Periferik arter bypass cerrahisinde greft seçimi ve bu seçimin greft açıklığına katkısı [Graft selection for the peripheral vascular by-pass surgery and its contribution to patency]

Öz

Objectives: In this study, we aimed to present clinical results associated with graft selection in peripheral bypass surgery. Materials and methods: Between August 2007 and January 2009, 68 patients who underwent peripheral arterial bypass surgery in our cardiovascular department were included in this study. Eighty-one percent (n=55) of them were male and 19 % (n=13) of them were female, patients\' mean age was 57±10 years. We have performed aorto-bifemoral bypass to 16 patients, femoro-politeal bypass to 36 patients, femoro-femoral cross over bypass to 7 patients, ilio-femoro-politeal bypass to 4 patients, aorto- femoral bypass to1 patient and axillo-bifemoral bypass in 4 patients, respectively. Saphenous vein, stented or stentless polytetrafluoroethylene (PTFE) and Dacron grafts and composite grafts were used according to atherosclerotic area and surgical technique. Results: Above knee bypass procedure was performed in 31 patients and the remaining 7 patients required knee level or below knee bypass procedure. Comparing synthetic grafts and composit vein grafts above knee and below knee regions, revealed that there was no difference in above knee region, but in the below knee region autogenous saphenous vein graft was superior to synthetic grafts in patency rate. Conclusion: In this study, according to patency rate, there was no difference in above knee bypass procedures; but in the below knee bypass procedures, autogenous saphenous vein graft was found superior to synthetic grafts.

Anahtar Kelimeler

• Peripheral by-pass, graft selection

Periferik arter bypass cerrahisinde greft seçimi ve bu seçimin greft açıklığına katkısı

Öz

Amaç: Bu çalışmada, periferik bypass cerrahisinde seçilen greftlerle ilgili klinik sonuçlarımızı sunmayı amaçladık. Gereç ve yöntem: Çalışmaya Ağustos 2007- Ocak 2009 tarihleri arasında Kalp ve Damar Cerrahisi kliniğinde periferik arter bypass cerrahisi uygulanan 68 hasta alınmıştır. Hastaların % 81\'i erkek (n=55), %19\'u kadındı (n=13) ve yaşları ortalama 57±10 idi. Hastalardan 16 tanesine aorto-bifemoral bypass, 36 hastaya femoro-popliteal bypass, 7\'sine femoro-femoral kros over bypass, 4\'üne ilio-femoro-popliteal bypass, 4\'üne axillo-bifemoral bypass ve 1 hastaya aorto- femoral bypass yapıldı. Aterosklerotik alana ve yapılacak cerrahi tekniğe göre Safen ven, ringli politetrafloroetilen (PTFE) ve Dacron, ringsiz PTFE ve Dacron veya kompozit greft kullanıldı ve bir yıllık açıklık oranları karşılaştırıldı. Bulgular: Hastalar bir yıl boyunca klinik olarak ve doppler ultrasonografi ile değerlendirmeye alındı. Ringli PTFE ile axillo-femoral yapılan 1 hastada 3. ayda, femoro-popliteal bypass yapılan 1 hastada 6. ayda total oklüzyon görüldü. Ringli PTFE femoro-femorol cross over yapılan bir vakada, ringsiz PTFE kullanılan dört femoro-popliteal vakasında ve otojen safenven kullanılan bir femoropopliteal vakasında asemptomatik %20-50 stenoza yol açan daralmalar tespit edildi. Hastaların 31\'ine diz üstü, 37\'sine de diz ve diz altı bölgelere cerrahi girişim uygulandı. Diz üstü bölgede kullanılan sentetik greftler arasında ve sentetik greftlerle safen ven greftleri arasında açıklık oranı bakımından önemli bir fark görülmezken, diz ve diz altı bölgesinde safen ven greftinin diğer sentetik greftlere gör daha üstün olduğu görülmüştür. Sonuç: Sonuç olarak, otolog safen ven greftleri özellikle diz ve diz altı yaklaşımlarda en avantajlı grefttir.

Anahtar Kelimeler

• Periferik bypass, greft seçimi

Kaynakça

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