Mehmet BALKANAY, Murat ÖKTEN, Kaan KIRALİ, Vedat ERENTUĞ, Esat AKINCI, Cevat YAKUT, İlker MATARACI, Mehmet AKSÜT

Torakoabdominal aort anevrizması ve diseksiyonlarının distal femoro-femoral perfüzyon tekniğiyle cerrahi onarımı

Amaç: Torakoabdominal aort anevrizma ve diseksiyonlarının onarımında distal vital organların iskemisi ve reperfüzyon hasarı en önemli sorundur. Distal femorofemoral perfüzyon tekniği bu riski önemli ölçüde azaltır. Çalışmamızda bu teknikle ameliyat edilen olguların sonuçları değerlendirildi. Çalışma planı: Torakoabdominal aort anevrizması ve diseksiyonu tanısıyla 15 hastaya (12 erkek, 3 kadın; ort. yaş 50±14; dağılım 29-80) distal femoro-femoral perfüzyon tekniği kullanılarak 17 cerrahi girişim uygulandı. Girişimlerin 14’ü (%82.4) elektif, üçü (%17.6) acil şartlarda gerçekleştirildi. Proksimal aortta normal arteryel ve venöz dolum basınçları idame ettirilirken, distal aortta arteryel basıncı 60-70 mmHg arasında tutmak için 1000-1500 ml/ dk femoro-femoral perfüzyon sağlandı. Rektal ısı 30 °C’nin altına düşürülmedi. Hastalar ortalama 3.5±1.9 yıl (dağılım 0.8-6.8 yıl) takip edildi.Bulgular: Dört hasta (%23.5) erken dönemde kaybedildi. Acil girişim mortalitesi %66.7 iken, elektif olgularda mortalite oranı %14.3 idi. Üç hastada (%17.6) akciğer sorunu, üç hastada (%17.6) geçici renal fonksiyon bozukluğu, bir hastada (%5.8) parapleji, bir hastada (%5.8) geçici paraparezi gelişti.Sonuç: Torakoabdominal aort anevrizması ve diseksiyonlarının cerrahi tedavisinde, medulla spinalis ve viseral organların korunmasında distal femoro-femoral perfüzyon tekniğiyle onarım mortalite ve morbiditeyi azaltabilecek bir teknik olarak uygulanabilir.

Surgical repair of thoracoabdominal aortic aneurysms and dissections using the femoro-femoral distal perfusion technique

Background: Ischemia of distal vital organs and reperfusion injury are the most important complications during surgical repair of thoracoabdominal aortic aneurysms and dissections. Distal femoro-femoral perfusion can reduce this risk in these patients. We evaluated the results of our patients operated on with this technique. Methods: The study included 15 patients (12 males, 3 females; mean age 50±14 years; range 29 to 80 years) who underwent 17 operations using the femoro-femoral perfusion technique for the treatment of thoracoabdominal aortic aneurysms and dissections. Of these, 14 (82.4%) were elective, and three (17.6%) were emergency operations. While normal arterial and venous filling pressures were maintained in the proximal aorta, femoro-femoral perfusion was employed at 1000-1500 ml/min to keep the arterial pressure at 60-70 mmHg in the distal aorta. Rectal temperature was kept above 30 ºC. The mean follow-up was 3.5±1.9 years (range 0.8 to 6.8 years).Results: Operative mortality occurred in four patients (23.5%) in the early postoperative period, being 66.7% in emergency cases and 14.3% in elective cases. Complications included respiratory problems (n=3, 17.6%), transient acute renal failure (n=3, 17.6%), paraplegia (n=1, 5.8), and temporary paraparesis (n=1, 5.8).Conclusion: The use of the distal femoro-femoral perfusion technique to protect visceral organs and prevent spinal cord ischemia may decrease mortality and morbidity in patients undergoing surgery for thoracoabdominal aortic aneurysms and dissections.

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