Editor-in-Chief Ufuk Demirkılıç Frequency Quarterly Abbreviation Turk J Vasc Surg Publisher Turkish National Vascular and Endovascular Surgery Society ISSN 2667-4947 E-ISSN 2667-5080



Turkish Journal of Vascular Surgery 2001 , Vol 10 , Issue 3
SURGICAL PRINCIPLES OF CAROTID ARTERY STEN OSIS: KOŞUYOLU EXPERIENCE
Mustafa Güler1, Nilgün Ulusoy Bozbuğa1, Kaan Kırali1, Ercan Eren1, Mehmet Erdem Toker1, Cüneyt Keleş1, Mehmet Balkanay1, Gökhan İpek1, Esat Akıncı1, Ömer Işık1, Cevat Yakut1
1Koşuyolu Kalp Eği tim ve Araştırma Hastanesi Kalp ve Damar Cerrahisi Bölümü, İstanbul Carotid endarterectomy is stili the most common procedure that is performed lor cerebrovascular ischemia due to at­ herosclerosis.

At Koşuyo lu Heart and Research Hospital Department of Cardiovascular Surgery, between February 1985 to Febru­ ary 2000, carotid endarterectomy (CEA) procedure was applied in 67 patients. The patients population included 61 men (91%) and 6 women (9%), with a mean age of 63.4±2.6 years (ranged !rom 46 to 74). Additional to the carotid stenosis, 56 cases (84%) had hypertension, 22 cases (33%) diabetes mel!itus and 18 cases (27%) myocardial infarc­tion.

44 patients were symtomatic (66%) versus 23 asymtomatic patients (34%). in 12 of the cases (18%) cerebrovascu­ lar accidents were revealed beforehand. in our series, 49 cases (73%) were demonstrated unilateral and 18 cases (27%) were demonstrated bileteral stenosis of carotid artery. 28 cases had (42%) had isolated and 39 cases (58%) had combined carotid lesions with coronary artery disease required CABG.

Out of 28 cases with isolated carotid lesion, 8 were underwent CEA with primary closure while 20 were underwent CEA with patch closure (17 otologeus saphenous patch, 3 PTFE patch). Out of the 39 cases, combined CEA and CABG operations were performed to one-stage procedure in 30 patients, and two-stage procedure in the others. in one case, CABG + CEA with patching + replacement of ascending aort were performed in the same operation sta­ ge. in combined operation group of patients, CEA was closed primarly in 9 cases, patching (17 otologeous sapheno­ us patch, 3 Dacron patch) was done in 30 cases.

The early mortality rate was 3% in 2 cases. Cerebrovascular morbidity was recorded in 5 cases (7.5%) (tefi hemipa­ resis in 2, right hemiparesis in 2, decerebation in 1) and cardiac morbidity was recorded in 5 cases (7.5%) (perioperative MI in 3, reexploration far mediastinal bleeding). Recurrent stenosis was occured in 5 patients (7.5%) in late-term follow-up. There were one cerebrovascular reoperation (1.5%), and two cardiac reoperations (3%). Lale mortality rate was 6% in 4 cases. The mean follow-up time was 5.3±1.7 years (range, 6 months ta 12 years), 312.7 patient-year. Keywords : Carotid endarterectomy, carotid artery stenosis, combined procedures o( carotid and coronary artery

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