RESUMEN
BACKGROUND: The role of carotid endarterectomy for the treatment of atherosclerotic carotid bifurcation disease is now well established. The aim of this study was to compare durability, postoperative death, stroke, minor strokes, cranial nerve injuries, neck hematomas, myocardial infarctions, or surgical defects and restenosis at the operative site following short- and mid-term duration of the advantages eversion carotid endarterectomy (E-CEA) compared to conventional carotid endarterectomy (C-CEA). PATIENTS AND METHODS: Between March 2003 and November 2012, primary CEAs were performed in 380 consecutive patients by the same surgical groups. These patients were evaluated retrospectively. C-CEA was performed in 202 patients, and E-CEA was performed in 178 patients. Carotid duplex ultrasonography was performed in all patients at 1, 6, 12 and 24 months after CEA to identify residual atherosclerotic carotid disease. RESULTS: Mean age was 67.3±13.4 years in the E-CEA group and 64.8±14.8 years in the C-CEA group. Mean cross-clamping time in the E-CEA group was 9.54±2.6 minutes and 12.62±2.7 minutes for C-CEA group (P=0.236). Three postoperative strokes occurred (one after E-CEA and two after C-CEA). In the E-CEA group and C-CEA group respectively, carotid stenosis rates were found in 4 patients (2.24%) and in 5 (2.97%) at a follow-up period of 26 months. CONCLUSION: Classical endarterectomy still remains the gold standard surgical technique for patients who are selected for coronary artery disease surgery. Nevertheless, we believe that eversion endarterectomy, which has some advantages, must be kept in mind as an alternative approach.
Asunto(s)
Estenosis Carotídea/cirugía , Endarterectomía Carotidea/métodos , Procedimientos Neuroquirúrgicos/métodos , Adulto , Anciano , Anciano de 80 o más Años , Estenosis Carotídea/diagnóstico , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Recurrencia , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
OBJECTIVE: We evaluated the early and late postoperative outcome of aorto/iliofemoral bypass operations using a retroperitoneal approach. METHODS: From December 1999 until the end of December 2005, unilateral aorto/iliofemoral bypass was performed on 23 patients (3 female, 20 male) for unilateral iliac occlusive disease. The average age was 57 years (range: from 45 to 68 years). Operative indications were claudication in seven patients, rest pain in 14 patients, and non-healing ulcer or gangrene in two patients. RESULTS: Surgical procedures included aortofemoral bypass in ten patients, iliofemoral bypass in 12 patients and aortoiliac bypass in one patient. Simultaneous femoropopliteal bypass was performed on seven patients. Mean follow-up period was 2.5 +/- 0.31 years. Graft patency was 100% during this period. CONCLUSIONS: A retroperitoneal approach for unilateral iliac obstructive disease is a valuable and well-tolerated alternative to conventional aortobilateral reconstruction in unilateral symptomatic aorto-iliac disease with excellent long-term outcome.
Asunto(s)
Angiografía de Substracción Digital/métodos , Arteriopatías Oclusivas/cirugía , Arteria Femoral/cirugía , Arteria Ilíaca/cirugía , Anciano , Anastomosis Quirúrgica , Arteriopatías Oclusivas/patología , Femenino , Arteria Femoral/patología , Humanos , Arteria Ilíaca/patología , Masculino , Persona de Mediana Edad , Espacio Retroperitoneal , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
OBJECTIVE: In ischemia-reperfusion, Iloprost decreases neutrophil activation and aggregation besides inhibition of oxygen-free radical production. Pentoxifylline (Ptx) attenuates reperfusion-associated membrane injury and tissue edema, suppresses leukocyte adhesion and improves hindlimb blood flow during the reperfusion period. The primary hypothesis in this study was that Iloprost could present better protection than pentoxyfillin on renal ischemia-reperfusion in rabbit model. MATERIALS AND METHODS: Forty rabbits were grouped into four. Iloprost was continuously infused starting half an hour before the reperfusion after 2 hours ischemia and during the 4 hours reperfusion period in Group 1 whereas the Group 2 was treated with pentoxyfillin. Group 3 was the control group which didn't receive any medication. Forth group was sham group. Renal tissues were histologically and biochemically evaluated. RESULTS: The histologic scores were obtained according to presence of tubuler necrosis and atrophy, regenerative atypia, hydropic degeneration (Group 1 vs Group 3; p<0.001, Group 2 vs Group 3; p = 0.001, Group 1 vs Group 2; p = 0.331). Malondialdehyde levels of the medicated groups were 109 +/- 11 nmol/gr tissue in Group 1, 119 +/- 15 nmol / gr tissue in Group 2 and 132 +/- 14 nmol / gr tissue in Group 3 (Group 1 vs Group 2; p = 0.130, Group 1 vs Group 3, p = 0.002, Group 2 vs Group 3; p = 0.045). Malondialdehyde levels and histologic scores of all of the groups were significantly different from the sham group. CONCLUSION: Iloprost and pentoxyfillin reduced renal ischemia-reperfusion injury in rabbit model. There was not a significant difference between these two medications.