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KORONER REVASKÜLARİZASYON GEREKTİREN HASTALARDA EK VASKÜLER

Journal Name:

  • Cerrahpaşa Tıp Dergisi

Publication Year:

  • 2003

Key Words:

Keywords (Original Language):

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Abstract (2. Language): 
In accordance with the developments in invasive cardiology, more high risk and elderly patients are seen for coronary artery bypass grafting. These patients often have extensive atherosclerosis, involving more than one system that contributes to morbidity and mortality. Material and Methods.- Between years 2001-2002, 130 patients who underwent coronary artery bypass grafting were retrospectively reviewed for presenting peripheral vascular disease which necessitates surgical revascularization. Sixteen patients were encountered to have co-existing critical carotid artery disease and/or lower limb ischemia. Results.- In 10 patients the choice of treatment modality was synchronous procedures. Eight patients underwent carotid endarterectomy concomitant to the coronary bypass, one patient aortobifemoral bypass and one patient carotid endarterectomy and cross femoral bypass. Six patients underwent staged surgery. Although there was no mortality in synchronous approach group, one patient in the staged surgery group died. In concomitant approach group we used beating heart coronary revascularization for 8 patients. In all staged procedures CABG was done under cardiopulmonary bypass. Conclusion.-The surgical management of patients with coronary artery disease and co-existing peripheral vascular disease has remained contraversial, however, this contraversy has gained momentum with the advent of off-pump coronary artery bypass grafting. According to our results, we highly recommend more liberal use of noninvasive vascular diagnostic tools for patients scheduled for coronary revascularization. We also believe that off-pump coronary artery surgery, as it avoids the harmful effects of cardiopulmonary bypass, may be the choice of surgical method for combined approach.
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Abstract (Original Language): 
İnvasiv kardiolojideki ilerlemelere paralel olarak, günümüzde koroner bypass ameliyatına aday hasta grubu daha yaşlı ve yüksek riskli hastalardır. Yaşlı hastalarda yaygın aterosklerotik tutulum nedeniyle aynı anda değişik vasküler sistemler tutulabilir ve bu nedenle bu grup hastalarda preoperatif değerlendirme ve intraoperatif tedavi stratejisi önem kazanmaktadır. Çalışmamızda 2001-2002 yılları arasında koroner bypass yapılan 130 hasta retrospektif olarak değerlendirildi. On altı hastada ciddi koroner arter hastalığına ek olarak kritik periferik arter hastalığı saptandı. On hastamıza eş zamanlı cerrahi girişim uygulandı. Bu hastaların sekizine koroner bypass ile eş zamanlı karotis endarterektomisi, birine aortobifemoral bypass, birine ise karotis endarterektomisi ve kros-femoral bypass yapıldı. Altı hastamıza ise basamaklı cerrahi tedavi uygulandı. Eş zamanlı cerrahi yapılan hasta grubumuzda mortalite sıfır iken; basamaklı tedavi yapılan bir hastamızı kaybettik. Eş zamanlı cerrahi yapılan hastalarımızdan sekizinde atan kalpte koroner bypass tekniğini kullandık. Basamaklı tedavi yaptığımız hastalarda koroner bypass kardiopulmoner bypass altında yapıldı. Koroner arter hastalığı ile aynı zamanda periferik arter hastalığı olan hasta grubunda seçilecek tedavi yaklaşımı tartışmalıdır. Atan kalpte koroner bypass cerrahisinin yaygınlaşması bu tartışmaya yeni bir boyut getirmiştir. Hasta grubumuzdaki sonuçlar göz önüne alındığında, koroner bypass ameliyatına aday hastalarda eşlik eden periferik vasküler hastalıkları araştırTemmuz- Eylül 2003 KORONER REVASKÜLARİZASYON; KÖKSAL VE ARK. 131 mak amacıyla noninvasiv vasküler tanı yöntemlerinin daha yaygın kullanılması gerektiğini ve ayrıca koroner bypass ile eş zamanlı vasküler cerrahi planlanan hastalarda, atan kalpte koroner bypass cerrahi tekniğinin tercih edilmesi gerektiğini düşünmekteyiz.
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  • 3
127-131
  • Turkish

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