Kontrollü arteryel hipertansiyon altında, geri kanama kontrolü ile şant kullanılmadan yapılan karotis endarterektomi; tek bir merkezin deneyimleri
Date
2011-05-02
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Uludağ Üniversitesi
Abstract
Bu çalışma, şantsız karotis endarterektomi yapılan hasta grubunda kontrollü arteryel hipertansiyon, normokapni ve geri kanama kontrolü hakkındaki tecrübemizi yansıtmaktadır. Genel anestezi, normokapni ve kontrollü hipertansiyon altında 112 hastada yapılmış 116 ardışık karotis endarterektomi (KEA) verileri retrospektif olarak incelendi. Karotis endarterektomi geri kanama, basınç ve renk değerlendirilmesi sonrası gerçekleştirildi. Hastaların ortalama yaşı 64.2 ± 8.6 (47-83), Erkek/kadın oranı 79/37 ve ortalama kros-klemp zamanı 25.63±5.1 (1555) dakika idi. Otuz hastada %70’in üzerinde bilateral karotis darlığı mevcuttu. On dört hasta asemptomatik (%12) ve 102 hasta (%88) semptomatik idi. Karotis endarterektomilerin tamamı intraluminal şant kullanılmadan uygulandı. 93 hastada(%80) arteriotomi primer, 23 hastada (%20) yama ile kapatıldı 30 günlük hastane içi nörolojik komplikasyonlar iki hastada (%1.7) gelişti. Bunlar; bir hastada inme ve bir hastada amarozis fugaks gelişti. Çalışma grubunda ölüm görülmedi. Bu çalışmanın gereksiz şant uygulamasından sakınmak için bir görüş sağladığını düşünmekteyiz. Şant uygulamadan kontrollü hipertansiyon, normokapni ve internal karotis arterden (İCA) geri kanama kontrolü ile karotis endarterektomi düşük morbitide ve mortalite oranlarıyla cerrahi yapabilmemizi sağlamaktadır.
This study reflects our experience with controlled arterial hypertension and normocapnia and controlling back bleeding in a cohort of patients who underwent carotid endarterectomy (CEA) without shunting. We reviewed retrospectively 116 consecutive CEA performed in 112 patients with controlled arterial hypertension and normocapnia under general anesthesia. CEA’s were performed after assessment of pressure and color with evaluation of back-bleeding. The mean age of the patients was 64.2 ± 8.6 (47-83). The male/female ratio was 79/37 and the mean cross-clamp time was 25.63±5.1 (15-55) minutes. Thirty patients had bilateral carotid lesions with more than %70 stenosis. Fourteen patients were asymptomatic (12%), and 102 had symptoms (88%). All of the CEA’s were performed without intraluminal shunting. In 93 patients the arteriotomy was closed primarily (80%), in 23 patients closed with patch (20%). Neurological complication occurred within 30 days in 2 patients (1.7%). One stroke and one amaurozis fugax occurred. There was no mortality in the study population. We think that this study provides opinion for avoiding unnecessary shunting. Without shunting, maintaining a controlled hypertensive state and normocapnia and checking back bleeding from ICA enables us to perform surgery with low mortality and morbidity rates.
This study reflects our experience with controlled arterial hypertension and normocapnia and controlling back bleeding in a cohort of patients who underwent carotid endarterectomy (CEA) without shunting. We reviewed retrospectively 116 consecutive CEA performed in 112 patients with controlled arterial hypertension and normocapnia under general anesthesia. CEA’s were performed after assessment of pressure and color with evaluation of back-bleeding. The mean age of the patients was 64.2 ± 8.6 (47-83). The male/female ratio was 79/37 and the mean cross-clamp time was 25.63±5.1 (15-55) minutes. Thirty patients had bilateral carotid lesions with more than %70 stenosis. Fourteen patients were asymptomatic (12%), and 102 had symptoms (88%). All of the CEA’s were performed without intraluminal shunting. In 93 patients the arteriotomy was closed primarily (80%), in 23 patients closed with patch (20%). Neurological complication occurred within 30 days in 2 patients (1.7%). One stroke and one amaurozis fugax occurred. There was no mortality in the study population. We think that this study provides opinion for avoiding unnecessary shunting. Without shunting, maintaining a controlled hypertensive state and normocapnia and checking back bleeding from ICA enables us to perform surgery with low mortality and morbidity rates.
Description
Keywords
Karotis endarterktomi, Şantsız karotis endarterektomi, Karotis stenozu, Carotid endarterctomy, Carotid stenosis, Without using shunt carotid endarterectomy
Citation
Biçer, M. vd. (2011). ''Kontrollü arteryel hipertansiyon altında, geri kanama kontrolü ile şant kullanılmadan yapılan karotis endarterektomi; tek bir merkezin deneyimleri''. Uludağ Üniversitesi Tıp Fakültesi Dergisi, 37(1), 1-5.