The Turkish Journal of Vascular Surgery
Yazarlar: Fatih İSLAMOĞLU, Anıl Ziya APAYDIN, Hakan POSACIOĞLU, Tahir YAĞDI, Tanzer ÇALKAVUR, Yüksel ATAY
Konular:-
Anahtar Kelimeler:Rupture,Abdominal Aortic Aneurysm,Clamp
Özet: Purpose: Infrarenal clamping of the aorta which seems possible in the preoperative evaluation can not be performed everytime in the repair of ruptured abdominal aortic aneurysm, because of CT technique, differences in interpretation and inadequate cooperation of the patient. Aim of our study was to evaluate comparatively the results and safety of routine hiatal clamping as a first choice with those of infrarenal clamping. Methods: Sixty-one patients with mean age of 19.9±8.8 years who had undergone ruptured abdominal aortic aneurysm repair between 1994-2005 were evaluated retrospectively. Hiatal clamping and infrarenal clamping were performed in 48 patients and 13 patients, respectively. By univariate and multivariate statistical analyses of respiratory, renal, gastrointestinal, cardiac complications, relaparotomy, infection, mortality, cell saver usage, blood and blood product requirements, and hospitalization time were evaluated comparatively between two groups. Results: Overall mortality was 20 (32.8%) and there was not any difference between two groups. Univariate analyses revealed that hospitalization time (p=0.008), postoperative respiratory complications (p=0.006), blood requirement (p=0.009), and cell-saver usage (p<0.001) were significantly higher in the hiatal clamping group. Multivariate analysis was also performed, since cell saver usage which had been found higher in the hiatal group, was also found related to postoperative respiratory complications (p=0.042), and prolonged hospitalization time (p=0.04); and tubular graft technique was found related to higher blood requirements in univariate analyses; however an independent risk factor could not be found. Prolonged renal ischemia time (>30 min) of hiatal group was an independent risk factor for renal complications (p=0.04), blood usage (p=0.005), and mortality (p<0.001) in this group. Conclusion: Hiatal clamping which is performed without any delay for infrarenal aortic exploration is not a significant risk factor in the repair of ruptured abdominal aortic aneurysm provided clamping time is less than 30 min. It can be performed safely and provides more comfortable operative conditions. (Turkish J Vasc Surg 2005;14(2):19-24).