Karotis endarterektomide geleneksel yöntemlerin canlandırılması: primer kapatma tekniklerinin kapsamlı bir incelemesi

Abstract

Amaç: Karotid endarterektomi (KEA), karotid arter hastalığının tedavisinde önemini korurken, son zamanlarda birincil kapatma tekniklerine olan ilgi artmıştır. Bu çalışma, geleneksel yöntemlerle karşılaştırıldığında birincil kapatmanın sonuçlarını, etkinliğini ve güvenliğini araştırmaktadır. Gereç ve yöntem: Ocak 2018 ile Nisan 2024 tarihleri arasında kliniğimizde primer kapatma ile KEA uygulanan 130 hastanın retrospektif analizi yapıldı. Tüm ameliyatlar genel anestezi altında standart bir prosedür izledi. Hastaların demografik özellikleri, ameliyat süresi, kros klemp süresi, mortalite, morbidite ve hastanede kalış süresiyle ilgili veriler toplandı. Takip değerlendirmeleri ameliyattan 1, 6 ve 12 ay sonra gerçekleştirildi. Bulgular: Çalışmaya 90 erkek (%69) ve 40 kadın (%31) olmak üzere toplam 130 hasta dahil edildi. Hastaların ortalama yaşı 69,54±5,42 yıldı. Takiplerin 12. ayında, asemptomatik olarak 5 hastada (%3) restenoz gelişti. Postoperatif dönemde 3 hastada geçici iskemik atak (TIA) görüldü ve bu ataklar bir ay içinde tamamen düzeldi. Önemli olarak, bir aylık takip süresi boyunca hiçbir erken ölüm vakası bildirilmedi. Sonuç: KEA'da primer kapatma tekniği, düşük restenoz ve postoperatif komplikasyon oranları ile erken mortalite olmaması bakımından umut verici sonuçlar ortaya koymaktadır. Bu bulgular, primer kapatma tekniğinin KEA’da avantajlı bir yaklaşım olabileceğini göstermektedir. Yöntemin doğrulanması ve optimize edilmesi amacıyla daha fazla araştırma ve prospektif çalışmalar gereklidir, böylece karotis arter hastalığının yönetiminde hasta sonuçları iyileştirilebilir.

Keywords

• Karotis endarterektomi
• primer kapatma
• cerrahi teknikler
• restenoz

Revitalizing traditional carotid endarterectomy methods: a comprehensive review of primary closure techniques

Abstract

Purpose: Carotid endarterectomy (CEA) remains essential for the treatment of carotid artery disease; however, primary closure techniques have recently gained interest. This study investigated the outcomes, efficacy, and safety of primary closure compared with conventional methods. Materials and methods: A retrospective analysis of 130 patients who underwent CEA with primary closure at our clinic between January 2018 and April 2024 was performed. All surgeries followed a standardized procedure under general anesthesia. Data on demographics, surgical time, cross-clamp time, mortality, morbidity, and length of hospital stay were collected. Follow-up evaluations were performed 1, 6, and 12 months post-surgery. Results: The study included 130 patients, 90 males (69%) and 40 females (31%), with an average age of 69.54±5.42 years. Restenosis occurred in five patients (3%) at 12 months, all of whom were asymptomatic. Three patients experienced transient ischemic attacks (TIA) postoperatively, which fully resolved within one month. Importantly, no early mortality was recorded during the one-month follow-up period. Conclusion: Primary closure in CEA demonstrates promising outcomes, with low rates of restenosis and postoperative complications and no early mortality. These findings highlight primary closure as a potentially advantageous approach for CEA. Further research and prospective trials are necessary to validate and optimize this technique and ultimately improve patient outcomes in carotid artery disease management.

Keywords

• Carotid endarterectomy
• primary closure
• surgical techniques
• restenosis

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