Our Attempts of Femoropopliteal Bypass

Year 2007, Volume: 12 Issue: 4, 265 - 268, 01.08.2007

Ayhan Uysal Kadir Kaan Özsin Rafet Tok Eflatun Yücedağ Sefa Şenol Oktay Burma Ali Rahman

Abstract

Objectives: We aimed to determine the yearly patency of the used grefts and case which is performing of femoro-popliteal bypass because of obstructer artery disease. Materials and Methods: 107 femoro-popliteal bypasses are performed for 89 cases because of the extreme chronic obstructer disease and these bypass operations are evaluated. The disease is diagnosed by the help of physical examination and subtraction angiography. As bypass material; reverse safen ven and polytetrafluoroethylene (PTFE) greft were used. Coroner angiography was performed to case which has got ischemic diversification in its preoperative electrocardiography and angina. The cases are evaluated for a monthly postoperative mortality and morbidity and for yearly primer greft patency. Results: 49 (45.7%) of the 107 bypasses were under knee and 58 (54.3%) of them were upper knee. 81 (75.7%) of the bypasses were achieved by revers safen ven and 26 of them were achieved by PTFE greft. Primer patency was determined as %95.5 at the revers safen ven grefts, and it was determined as 70% at the PTFE grefts. PTCA was performed to the 11 (12.3%) of the cases with coroner artery disease, and to the 15 (16.8%) of them, peripheral vascular attempt was performed after coroner bypass. Conclusion: We suggest that in the cases with the disease of peripheral vascular, safen ven greft must be used because of the high patency rate at the appropriate patients, and because of the coroner artery disease which is commonly associated with the disease of peripheral vascular, the angiography must be performed as a preoperative routine survey. ©2007, Fırat Üniversity, Medical Faculty

Keywords

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Femoro-Popliteal By-Pass Girişimlerimiz

Abstract

Giriş: Tıkayıcı arter hastalığı nedeniyle femoro-popliteal bypass uyguladığımız olguları ve kullanılan greftlerin 1 yıllık patensi oranlarını belirlemeyi amaçladık. Gereç ve Yöntem: Alt ekstremite kronik tıkayıcı arter hastalığı nedeniyle 89 olguya uygulanan toplam 107 femoro-popliteal bypass operasyonu değerlendirildi. Tanı fizik muayene ve dijital substraksiyon anjiyografi ile konuldu. Bypass materyali olarak revers safen ven ve politetrafloroetilen (PTFE) greft kullanıldı. Preoperatif elektrokardiyografisinde iskemik değişiklikler olan ve/veya anjinası olan olgulara koroner anjiografi yapıldı. Olgular ilk 1 aylık postoperatif mortalite ve morbidite ile 1 yıllık primer greft patensisi açısından değerlendirildiler. Bulgular: Yapılan 107 femoro-popliteal bypassın 49'u (%45.7) dizüstü, 58'i (%54.3) ise diz altı idi. Bypasslardan 81'i (%75.7) revers safen ven, 26'sı (%24.3) PTFE greft ile gerçeklestirildi. Primer patensi revers safen ven greftlerde % 95.5 iken PTFE greftlerde %70 olarak bulundu. Koroner arter hastalığı saptanan olguların 11'ine (%12.3) PTCA, 15'ine (%16.8) ise koroner bypass sonrası periferik vasküler girişim uygulandı. Sonuç: Periferik vasküler hastalığı bulunan olgularda yüksek patensi oranları nedeniyle uygun hastalarda öncelikli olarak safen ven greftinin kullanılmasını ayrıca koroner arter hastalığı birlikteliği sık olarak görüldüğünden koroner anjiografinin preoperatif rutin tetkik olarak yapılmasını önermekteyiz. ©2007, Fırat Üniversitesi, Tıp Fakültesi

Keywords

Femoro-popliteal bypass, safen ven, PTFE, koroner arter hastalığı

References

• Kurç E, Enç Y, Çınar B, Kurç P, Kösem M, Sezerman Ö. Femoropopliteal bypass cerrahisinde greft seçimimiz ve uzun dönem patency sonuçlarımız. Türk Göğüs Kalp Damar Cer Derg 2000; 8: 616-618.
• Ünlü Y, Karapolat S, Karaca Y, Kızıltunç A. Comparison of levels of inflammatory markers and hemostatic factors in the patients with and without peripheral arterial disease. Thromb Res 2006; 117: 357-364.
• Criqui MH, Langer RD, Fronek A, et al. Mortality over a period of 10 years in patients with peripheral arterial disease. N Engl J Med 1992; 326: 381-386.
• Veith FJ, Haimovici H. Femoropopliteal aterosclerotic occlusive disease. Haimovici H, Ascer E, Hollier LH, Strandness DE, Towne JB (editors). Haimovici’s Vascular Surgery Principles and Techniques. 4.Baskı, Cambridge Massachusets, USA Blackwell Science Inc. 1996: 605-631.
• Edwards WH, Mulherin JL. The role of graft material in femorotibial bypass grafts. Ann Surg1980; 191: 721-726.
• Buckels JA, Wilson SE. The prevention and management of prosthetic graft infection. Wilson SE, VeithFJ, Hobson RW, WilIiams RA (editors). Vascular Surgery, McGraw-Hill Inc, 1987: 889-897.
• Falco E, Celoria G, Nardini A. Femoropopliteal bypass with reversed saphenous vein. Minerva Chir 1995; 50: 883-888.
• Plecha EJ, Freischlag JA, Seabrook GR. Femoropopliteal bypass revisted an analysis of 138 cases. Cardiovasc Surg 1996; 4: 195- 199.
• Soury PS, Pellion C, Watelet J, et al. Prosthetic reinforcement of varicose sapnenous vein grafts for infrainguinal bypass. Ann Vasc Surg 1999; 13: 290-393.
• Klinkert P, Schepers A, Burger DHC, et al. Vein versus polytetrofluoroethylene in above-knee femoropopliteal bypass grafting. Five years results of a randomized controlled trail. J Vasc Surg 2003; 37: 149-155.
• Kolbakır F, Keçeligil HT, Yılman M, Erk MK. Femoropopliteal ve infrapopliteal bypass uygulamaları. GKD Cer Derg 1995; 3: 131-133.
• Hamulu AR. Kombine koroner, karotis ve periferik girişimler. Paç M, Akçevin A, Aka SA, Büket S, Sarıoğlu T (editörler). Kalp ve Damar Cerrahisi. 1.Baskı, Ankara, MN Medikal & Nobel Tıp Kitap Sarayı. 2004:737-742.
• Kabul Tarihi: 21.05.2007