Koroner By-pass Cerrahisinde Alternatif Arteryel Greft Olarak A. Thoracodorsalis ve A. Thoracica Lateralis: Morfolojik Bir Çalıșma

Yıl 2017, , 19 - 27, 21.04.2017

Deniz Uzmansel

https://doi.org/10.1501/Tipfak_0000000960

Öz

Amaç: A. thoracica interna ve v. saphena magna günümüzde en sık kullanılan koroner by-pass greftleridir. Arteryel greftler, venöz greftlere göre daha iyi açık kalma oranlarına sahiptir. A. thoracica interna ve v. saphena magna’nın kullanılamayacağı veya daha önceki operasyonda kullanıldığı, ayrıca birden fazla koroner artere aynı anda by-pass gerektiren veya birden fazla grefte ihtiyaç duyulan durumlarda halen alternatif arteryel greftlere ihtiyaç vardır.

Gereç ve Yöntem: Bu çalıșmada, yaș ortalaması 56,67±6,38 olan 9 erkek kadavradan bilateral olarak elde edilen, a. thoracica lateralis ve a. thoracodorsalis’in koroner by-pass operasyonlarında greft olarak kullanıma uygun olup olmadıklarının ortaya konulması amaçlandı. Bu arterlerin baș, orta ve son kısımlarına ait morfolojik özellikler (boy, lümen çapı, tunica intima ve media kalınlıkları, lamina elastica interna ve externa’nın özellikleri, tunica media tabakasının elastik ve düz kas dokusu içeriği) a. thoracica interna, a. radialis ve koroner arterlerin (r. interventricularis anterior, r. circumflexus, a. coronaria dextra) morfolojik özellikleriyle karșılaștırıldı. 

Bulgular: A. thoracica lateralis ve a. thoracodorsalis’in iyi gelișmiș lamina elastica interna’ya sahip oldukları saptandı. Ayrıca a. thoracica lateralis ve a. thoracodorsalis’nin tunica intima ve media kalınlıkları genellikle a. thoracica interna ve a. radialis’in tunica intima ve media kalınlıklarına benzer veya daha ince olduğu görüldü. Bu bulgular, her iki arterin koroner by-pass cerrahisinde greft olarak kullanılabilmesi açısından olumlu özellikler olarak değerlendirildi.

Sonuç: A. thoracica lateralis’in boy ve lümen çapı, tek bașına serbest greft olarak kullanım için yeterli bulunmazken, a. thoracodorsalis ise yeterli bulundu. Bununla birlikte her iki arterin, diğer greftlerle birlikte kompozit greft (Y greft gibi) uygulamalarında, boy ve lümen açısından yeterli olabileceği sonucuna varıldı. 

Anahtar Kelimeler

Alternatif Arteryel Greft, a. Thoracic a Lateralis, a. Thoracodorcalis

Kaynakça

• 1. Angelini GD, Bryan AJ, Dion R. Arterial Conduits in Myocardial Revascularization. New York, Oxford University Press, 1996:3–6,32,33,141,142.
• 2. Tezcaner T, Karagöz H, Çatav Z, et. al.. Koroner Bypass Cerrahisinde Arteriel Greftler. GKD Cer. Derg. 1992;1:80–86.
• 3. Erentürk S, Bakır İ, Mert M, Gübaran M, Soybir N. Koroner Bypass Operasyonlarında Gastroepiploik Arter Kullanılması. TGKDCD. 2000;8:501–504.
• 4. Kwang Ree C, Jun-Sung K, Jae-Sung C, et. al. Serial angiographic follow-up of grafts one year and five years after coronary artery bypass surgery. European Journal of Cardio-thoracic Surgery. 2006:1–6.
• 5. Berger A, MacCarthy PA, Vanermen H, et al. Occlusion of Internal Mammary Grafts: a review of the Potential Causative Factors. Acta Chir Belg. 2004;104:630–63.
• 6. Desai ND, Cohen EA, Naylor CD, et. al. A Randomized Comparison of RadialArtery and Saphenous-Vein Coronary Bypass Grafts. N Engl J Med. 2004;351:2302–9.
• 7. Eagle KA, Guyton RA, Davidoff R, et. al. ACC/AHA guidelines for coronary artery bypass graft surgery: A report of the American College of Cardiology/ American Heart Association task force on Practice Guidelines (Committee to revise the 1991 Guidelines for Coronary Artery Bypass Graft Surgery). J. Am. Coll. Cardiol. 1999;34:1262–1347.
• 8. Kuan-Ming C, Shu-Hsun C. Coronary Artery Surgery-Recent Developments. Acta Cardiol Sin. 2005;21:131–136
• 9. Lemma M, Mangini A, Gelpi G, et. al. Is it better to use the radial artery as a composite graft? Clinical and angiographic results of aorto-coronary versus Y-graft. European Journal of Cardio-thoracic Surgery. 2004;26:110–117.
• 10. Schamun CM, Duran JC, Rodriguez JM, et. al. Coronary revascularization with the descending branch of the lateral femoralcircumflex artery as a composite arterial graft. J Thorac Cardiovasc Surg. 1998;116:870–871.
• 11. Bozbuğa NU, Yaymacı B, Kırali K et. al.. Femoral Arterin Lateral Sirkumfleks Dalının Potansiyel Bir Arteriyel Greft Olarak Morfometrik Özellikleri. Türk Göğüs Kalp Damar Cer Derg. 2001;9:145–148.
• 12. Egidius EHLA, Joop HMS, Mehran F, et. al.. The Left Gastric Artery as an In-Situ Conduit in Coronary Artery Bypass Grafting. Ann Thorac Surg. 2001;71:1013– 1014.
• 13. Suma H, Isomura T. The right gastroepiploic artery graft. Multimedia Manual of Cardiothoracic Surgery. doi:10.1510/mmcts.2004.000802.
• 14. Buxton BF, Chan AT, Dixit AS, et. al. Marshall RD, Raman JS. Ulnar Artery as a Coronary Bypass Graft. Ann Thorac Surg. 1998;65:1020–1024.
• 15. Šimić O, Zambelli M, Zelić M, et. al. How to do it Thoracodorsal artery as a free graft for coronary artery bypass grafting. European Journal of Cardio-thoracic Surgery. 1999;16:94–96.
• 16. Van Son JA, Smedts F, Korving J, et. al. Intercostal artery: histomorphometric study to assess its suitability as a coronary bypass graft. Ann Thorac Surg. 1993;56:1078–1081.
• 17. John LCH, Chan CLH, Anderson DR. Potential Use of the Intercostal Artery as an In Situ Graft: A Cadaveric Study. Ann Thorac Surg. 1995;59:190–195.
• 18. He GW, Yang Q, Yang CQ. Smooth Muscle and Endothelıal Functıon of Arterıal Grafts for Coronary Artery Bypass Surgery. Clinical and Experimental Pharmacology and Physiology. 2002;29:717– 720.
• 19. Malikov S, Casanova D, Champsaur P, et. al. The Bypass Flap: An Innovative Technique of Distal RevascularizationAnatomical Study and Clinical Application. Annals of Vascular Surgery. 2004;18:535–543.
• 20. Kawamura K, Yajima H, Kobata Y, et. al. Anatomy of Y-Shaped Configurations in the Subscapular Arterial System and Clinical Application to Harvesting FlowThrough Flaps. Plastic And Reconstructive Surgery. 2005;116:1082–1089.
• 21. Chen SL, Chen TM, Wang HJ. Free thoracodorsal artery perforator flap in extremity reconstruction: 12 cases. The British Association of Plastic Surgeons. 2004;57:525–530.
• 22. Mills NL, Dupin CL, Everson CT, et. al. The subscapular artery: an alternative conduit for coronary bypass. J Card Surg. 1993;8:66–71.
• 23. Watanabe G, Misaki T, Kotoh K, et. al. Left thoracodorsal artery as an inflow graft for minimally invasive direct coronary artery bypass grafting. J Thorac Cardiovasc Surg. 1998;116:524-5.
• 24. Yaginuma G, Sakurai M, Meguro T, et. al. Thoracodorsal artery as a free arterial graft for myocardial revascularization. Ann Thorac Surg. 2001;72:915–916.
• 25. Moro H, Ohzeki H, Hayashi JI, et. al. Evaluation of the thoracodorsal artery as an alternative conduit for coronary bypass. Thorac Cardiovasc Surg. 1997;45:277–279.
• 26. Yüksel M, Yüksel E. Anomalous Branching Order of the Superior and Lateral Thoracic Arteries. Clinical Anatomy. 1997;10:394–396.
• 27. Lipa JE, Chang DW. Lateral Thoracic Artery as a Vascular Variant in the Supply to the Free Serratus Anterior Flap. Journal Of Reconstructive Microsurgery. 2001;17:413-415.
• 28. Mac Quillan A, Horlock N, Grobbelaar A, et. al. Arterial and Venous Anatomical Features of the Pectoralis Minor Muscle Flap Pedicle. Plastıc And Reconstructıve Surgery. 2004;113:872–876.
• 29. Yuan SM, Shinfeld A, Kachal E, et. al. The Alternatives of Autologous Arterial Grafts for Coronary Bypass Surgery. Acta Cardiol Sin. 2006;22:121–133.
• 30. Rowsell AR, Davies DM, Eisenberg N, et. al. The anatomy of the subscapularthoracodorsal arterial system: study of 100 cadaver dissections. Br J Plast Surg. 1984;37:574-576.
• 31. Malikov S, Magnan DCPE, Champsaur ABP. Anatomical bases of the bypassflap: study of the thoracodorsal axis. Surg Radiol Anat. 2005;27:86–93.
• 32. Seitz A, Papp S, Papp C, et. al. The Anatomy of the Angular Brach of the Thoracodorsal Artery. Cell Tissues Organs. 1999;164:227-236.
• 33. http://www.medicine.ankara.edu.tr/cerra hi_tip/kvc/modules/show.php?page=C ABG_conduit (2007-04-24).
• 34. Taşdemir K, Emiroğulları ÖN, Kunt A et. al. Yaşlılarda koroner arter cerrahisi. Ank Üni Tıp Fak Mecm 1997;50:149-151.
• 35. Arıncı K, Elhan A. Anatomi, 2. Cilt. 4. baskı. Ankara, Güneş Kitapevi Ltd. Şti., 2006:19–20, 46–47, 48–49.
• 36. Netter FH. The Netter Collection of Medical Illustrations, Musculoskeletal System. East Hanover, Novartis, 1997;8:26.