DAMAR YARALANMALARINDA CERRAHÝ YAKLAÞIM

Damar yaralanmalarýnýn acil giriþim gerektirmesi, mortalite ve morbidite açýsýndan önemli bir klinik antite olmasý önemini artýrmaktadýr. 1987-1996 yýllarý arasýnda G.A.T.A Haydarpaþa Eðitim Hastanesi Kalp ve Damar Cerrahi Kliniði'inde damar yaralanmasý nedeniyle tedavi yaþlarý 19-61 arasýnda deðiþen, 52'si erkek, 7'si kadýn toplam 59 olgu retrospektif olarak incelendi. Ýncelenen olgularýn %59.3'ünde sadece arter, %5.1'inde sadece ven ve %21'inde ise her iki damarýn birlikte yaralandýðý gözlendi, %52,5'inde primer onarým, %44.1'inde greft interpozisyonu ve %3.4'ünde ise ligasyon gerekti. Mortalite olmadý ve olgularýn %3.5'inde venöz yetmezlik (n=2), %3.5'inde enfeksiyon (n=2), %1.7'inde erken tromboz (n=1), %1.7'sinde arteriovenöz fistül (n=1) ve %1.7'sinde (n=1) ise metatarsal düzeyde amputasyon olmak üzere toplam %10.3'ünde komplikasyon geliþti. Damar yaralanmalarýnda, müdahale yapýlana kadar geçen sürenin kýsalýðý prognozu belirleyen en önemli unsur olurken, deneyimli bir ekiple en uygun cerrahi giriþimin uygulanmasý ve ciddi bir postoperatif bakým prognozu belirleyen en önemli faktör olmaktadýr.

SURGICAL INTERVENTION IN VASCULAR INJURIES

Vascular injuries require urgent surgical interventions in order to prevent serious complications of (mortality and morbidity. This study retrospectively reviews ten years experience of the vascular traumas managed at the Department of Cardiovascular Surgery, GATA Training Hospital between 1987 and 1996. Amongst these cases, (59) 59.3% were arterial, 5.1% were venous and 21% combined arterial and venous traumas. 52.5% of cases were managed by primary surgical repair, 44% of cases by graft interpositioning and 3.4% of cases were managed by ligation. Overall complication rate was 10.3%. As we investigated the complications; 1.7% (n=1) early fistula, 3.5% (n=1) the most serious complication which was an amputation at metatarsal level. The most important prognostic factor of the outcome of surgical treatment was the time period between the traumatic injury and surgical intervention. Shorter the time elapsed after the injury, after better the results in terms of prognosis. Additionally, appropriate intervention by an experienced surgical team and intensive postoperative care were the important points to consider.