Ahmet Turan YILMAZ, Veysel TEMİZKAN, Gökhan ARSLAN, İsmail SELÇUK, Şahin ŞENAY, Murat UĞUR, Alper UÇAK, İbrahim ALP, Arif SELÇUK

Vasküler hastalıkların yönetiminde endovasküler ve hibrid uygulamalar: Kardiyovasküler cerrahi kliniği deneyimleri

Amaç: Bu çalışmada kalp damar cerrahisi kliniğinde vasküler hastalıkların endovasküler olarak ya da hibrid işlemler ile tedavi edildiği üç yıllık deneyim bildirilmiştir. Çalışma planı: Ekim 2007 - Aralık 2010 tarihleri arasında GATA Haydarpaşa Eğitim Hastanesi Kalp Damar Cerrahisi Kliniği’nde endovasküler yöntemlerle tedavi edilen 66 hasta çalışmaya dahil edildi. Akut venöz trombozlu dört olguda kateter aracılığı ile fibrinolitik tedavi uygulandı. Travmaya bağlı infrapopliteal arteriyel kanamalı üç hastaya ve splenik arter anevrizması bulunan bir hastaya koil embolizasyon uygulandı. On üç hastaya torasik aort endovasküler stent greft implantasyonu uygulandı. Bu hastaların yedisinde sol karotiko-subklaviyan baypas ya da supraaortik damarların baypaslandığı hibrid işlemler uygulandı. Abdominal aort anevrizması nedeni ile 12 hastaya stent greft implantasyonu uygulandı. Karotis stent implantasyonu uygulanan 11 hastanın üçüne eş zamanlı olarak koroner arter baypas greft (KABG) cerrahisi yapıldı. Periferik arter stent implantasyonu uygulanan 22 hastadan ikisine eş zamanlı olarak profundaplasti ve birine femoropopliteal baypas ameliyatı uygulandı. Bulgular: Ameliyat sırasında mortalite görülmedi. Endovasküler işleme bağlı olarak gelişen aortik stent greftin retrograd migrasyonu ya da iliyak bacağın oklüzyonu gibi komplikasyonlar hibrid ameliyathanenin sağladığı avantaj ile eş zamanlı olarak tedavi edildi. Hastalar ameliyat sonrası ortalama 4.9±3.7 günde taburcu edildi. Torasik endovasküler işlem uygulanan bir hasta işlem sonrası ikinci ayda aortoözofageal fistül gelişmesi sonrası ameliyat edildi; ancak takiplerinde gelişen mediastinit nedeni ile kaybedildi. İki hasta da kalp ve damar dışı rahatsızlıkları nedeni ile takip döneminde kaybedildi. Sonuç: Özellikle yüksek riski hastalarda endovasküler tekniklerin uygulanması düşük mortalite ve morbidite ile uygulanabilir. Kalp damar cerrahisi kliniklerinde hibrid ameliyathanelerin ya da girişimsel laboratuvarların düzenlenmesi endovasküler işlemlerin uygulanabilmesi için önem arz etmektedir.

Endovascular and hybrid treatment in the management of vascular disease: Experience of a cardiovascular surgery department

Background: This study reports a three year experience of a cardiovascular surgery department in endovascular and hybrid procedures for the treatment of vascular diseases. Methods: Between October 2007 - December 2010, 66 patients who were treated with endovascular methods in the Department of Cardiovascular Surgery of GATA Haydapasa Training Hospital were included in this study. Fibrinolitic treatment was performed with a guidance of catheter in four cases with acute venous thrombosis. Coil embolization was performed in three patients with infrapopliteal arterial hemorrhage due to trauma, and one patient with splenic artery aneurysm. Thoracic aortic endovascular stent graft implantation was performed on 13 patients. Hybrid procedures including left carotico-subclavian bypass or supraaortic bypasses were performed on seven of them. Stent graft implantation was also performed on 12 patients due to abdominal aortic aneurysm. Simultaneous coronary artery bypass graft (CABG) surgery was performed in three of 11 patients who underwent carotid stent implantation. Two of 22 patients with peripheral arterial stent implantation underwent profundoplasty, while one of them underwent femoropopliteal bypass surgery. Results: No intraoperative mortality was observed. Complications due to endovascular procedure such as retrograde migration or iliac leg occlusion were treated in the same procedure with an advantage of hybrid operating room. Patients were discharged from the hospital with a mean of 4.9±3.7 days following surgery. One patient who experienced aortoesophageal fistula at two months following thoracic endovascular procedure was operated; however the patient died due to mediastinitis during follow-up visits. Two patient died related to extracardiac or extravascular events during the follow-up period. Conclusion: The usage of endovascular techniques may offer a lower mortality and morbidity rate especially in high-risk patients. Installation of hybrid operating rooms or interventional laboratories in the cardiovascular surgery department is of utmost importance for the implantation of endovascular procedures.

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