Beşir AKPINAR, Volkan YURTMAN, Veysel ŞAHİN, Feyzi ABACILAR, İhsan Sami UYAR, Faik Fevzi OKUR, Mehmet ATEŞ, Emin Alp ALAYUNT

Surgical treatment alternatives for occlusive disease of the subclavian artery based on our clinical experience

Amaç: Çalışmamızda, subklaviyan karotis transpozisyon (SKT), karotis subklaviyan baypas (KSB) ve subklaviyan- subklaviyan baypas (SSB) işlemlerinin sonuçları tanımlandı. Çalışma planı: Ocak 1999 - Aralık 2009 tarihleri arasında kliniğimizde semptomatik tıkayıcı subklaviyan arter hastalığı tanısıyla cerrahi tedavi uygulanan 20 hastanın (19 erkek, 1 kadın; ort. yaş 58.5 yıl; dağılım 46-73 yıl) tıbbi kayıtları retrospektif olarak incelendi. On hastaya SKT, altı hastaya KSB, dört hastaya da SSB ameliyatı uygulandı. Bütün hastalarda ciddi subklaviyan arter yetersizliği semptomları vardı ve etkilenen taraftaki sistolik kan basıncı diğer tarafa göre en az 50 mmHg daha düşük idi. Ortalama takip süresi 7.1±2.1 yıl (dağılım 2-10 yıl) idi. Bulgular: Yüzde doksan beş erken greft başarı oranı (30 günlük açık kalma) ile hastaların %100ünde semptomların düzeldiği görüldü. Bir, beş ve 10 yıllık not edilen primer açıklık oranları sırasıyla SKT serisinde %100, %100, %90, KSB serisinde, %100, %83.3, %66.7, ve SSB serisinde %100, %50, %50 idi. Sonuç: Erken ve geç dönem ameliyat sonrası sonuçlar karşılaştırıldığında, uygun olan hastalarda subklaviyan arterin karotis artere transpozisyonunun güvenli, etkin ve kalıcı bir işlem olduğu görülmektedir.

Klinik deneyimlerimiz eşliğinde subklaviyan arterin tıkayıcı ha stalığında cerrahi tedavi alternatifler

Background: In this study, we described the outcomes of the procedures including subclavian carotid transposition (SCT), carotid subclavian bypass (CSB) and subclavian- subclavian bypass (SSB). Methods: Between January 1999 and December 2009, the medical records of 20 patients (19 males, 1 female; mean age 58.5 years; range 46 to 73 years) undergoing surgical intervention for symptomatic occlusive subclavian artery disease in our clinic were retrospectively analyzed. Ten of these patients underwent SCT, six underwent CSB and four underwent SSB. All patients had symptoms of severe subclavian artery insufficiency and a significant decrease of >50 mmHg in systolic blood pressure on the affected side. The mean follow-up was 7.1±2.1 years (range, 2-10 years). Results: Immediate relief of symptoms was achieved in 100% of patients, with an early graft success (30-day patency) of 95%. As noted primary patency rates at 1, 5, and 10 years in SCT series were %100, %100, %90, in CSB series %100, %83.3, % 66.7, in SSB series %100, %50, %50 respectively. Conclusion: The comparison of the early and late postoperative results show that transposition of subclavian artery to carotid artery is a safe, effective and durable procedure in eligible patients.

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