大腿動脈血栓内膜摘除術と血管内治療を併施した「ハイブリッド下肢動脈血行再建」の実際
外科的血行再建として（1）バイパス（2）血栓内膜摘除（TEA）がある。このうち総大腿動脈病変（CFA）に対しては，non-stenting zoneに対する治療であることと血行再建成績が良好であることからTEAが第一選択である。下肢閉塞性動脈疾患に対する血行再建としてのハイブリッド手術は血管外科医特有の有効な治療であるが，とくにCFAに対するTEAと血管内治療（EVT）を併施するものはEVTのみ，あるいは外科治療のみと比較し低侵襲で有用性が高い。EVTについては近年浅大腿動脈領域を中心にステントグラフトや薬剤コーティングバルーン，薬剤コーテッドステントなど新規デバイスの出現があり進歩が著しく，...
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| Published in | 脈管学 Vol. 62; no. 6; pp. 43 - 47 |
|---|---|
| Main Author | |
| Format | Journal Article |
| Language | Japanese |
| Published |
日本脈管学会
10.06.2022
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0387-1126 1880-8840 |
| DOI | 10.7133/jca.21-00023 |
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| Abstract | 外科的血行再建として（1）バイパス（2）血栓内膜摘除（TEA）がある。このうち総大腿動脈病変（CFA）に対しては，non-stenting zoneに対する治療であることと血行再建成績が良好であることからTEAが第一選択である。下肢閉塞性動脈疾患に対する血行再建としてのハイブリッド手術は血管外科医特有の有効な治療であるが，とくにCFAに対するTEAと血管内治療（EVT）を併施するものはEVTのみ，あるいは外科治療のみと比較し低侵襲で有用性が高い。EVTについては近年浅大腿動脈領域を中心にステントグラフトや薬剤コーティングバルーン，薬剤コーテッドステントなど新規デバイスの出現があり進歩が著しく，以前と比べ治療適応が変化拡大している。本稿では最近のTEAとEVTを併施したハイブリッド手術の現状を当科の早期成績をもとに提示する。引き続き長期成績を示す必要がある。 |
|---|---|
| AbstractList | 外科的血行再建として（1）バイパス（2）血栓内膜摘除（TEA）がある。このうち総大腿動脈病変（CFA）に対しては，non-stenting zoneに対する治療であることと血行再建成績が良好であることからTEAが第一選択である。下肢閉塞性動脈疾患に対する血行再建としてのハイブリッド手術は血管外科医特有の有効な治療であるが，とくにCFAに対するTEAと血管内治療（EVT）を併施するものはEVTのみ，あるいは外科治療のみと比較し低侵襲で有用性が高い。EVTについては近年浅大腿動脈領域を中心にステントグラフトや薬剤コーティングバルーン，薬剤コーテッドステントなど新規デバイスの出現があり進歩が著しく，以前と比べ治療適応が変化拡大している。本稿では最近のTEAとEVTを併施したハイブリッド手術の現状を当科の早期成績をもとに提示する。引き続き長期成績を示す必要がある。 |
| Author | 赤木, 大輔 |
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| References | 3) Ohki T, Kichikawa K, Yokoi H, et al: Long-term results of the Japanese multicenter Viabahn trial of heparin bonded endovascular stent grafts for long and complex lesions in the superficial femoral artery. J Vasc Surg 2021; 74: 1958–1967.e2 11) Aboyans V, Ricco JB, Bartelink MEL, et al; ESC Scientific Document Group: 2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS). Eur Heart J 2018; 39: 763–816 1) Dufranc J, Palcau L, Heyndrickx M, et al: Technique and results of femoral bifurcation endarterectomy by eversion. J Vasc Surg 2015; 61: 728–733 8) Barkmeier LD, Hood DB, Sumner DS, et al: Local anesthesia for infrainguinal arterial reconstruction. Am J Surg 1997; 174: 202–204 2) Tepe G, Laird J, Schneider P, et al; IN.PACT SFA Trial Investigators: Drug-coated balloon versus standard percutaneous transluminal angioplasty for the treatment of superficial femoral and popliteal peripheral artery disease: 12-month results from the IN.PACT SFA randomized trial. Circulation 2015; 131: 495–502 10) Murakami A: Hybrid operations in patients with peripheral arterial disease. Ann Vasc Dis 2018; 11: 57–65 12) Conte MS, Bradbury AW, Kolh P, et al; GVG Writing Group: Global vascular guidelines on the management of chronic limb-threatening ischemia. J Vasc Surg 2019; 69: 3S–125S, e40 14) Soga Y, Fujihara M, Yamamoto Y, et al: One-year results for Japanese patients in RANGER II SFA. Heart Vessels 2022; 37: 568–573 13) Conte MS: Critical appraisal of surgical revascularization for critical limb ischemia. J Vasc Surg 2013; 57 8S–13S 4) Mousa A, Abdel-Hamid M, Ewida A, et al: Combined percutaneous endovascular iliac angioplasty and infrainguinal surgical revascularization for chronic lower extremity ischemia: preliminary result. Vascular 2010; 18: 71–76 5) Goodney PP, Beck AW, Nagle J, et al: National trends in lower extremity bypass surgery, endovascular interventions, and major amputations. J Vasc Surg 2009; 50: 54–60 7) Flaherty J, Horn JL, Derby R: Regional anesthesia for vascular surgery. Anesthesiol Clin 2014; 32: 639–659 6) Sapienza P, Napoli F, Tartaglia E, et al: Infection of prosthetic patches after femoral endarterectomy: an unreported complication. Ann Vasc Surg 2019; 56: 11–16 9) Kawai Y, Sugimoto M, Aikawa K, et al: Endovenous laser ablation with and without concomitant phlebectomy for the treatment of varicose veins: a retrospective analysis of 954 limbs. Ann Vasc Surg 2020; 66: 344–350 |
| References_xml | – reference: 9) Kawai Y, Sugimoto M, Aikawa K, et al: Endovenous laser ablation with and without concomitant phlebectomy for the treatment of varicose veins: a retrospective analysis of 954 limbs. Ann Vasc Surg 2020; 66: 344–350 – reference: 4) Mousa A, Abdel-Hamid M, Ewida A, et al: Combined percutaneous endovascular iliac angioplasty and infrainguinal surgical revascularization for chronic lower extremity ischemia: preliminary result. Vascular 2010; 18: 71–76 – reference: 14) Soga Y, Fujihara M, Yamamoto Y, et al: One-year results for Japanese patients in RANGER II SFA. Heart Vessels 2022; 37: 568–573 – reference: 13) Conte MS: Critical appraisal of surgical revascularization for critical limb ischemia. J Vasc Surg 2013; 57 8S–13S – reference: 1) Dufranc J, Palcau L, Heyndrickx M, et al: Technique and results of femoral bifurcation endarterectomy by eversion. J Vasc Surg 2015; 61: 728–733 – reference: 11) Aboyans V, Ricco JB, Bartelink MEL, et al; ESC Scientific Document Group: 2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS). Eur Heart J 2018; 39: 763–816 – reference: 6) Sapienza P, Napoli F, Tartaglia E, et al: Infection of prosthetic patches after femoral endarterectomy: an unreported complication. Ann Vasc Surg 2019; 56: 11–16 – reference: 5) Goodney PP, Beck AW, Nagle J, et al: National trends in lower extremity bypass surgery, endovascular interventions, and major amputations. J Vasc Surg 2009; 50: 54–60 – reference: 3) Ohki T, Kichikawa K, Yokoi H, et al: Long-term results of the Japanese multicenter Viabahn trial of heparin bonded endovascular stent grafts for long and complex lesions in the superficial femoral artery. J Vasc Surg 2021; 74: 1958–1967.e2 – reference: 2) Tepe G, Laird J, Schneider P, et al; IN.PACT SFA Trial Investigators: Drug-coated balloon versus standard percutaneous transluminal angioplasty for the treatment of superficial femoral and popliteal peripheral artery disease: 12-month results from the IN.PACT SFA randomized trial. Circulation 2015; 131: 495–502 – reference: 7) Flaherty J, Horn JL, Derby R: Regional anesthesia for vascular surgery. Anesthesiol Clin 2014; 32: 639–659 – reference: 8) Barkmeier LD, Hood DB, Sumner DS, et al: Local anesthesia for infrainguinal arterial reconstruction. Am J Surg 1997; 174: 202–204 – reference: 10) Murakami A: Hybrid operations in patients with peripheral arterial disease. Ann Vasc Dis 2018; 11: 57–65 – reference: 12) Conte MS, Bradbury AW, Kolh P, et al; GVG Writing Group: Global vascular guidelines on the management of chronic limb-threatening ischemia. J Vasc Surg 2019; 69: 3S–125S, e40 |
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| Snippet | 外科的血行再建として（1）バイパス（2）血栓内膜摘除（TEA）がある。このうち総大腿動脈病変（CFA）に対しては，non-stenting zoneに対する治療であることと血行再建成... |
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| SubjectTerms | bovine pericardium patch endovascular therapy (EVT) hybrid revascularization peripheral artery disease (PAD) thromboendarterectomy (TEA) |
| Title | 大腿動脈血栓内膜摘除術と血管内治療を併施した「ハイブリッド下肢動脈血行再建」の実際 |
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