a mean follow-up of 96 months (6-44 months) after operation, 13 patients died. The primary patency rates at 1, 3, 5 and 10 years were 98%, 91%, 83% and 47% and the overall survival rates at 1, 3, 5 and 10 years were 100%, 95%, 93% and 38%, respectively.Conclusions: Carotid-subclavian bypass with PTFE grafts is a safe, effective and durable procedure. It can be easily applied to patients under regional anaesthesia when percutaneous intervention is unsuccessful or impossible.

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