腸骨動脈閉塞症に対する手術成績と術式およびバイパス流量と開存率の関係の検討

腸骨動脈閉塞症 (IAO) に対する血行再建術81例における術後成績より術式, さらにバイパス流量 (BF) と開存率について検討した. 手術の内訳は, 大動脈大腿動脈バイパス術46例 (AF-B群), 腸骨動脈血栓内膜剔除術11例 (TEA群), 大腿動脈大腿動脈バイパス術26例 (FF-B群), 腋窩動脈大腿動脈バイパス術2例 (AXF-B群) であった. 術後早期閉塞はAF-B群, TEA群, AXF-B群ではなく, FF-B群の2例であった. BFは, AF-B群, TEA群, FF-B群, AXF-B群でそれぞれ平均382, 331, 219, 200ml/minであった. 遠隔期成...

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Published in日本心臓血管外科学会雑誌 Vol. 22; no. 4; pp. 339 - 344
Main Authors 三木, 成仁, 楠原, 健嗣, 大北, 裕, 田畑, 隆文, 上田, 裕一, 山中, 一朗
Format Journal Article
LanguageJapanese
Published 特定非営利活動法人 日本心臓血管外科学会 1993
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ISSN0285-1474
1883-4108
DOI10.4326/jjcvs.22.339

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Abstract 腸骨動脈閉塞症 (IAO) に対する血行再建術81例における術後成績より術式, さらにバイパス流量 (BF) と開存率について検討した. 手術の内訳は, 大動脈大腿動脈バイパス術46例 (AF-B群), 腸骨動脈血栓内膜剔除術11例 (TEA群), 大腿動脈大腿動脈バイパス術26例 (FF-B群), 腋窩動脈大腿動脈バイパス術2例 (AXF-B群) であった. 術後早期閉塞はAF-B群, TEA群, AXF-B群ではなく, FF-B群の2例であった. BFは, AF-B群, TEA群, FF-B群, AXF-B群でそれぞれ平均382, 331, 219, 200ml/minであった. 遠隔期成績 (5年) ではTEA群では閉塞例はなく, AF-B群で96%, FF-B群で63%であった. 早期および遠隔期閉塞はBFも150ml/min以下の例が多く, run-offの悪い例であった. 開存率向上のため, 高齢者でも, 重篤な心疾患のない症例は, 安定した成績の得られるAF-Bを用いる, また下肢末梢の血管病変のある場合は積極的に膝窩動脈以下への同時バイパスを行う方針である.
AbstractList 腸骨動脈閉塞症 (IAO) に対する血行再建術81例における術後成績より術式, さらにバイパス流量 (BF) と開存率について検討した. 手術の内訳は, 大動脈大腿動脈バイパス術46例 (AF-B群), 腸骨動脈血栓内膜剔除術11例 (TEA群), 大腿動脈大腿動脈バイパス術26例 (FF-B群), 腋窩動脈大腿動脈バイパス術2例 (AXF-B群) であった. 術後早期閉塞はAF-B群, TEA群, AXF-B群ではなく, FF-B群の2例であった. BFは, AF-B群, TEA群, FF-B群, AXF-B群でそれぞれ平均382, 331, 219, 200ml/minであった. 遠隔期成績 (5年) ではTEA群では閉塞例はなく, AF-B群で96%, FF-B群で63%であった. 早期および遠隔期閉塞はBFも150ml/min以下の例が多く, run-offの悪い例であった. 開存率向上のため, 高齢者でも, 重篤な心疾患のない症例は, 安定した成績の得られるAF-Bを用いる, また下肢末梢の血管病変のある場合は積極的に膝窩動脈以下への同時バイパスを行う方針である.
Author 三木, 成仁
楠原, 健嗣
山中, 一朗
田畑, 隆文
上田, 裕一
大北, 裕
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References 9) Szilagyi, D. E., Elliot, J. P., Hageman, J. H. et al.: Biologic fate of autogenous vein implants as arterial substitutes: Clinical, angiographic and histologic observations in femoropopliteal operations for atherosclerosis. Ann. Surg. 178: 232-246, 1973.
2) Szilagyi, D. E., Elliott, J. P., Jr., Smith, R. F. et al.: A thirty-year survey of the reconstructive surgical treatment of aortoiliac occlusive disease. J. Vasc. Surg. 3: 421-436, 1986.
11) Bond, M. G., Hostetler, J. R., Karayanaccos, P. E. et al.: Intimal changes in arteriovenous bypass grafts. Effects of varying the angle of implantation at the proximal anastomosis and of producing stenosis in the distal run-off artery. J. Thorac. Cardiovasc. Surg. 71: 907-916, 1976.
24) Haimovici, H.: Metabolic complications of acute arterial occlusions. J. Cardiovasc. Surg. 20: 349-357, 1979.
13) 佐藤伸一, 西山勝彦, 白方秀二ほか: 小口径 Expanded polytetrafluoroethylene graft 使用例の晩期閉塞例の検討. 日外会誌 89: 109-115, 1988.
15) Evans, L. E., Webster, M. W., Brooks, D. H. et al.: Expanded polytetrafluoroethylene femoropopliteal grafts: Forty-eight-month follow-up. Surgery 89: 16-22, 1981.
3) Eugene, J., Goldstone, J. and Moore, W. S.: Fifteen year experience with subcutaneous bypass grafts for lower extremity ischemia. Ann. Surg. 186: 177-183, 1977.
8) 笹嶋唯博, 久保良彦, 小窪正樹ほか: Bypass Graft 血流量の術前予測法. 脈管学 24: 463-468, 1984.
23) Hagihara, P. F., Ernst, C. B. and Griffen, W. O., Jr.: Incidence of ischemic colitis following abdominal aortic reconstruction. Surg. Gynecol. Obstet. 149: 571-573, 1979.
10) Imparato, A. M., Bracco, A., Kim, G. E. et al.: Intimal and neointimal fibrous proliferation causing failure of arterial reconstructions. Surgery 72: 1007-1017, 1972.
6) Ascer, E., Veith, F. J., Gupta. S. K. et al.: Six year experience with expanded polytetrafluoroethylene arterial grafts for limb salvage. J. Cardiovasc. Surg. 26: 468-472, 1985.
5) Sauvage, R. J. and Wood, S. J.: Unilateral axillary bilateral femoral bifurcation graft: A procedure for the poor risk patient with aortoiliac disease. Surgery 60: 573-577, 1966.
21) 森彬, 坂田久信, 黒木政純ほか: EXS Dacron graft による大腿-膝窩動脈バイパスの成績. 脈管学28: 123-126, 1988.
25) Bush, H. L.: Renal failure following abdominal aortic reconstruction. Surgery 93: 107-109, 1983.
16) 橋本宇史, 白方秀二, 北浦一弘ほか: Gore-Tex graft を用いた血行再建術の検討. 人工臓器 15: 392-396, 1985.
19) Schultz, G. A., Sauvage, L. R., Mathisen, S. R. et al.: A five-to seven-year experience with externally supported (EXS) Dacron prosthesis in axillofemoral and femoropopliteal bypass. Ann. Vasc. Surg. 1: 214-223, 1986.
17) Sauvage, L. R., Walker, M. W., Berger, K. et al.: Current arterial prostheses. Experimental evaluation by implantation in the carotid and circumflex coronary arteries of the dog. Arch. Surg. 114: 687-691, 1979.
26) Bush, H. L., Huse, J. B., Johnson, W. C. et al.: Prevention of renal insufficiency after abdominal aortic aneurysm resection by optimal volume loading. Arch. Surg. 116: 1517-1524, 1981.
18) Sanders, R. J., Kempczinski, R. F., Hammond, W. et al.: The significance of graft diameter. Surgery 88: 856-867, 1980.
1) Brewster, D. C. and Darling, R. C.: Optimal methods of aortoiliac reconstruction. Surgery 84: 739-748, 1978.
20) Kremen, A. F., Mendez-Fernandez, M. A., Geis, R. C. et al.: The dacron EXS graft: Patency in femoropopliteal and femorotibial surgery. J. Cardiovasc. Surg. 27: 125-130, 1986.
12) 野一色泰晴: 人工血管の構造. 臨床水電解質6: 345-351, 1986.
4) Rutherford, R. B., Patt, A. and Pearce, W. H.: Extraanatomic bypass: A closer view. J. Vasc. Surg. 6: 437-446, 1987.
14) Campbell, C. D., Brooks, D. H., Webster, M. W. et al.: Expanded microporous polytetrafluoroethylene as a vascular substitute: A two year follow-up. Surgery 85: 177-183, 1979.
22) Ernst, C. B., Hagihara, P. F., Daugherty, M. E. et al.: Inferior mesenteric artery stump pressure: A reliable index for safe IMA ligation during abdominal aortic aneurysmectomy. Ann. Surg. 187: 641-646, 1978.
7) Ascer, E., Veith, F. J., Gupta, S. K. et al.: Comparison of axillounifemoral and axillobifemoral bypass operations. Surgery 97: 169-175, 1985.
References_xml – reference: 5) Sauvage, R. J. and Wood, S. J.: Unilateral axillary bilateral femoral bifurcation graft: A procedure for the poor risk patient with aortoiliac disease. Surgery 60: 573-577, 1966.
– reference: 11) Bond, M. G., Hostetler, J. R., Karayanaccos, P. E. et al.: Intimal changes in arteriovenous bypass grafts. Effects of varying the angle of implantation at the proximal anastomosis and of producing stenosis in the distal run-off artery. J. Thorac. Cardiovasc. Surg. 71: 907-916, 1976.
– reference: 20) Kremen, A. F., Mendez-Fernandez, M. A., Geis, R. C. et al.: The dacron EXS graft: Patency in femoropopliteal and femorotibial surgery. J. Cardiovasc. Surg. 27: 125-130, 1986.
– reference: 8) 笹嶋唯博, 久保良彦, 小窪正樹ほか: Bypass Graft 血流量の術前予測法. 脈管学 24: 463-468, 1984.
– reference: 14) Campbell, C. D., Brooks, D. H., Webster, M. W. et al.: Expanded microporous polytetrafluoroethylene as a vascular substitute: A two year follow-up. Surgery 85: 177-183, 1979.
– reference: 23) Hagihara, P. F., Ernst, C. B. and Griffen, W. O., Jr.: Incidence of ischemic colitis following abdominal aortic reconstruction. Surg. Gynecol. Obstet. 149: 571-573, 1979.
– reference: 1) Brewster, D. C. and Darling, R. C.: Optimal methods of aortoiliac reconstruction. Surgery 84: 739-748, 1978.
– reference: 2) Szilagyi, D. E., Elliott, J. P., Jr., Smith, R. F. et al.: A thirty-year survey of the reconstructive surgical treatment of aortoiliac occlusive disease. J. Vasc. Surg. 3: 421-436, 1986.
– reference: 3) Eugene, J., Goldstone, J. and Moore, W. S.: Fifteen year experience with subcutaneous bypass grafts for lower extremity ischemia. Ann. Surg. 186: 177-183, 1977.
– reference: 4) Rutherford, R. B., Patt, A. and Pearce, W. H.: Extraanatomic bypass: A closer view. J. Vasc. Surg. 6: 437-446, 1987.
– reference: 16) 橋本宇史, 白方秀二, 北浦一弘ほか: Gore-Tex graft を用いた血行再建術の検討. 人工臓器 15: 392-396, 1985.
– reference: 24) Haimovici, H.: Metabolic complications of acute arterial occlusions. J. Cardiovasc. Surg. 20: 349-357, 1979.
– reference: 12) 野一色泰晴: 人工血管の構造. 臨床水電解質6: 345-351, 1986.
– reference: 22) Ernst, C. B., Hagihara, P. F., Daugherty, M. E. et al.: Inferior mesenteric artery stump pressure: A reliable index for safe IMA ligation during abdominal aortic aneurysmectomy. Ann. Surg. 187: 641-646, 1978.
– reference: 19) Schultz, G. A., Sauvage, L. R., Mathisen, S. R. et al.: A five-to seven-year experience with externally supported (EXS) Dacron prosthesis in axillofemoral and femoropopliteal bypass. Ann. Vasc. Surg. 1: 214-223, 1986.
– reference: 25) Bush, H. L.: Renal failure following abdominal aortic reconstruction. Surgery 93: 107-109, 1983.
– reference: 15) Evans, L. E., Webster, M. W., Brooks, D. H. et al.: Expanded polytetrafluoroethylene femoropopliteal grafts: Forty-eight-month follow-up. Surgery 89: 16-22, 1981.
– reference: 17) Sauvage, L. R., Walker, M. W., Berger, K. et al.: Current arterial prostheses. Experimental evaluation by implantation in the carotid and circumflex coronary arteries of the dog. Arch. Surg. 114: 687-691, 1979.
– reference: 21) 森彬, 坂田久信, 黒木政純ほか: EXS Dacron graft による大腿-膝窩動脈バイパスの成績. 脈管学28: 123-126, 1988.
– reference: 6) Ascer, E., Veith, F. J., Gupta. S. K. et al.: Six year experience with expanded polytetrafluoroethylene arterial grafts for limb salvage. J. Cardiovasc. Surg. 26: 468-472, 1985.
– reference: 7) Ascer, E., Veith, F. J., Gupta, S. K. et al.: Comparison of axillounifemoral and axillobifemoral bypass operations. Surgery 97: 169-175, 1985.
– reference: 10) Imparato, A. M., Bracco, A., Kim, G. E. et al.: Intimal and neointimal fibrous proliferation causing failure of arterial reconstructions. Surgery 72: 1007-1017, 1972.
– reference: 9) Szilagyi, D. E., Elliot, J. P., Hageman, J. H. et al.: Biologic fate of autogenous vein implants as arterial substitutes: Clinical, angiographic and histologic observations in femoropopliteal operations for atherosclerosis. Ann. Surg. 178: 232-246, 1973.
– reference: 18) Sanders, R. J., Kempczinski, R. F., Hammond, W. et al.: The significance of graft diameter. Surgery 88: 856-867, 1980.
– reference: 13) 佐藤伸一, 西山勝彦, 白方秀二ほか: 小口径 Expanded polytetrafluoroethylene graft 使用例の晩期閉塞例の検討. 日外会誌 89: 109-115, 1988.
– reference: 26) Bush, H. L., Huse, J. B., Johnson, W. C. et al.: Prevention of renal insufficiency after abdominal aortic aneurysm resection by optimal volume loading. Arch. Surg. 116: 1517-1524, 1981.
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Snippet 腸骨動脈閉塞症 (IAO) に対する血行再建術81例における術後成績より術式, さらにバイパス流量 (BF) と開存率について検討した. 手術の内訳は, 大動脈大腿動脈バイパス術46...
SourceID jstage
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StartPage 339
SubjectTerms 腸骨動脈閉塞症
血行再建術
Title 腸骨動脈閉塞症に対する手術成績と術式およびバイパス流量と開存率の関係の検討
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