Surgical experiences in concomitant carotid endarterectomy and coronary artery bypass surgery

Yıl 2014, Cilt: 17 Sayı: 2, 124 - 127, 01.02.2013

Bayram Yılmazkaya Sami Gürkahraman Alaa Hijazi Murat Ercişli Deniz Demir Aytekin Yeşilay

https://doi.org/10.4274/khj.09825

Öz

Introduction: We aimed to investigate the results of concomitant carotid endarterectomy and coronary artery bypass grafting operations in patients with coronary artery disease and carotid artery stenosis. Patients and Methods: 38 consecutive patients who were operated on concomitantly were included in this study. Digital substraction angiography or computerized tomoghraphic angiography was performed for the patients and stenosis 70 % or higher were accepted for operation. The mean age was 69 ± 8,5. There was a history of vertigo in 21 (55.3 %), syncope in 10 (26.3 %), carotid souffle in 16 (42.1 %), and transient ischemic attack in 12 (31.6 %) patients. 17 (44,7 %) patients were asymptomatic. Carotid endarterectomy was performed first and patch angioplasty was performed with synthetic patch. Then, intraluminal shunt was used for all patients. Coronary artery bypass grafting was performed under cardiopulmonary bypass. Proximal anastomosis were fashioned under single cross clamp. Results: Hospital deaths occured in one patient due to low cardiac output. The mean length of intensive care unit stay was 16.9 ± 7.4 hours, ventilatıon period 7 ± 1,5 hours and mean length of hospital stay was 6.6 ± 2.9 days. Conclusion: Concomitant carotid endarterectomy and coronary artery bypass grafting operations can be safely performed with using intraluminal shunt in patients with significant carotid artery stenosis and coronary artery disease.

Anahtar Kelimeler

Endarterctomy, carotid Artery, Coronery Bypass

Kombine karotid endarterektomi ve koroner baypas cerrahisinde deneyimlerimiz

Öz

Giriş: Karotid arter stenozu ve koroner arter hastalığı birlikteliğinde kombine şekilde tek anestezi seansında karotid endarterektomi ve koroner baypas yaptığımız hastaların sonuçlarını incelemek ve deneyimlerimizi sunmaktırHastalar ve Yöntem: Kombine şekilde karotid endarterektomi ve koroner baypas yapılan 38 hasta retrospektif olarak incelendi. Digital substraksiyon anjiyografi veya bilgisayarlı tomografik anjiografi % 70 ve üzerindeki darlıklar ameliyat yapıldı. Yaş ortalaması 69 ± 8,5 yıldı. Hastalardan vertigo 21 (% 55,3), senkop 10 (% 26,3), karotid üfürüm 16 (% 42.1), geçici iskemik atak öyküsü 12 (% 31,6) hastada vardı. On yedi (% 44.7) hastada herhangi bir semptom yoktu. Önce karotid endarterektomi sonra sentetik yamayla anjiyoplasti yapıldı. Bütün hastalarda intraluminal şant kullanıldı. Daha sonra kardiyopulmoner baypas altında koroner baypas yapıldı. Proksimal anastomozlar, kros klemp eşliğinde yapıldı. Bulgular: Bir hasta düşük debi nedeni ile hastanede kaybedildi (% 2,6). Hastaların yoğun bakımda ventilasyon süresü 7 ± 1,5 saat, kalış süresi 16,9 ± 7,4 saat, hastanede kalış süresi 6,6 ± 2,9 gündü. Postoperatif dönemde hiçbir hastada serebrovasküler olay olmadı. Sonuç: Anlamlı karotid arter stenozu ve koroner arter hastalığı olan hastalarda, kombine şekilde aynı seansta karotid endarterektomi ve koroner baypas intraluminal şant kullanılarak düşük morbidite ve mortalite oranlarıyla güvenle yapılabilir.

Anahtar Kelimeler

Endarterektomi, Karotis Arter, Koroner Bypass

Kaynakça

• Mackey WC, Khabbaz K, Bojar R, O’Donnell TF Jr. Simultaneous carotid endarterectomy and coronary bypass: perioperative risk and long-term survival. J Vasc Surg 1996;24:58-64.
• Hertzer NR, Loop FD, Taylor PC, Beven EG. : Combined myocardial revascularization and carotid endarterectomy. Operative and late results in 331 patients. J Thorac Cardiovasc Surg 1983;85:577-89.
• Breslau PJ, Fell G, Ivey TD, Bailey WW, Miller DW, Strandness DE Jr. Carotid arterial disease in patients undergoing coronary artery bypass operations. J Thorac Cardiovasc Surg 1981;82:765-7.
• Faggioli GL, Curl GR, Ricotta JJ. The role of carotid screening before coronary artery bypass. J Vasc Surg 1990;12:724-31.
• Rizzo RJ, Whittemore AD, Couper GS, Donaldson MC, Aranki SF, Collins JJ Jr, et al. Combined carotid and coronary revascularization: the preferred approach to the severe vasculopath. : Ann Thorac Surg 1992;54:1099-109.
• Chang BB, Darling RC 3rd, Shah DM, Paty PS, Leather RP. Carotid endarterectomy can be safely performed with acceptable mortality and morbidity in patients requiring coronary artery bypass grafts. Am J Surg 1994;168:94-6.
• Brener BJ, Brief DK, Alpert J, Goldenkranz RJ, Parsonnet V. The risk of stroke in patients with asymptomatic carotid stenosis undergoing cardiac surgery: a follow-up study. J Vasc Surg 1987;5:269-79.
• Jones EL, Craver JM, Michalik RA, Murphy DA, Guyton RA, Bone DK, et al. Combined carotid and coronary operations: when are they necessary? J Thorac Cardiovasc Surg 1984;87:7-16.
• Chiariello L, Tomai F, Zeitani J, Versaci F. Simultaneous hybrid revascularization by carotid stenting and coronary artery bypass grafting. Ann Thorac Surg 2006;81:1883-5.
• Moore WS, Barnett HJ, Beebe HG, Bernstein EF, Brener BJ, Brott T, et al. Guidelines for carotid endarterectomy. A multidisciplinary consensus statement from the Ad Hoc Committee, American Heart Association. Circulation 1995;91:566-79.
• Dylewski M, Canver CC, Chanda J, Darling RC 3rd, Shah DM. Coronary artery bypass combined with bilateral carotid endarterectomy. Ann Thorac Surg 2001;71:777-82.
• D’ agostino RS, Svensson LG, Neumann DJ, Balkhy HH, Williamson WA, Shahian DM. Screening carotid ultrasonography and risk factors for stroke in coronary artery surgery patients. Ann Thorac Surg 1996;62:1714-23.
• NASCET North American Symtomatic Carotid Endarterectomy Trial: Methods, patient characterics and progress. Stroke 1991;22:711-20.
• MRC European Carotid Surgery Trial: interim results for symptomatic patients with severe (70-99%) or with mild (0-29%) carotid stenosis. European Carotid Surgery Trialists’ Collaborative Group. Lancet 1991;337:1235-43.
• Hobson RW 2nd 1, Weiss DG, Fields WS, Goldstone J, Moore WS, Towne JB, et al. Efficacy of carotid endarterectomy for asymptomatic carotid stenosis. The Veterans Affairs Cooperative Study Group. N Engl J Med 1993;328:221-7.
• Salasidis GC, Latter DA, Steinmetz OK, Blair JF, Graham AM. Carotid artery duplex scanning in preoperative assessment for coronary artery revascularization: the association between peripheral vascular disease, carotid artery stenosis, and stroke. J Vasc Surg 1995;21:154-62.
• Busch T, Sirbu H, Aleksic I, Kazmaier S, Friedrich M, Buhre W, Dalichau H. Combined approach for internal carotid artery stenosis and cardiovascular disease in septuagenarians--a comparative study. Eur J Cardiothorac Surg 1999;16:602-6.
• Trachiotis GD, Pfister AJ. Management strategy for simultaneous carotid endarterectomy and coronary vascularization. Ann Thorac Surg 1997;64:1013-8.
• Harada RN, Comerota AJ, Good GM, Hashemi HA, Hulihan JF. Stump pressure, electroencephalographic changes, and the contralateral carotid artery another look at selective shunting. Am J Surg 1995;170:148-53.
• Chang BB, Darling RC 3rd, Patel M, Roddy SP, Paty PS, Kreienberg PB, et al. Use of shunts with eversion carotid endarterectomy. J Vasc Surg. 2000;32:655-62.
• Archie JP. Carotid endarterectomy outcome with vein or Dacron patch angioplasty and internal carotid artery shortening. J Vasc Surg 1999;29:654- 64.