重症虚血肢に対する膝窩－下腿・足部動脈バイパス術の妥当性に関する検討
【背景】重症虚血肢に対する下腿・足部動脈バイパス術の流入動脈を膝窩動脈とする妥当性につき，われわれの経験を中心に検討した．【対象と方法】2003年より2008年に経験した膝窩－下腿・足部動脈バイパス術10例を対象とした．症例の内訳は男性 7 例，女性 3 例，平均年齢は72.7歳で，全例Fontaine IV度，8 例(80%)が糖尿病を合併，1 例(10%)が慢性血液透析例であった．全例に大伏在静脈を用いたバイパス術が施行され，流入動脈は膝上膝窩動脈が 7 例，膝下膝窩動脈が 3 例，末梢側吻合部は後脛骨動脈が 6 例，足背動脈が 4 例であった．また10例中 2 例に同時期に浅大腿動脈に対...
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| Published in | Japanese Journal of Vascular Surgery Vol. 18; no. 7; pp. 659 - 665 |
|---|---|
| Main Authors | , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
特定非営利活動法人 日本血管外科学会
2009
JAPANESE SOCIETY FOR VASCULAR SURGERY |
| Subjects | |
| Online Access | Get full text |
| ISSN | 0918-6778 1881-767X |
| DOI | 10.11401/jsvs.18.659 |
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| Abstract | 【背景】重症虚血肢に対する下腿・足部動脈バイパス術の流入動脈を膝窩動脈とする妥当性につき，われわれの経験を中心に検討した．【対象と方法】2003年より2008年に経験した膝窩－下腿・足部動脈バイパス術10例を対象とした．症例の内訳は男性 7 例，女性 3 例，平均年齢は72.7歳で，全例Fontaine IV度，8 例(80%)が糖尿病を合併，1 例(10%)が慢性血液透析例であった．全例に大伏在静脈を用いたバイパス術が施行され，流入動脈は膝上膝窩動脈が 7 例，膝下膝窩動脈が 3 例，末梢側吻合部は後脛骨動脈が 6 例，足背動脈が 4 例であった．また10例中 2 例に同時期に浅大腿動脈に対してバルーン血管拡張術が追加施行されたが，いずれも浅大腿動脈中央部に存在する各々が 2cm長の多発性狭窄病変であった．【結果】全例にバイパスグラフトの初期開存が得られ，術前20.5 ± 9.3mmHgであった皮膚灌流圧(SPP)は，術後67.5 ± 23.9mmHgにまで上昇した．6 例で小切断が施行されたが，全例で大切断が回避できた．平均15.9カ月のフォローアップで全例に二次開存が得られ，術後 9 カ月目に脳出血にて死亡した 1 例を除いて健在である．なお，フォローアップ中に浅大腿動脈における新病変出現や血管内治療部位の再狭窄は認めなかった．【結論】浅大腿動脈病変を適切に評価，治療すれば，膝窩－下腿・足部動脈バイパス術は重症虚血肢に対する血行再建術の有効な選択肢の一つになりうる可能性が示唆された． |
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| AbstractList | Background: The aim of this study was to evaluate graft patency and limb salvage rates of popliteal-to-distal bypass for patients with critical limb ischemia. Patients and Methods: Between 2003 and 2008, 10 patients with toe gangrene underwent popliteal-to-distal bypass. The mean age at operation was 72.7 years; 7 were men, 8 (80%) had diabetes, and 1 (10%) had end-stage renal failure with hemodialysis. The inflow source in 7 patients was the supragenicular popliteal artery and the infragenicular popliteal artery in 3 pataients. Distal outflow was to the posterior tibial artery in 6 patients and to the dorsalis pedis artery in 4 patients. In 2 cases, percutaneous balloon angioplasty was perioperatively added for multiple short stenoses in the superficial femoral artery. Results: Initial success was obtained in all cases, and skin perfusion pressure elevated from 20.5 ± 9.3 mmHg to 67.5 ± 23.9 mmHg postoperatively. Minor amputation was necessary in 6 but none required major amputation. With an average follow-up period of 15.9 months, secondary patency was obtained in all cases and 9 out of 10 patients survived with complete healing of their toe gangrene. There was no new lesion or restenosis in the superficial femoral artery during the follow-up period. Conclusions: Popliteal-to-distal bypass, with or without an additional angioplasty, for lesions of the superficial femoral artery can yield good long-term results for appropriately selected patients with critical limb ischemia.
【背景】重症虚血肢に対する下腿・足部動脈バイパス術の流入動脈を膝窩動脈とする妥当性につき，われわれの経験を中心に検討した．【対象と方法】2003年より2008年に経験した膝窩－下腿・足部動脈バイパス術10例を対象とした．症例の内訳は男性 7 例，女性 3 例，平均年齢は72.7歳で，全例Fontaine IV度，8 例(80%)が糖尿病を合併，1 例(10%)が慢性血液透析例であった．全例に大伏在静脈を用いたバイパス術が施行され，流入動脈は膝上膝窩動脈が 7 例，膝下膝窩動脈が 3 例，末梢側吻合部は後脛骨動脈が 6 例，足背動脈が 4 例であった．また10例中 2 例に同時期に浅大腿動脈に対してバルーン血管拡張術が追加施行されたが，いずれも浅大腿動脈中央部に存在する各々が 2cm長の多発性狭窄病変であった．【結果】全例にバイパスグラフトの初期開存が得られ，術前20.5 ± 9.3mmHgであった皮膚灌流圧(SPP)は，術後67.5 ± 23.9mmHgにまで上昇した．6 例で小切断が施行されたが，全例で大切断が回避できた．平均15.9カ月のフォローアップで全例に二次開存が得られ，術後 9 カ月目に脳出血にて死亡した 1 例を除いて健在である．なお，フォローアップ中に浅大腿動脈における新病変出現や血管内治療部位の再狭窄は認めなかった．【結論】浅大腿動脈病変を適切に評価，治療すれば，膝窩－下腿・足部動脈バイパス術は重症虚血肢に対する血行再建術の有効な選択肢の一つになりうる可能性が示唆された． 【背景】重症虚血肢に対する下腿・足部動脈バイパス術の流入動脈を膝窩動脈とする妥当性につき，われわれの経験を中心に検討した．【対象と方法】2003年より2008年に経験した膝窩－下腿・足部動脈バイパス術10例を対象とした．症例の内訳は男性 7 例，女性 3 例，平均年齢は72.7歳で，全例Fontaine IV度，8 例(80%)が糖尿病を合併，1 例(10%)が慢性血液透析例であった．全例に大伏在静脈を用いたバイパス術が施行され，流入動脈は膝上膝窩動脈が 7 例，膝下膝窩動脈が 3 例，末梢側吻合部は後脛骨動脈が 6 例，足背動脈が 4 例であった．また10例中 2 例に同時期に浅大腿動脈に対してバルーン血管拡張術が追加施行されたが，いずれも浅大腿動脈中央部に存在する各々が 2cm長の多発性狭窄病変であった．【結果】全例にバイパスグラフトの初期開存が得られ，術前20.5 ± 9.3mmHgであった皮膚灌流圧(SPP)は，術後67.5 ± 23.9mmHgにまで上昇した．6 例で小切断が施行されたが，全例で大切断が回避できた．平均15.9カ月のフォローアップで全例に二次開存が得られ，術後 9 カ月目に脳出血にて死亡した 1 例を除いて健在である．なお，フォローアップ中に浅大腿動脈における新病変出現や血管内治療部位の再狭窄は認めなかった．【結論】浅大腿動脈病変を適切に評価，治療すれば，膝窩－下腿・足部動脈バイパス術は重症虚血肢に対する血行再建術の有効な選択肢の一つになりうる可能性が示唆された． |
| Author | 辻, 依子 北野, 育郎 寺師, 浩人 辻, 義彦 杉本, 幸司 |
| Author_FL | Kitano Ikuro Sugimoto Koji Tsuji Yoriko Tsuji Yoshihiko Terashi Hiroto |
| Author_FL_xml | – sequence: 1 fullname: Tsuji Yoshihiko – sequence: 2 fullname: Kitano Ikuro – sequence: 3 fullname: Tsuji Yoriko – sequence: 4 fullname: Terashi Hiroto – sequence: 5 fullname: Sugimoto Koji |
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| Publisher | 特定非営利活動法人 日本血管外科学会 JAPANESE SOCIETY FOR VASCULAR SURGERY |
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| References | 2) Cantelmo NL, Snow JR, Menzoian JO, et al. Successful vein bypass in patients with an ischemic limb and a palpable popliteal pulse. Arch Surg 1986;121:217-220. 10) Albers M, Romiti M, Brochado-Neto FC, et al. Meta-analysis of popliteal-to-distal vein bypass grafts for critical ischemia. J Vasc Surg 2006;43:498-503. 5) Brown PS Jr, McCarthy WJ, Yao JST, et al. The popliteal artery as inflow for distal bypass grafting. Arch Surg 1994;129:596-602. 7) Ballard JL, Killeen JD, Bunt TJ, et al. Autologous saphenous vein popliteal-tibial artery bypass for limb-threatening ischemia: a reassessment. Am J Surg 1995;170:251-255. 16) Cotroneo AR, Pascali D, Iezzi R. Cutting balloon versus conventional balloon angioplasty in short femoropopliteal arterial stenosis. J Endovasc Ther 2008;15:283-291. 12) Schneider PA, Caps MT, Ogawa DY, et al. Intraoperative superficial femoral artery balloon angioplasty and popliteal to distal bypass graft: an option for combined open and endovascular treatment of diabetic gangrene. J Vasc Surg 2001;33:955-962. 11) Wengerter KR, Yang PM, Veith FJ, et al. A twelve-year experience with the popliteal-to-distal artery bypass: the significance and management of proximal disease. J Vasc Surg 1992;15:143-151. 8) Eckstein HH, Schumacher H, Maeder N, et al. Pedal bypass for limb-threatening ischaemia: an 11-year review. Br J Surg 1996;83:1554-1557. 1) Veith FJ, Gupta SK, Samson RH, et al. Superficial femoral and popliteal arteries as inflow sites for distal bypass. Surgery 1981;90:980-990. 14) Lantis J, Jensen M, Benvenisty A, et al. Outcomes of combined superficial femoral endovascular revascularization and popliteal to distal bypass for patients with tissue loss. Ann Vasc Surg 2008;22:366-371. 6) Mills JL, Gahtan V, Fujitani RM, et al. The utility and durability of vein bypass grafts originating from the popliteal artery for limb salvage. Am J Surg, 1994;168: 646-651. 13) Schanzer A, Owens CD, Conte MS, et al. Superficial femoral artery percutaneous intervention is an effective strategy to optimize inflow for distal origin bypass grafts. J Vasc Surg 2007;45:740-743. 15) Duda SH, Bosiers M, Lammer J, et al. Drug-eluting and bare nitinol stents for the treatment of atherosclerotic lesions in the superficial femoral artery: long-term results from the SIROCCO trial. J Endovasc Ther 2006;13: 701-710. 3) Rhodes GR, Rollins D, Sidawy AN, et al. Popliteal-to- tibial in situ saphenous vein bypass for limb salvage in diabetic patients. Am J Surg 1987;154:245-247. 4) Marks J, King TA, Baele H, et al. Popliteal-to-distal bypass for limb-threatening ischemia. J Vasc Surg 1992; 15:755-760. 9) Biancari F, Kantonen I, Albäck A, et al. Popliteal-to-distal bypass grafts for critical leg ischaemia. J Cardiovasc Surg 2000;41:281-286. |
| References_xml | – reference: 16) Cotroneo AR, Pascali D, Iezzi R. Cutting balloon versus conventional balloon angioplasty in short femoropopliteal arterial stenosis. J Endovasc Ther 2008;15:283-291. – reference: 15) Duda SH, Bosiers M, Lammer J, et al. Drug-eluting and bare nitinol stents for the treatment of atherosclerotic lesions in the superficial femoral artery: long-term results from the SIROCCO trial. J Endovasc Ther 2006;13: 701-710. – reference: 3) Rhodes GR, Rollins D, Sidawy AN, et al. Popliteal-to- tibial in situ saphenous vein bypass for limb salvage in diabetic patients. Am J Surg 1987;154:245-247. – reference: 8) Eckstein HH, Schumacher H, Maeder N, et al. Pedal bypass for limb-threatening ischaemia: an 11-year review. Br J Surg 1996;83:1554-1557. – reference: 1) Veith FJ, Gupta SK, Samson RH, et al. Superficial femoral and popliteal arteries as inflow sites for distal bypass. Surgery 1981;90:980-990. – reference: 14) Lantis J, Jensen M, Benvenisty A, et al. Outcomes of combined superficial femoral endovascular revascularization and popliteal to distal bypass for patients with tissue loss. Ann Vasc Surg 2008;22:366-371. – reference: 4) Marks J, King TA, Baele H, et al. Popliteal-to-distal bypass for limb-threatening ischemia. J Vasc Surg 1992; 15:755-760. – reference: 7) Ballard JL, Killeen JD, Bunt TJ, et al. Autologous saphenous vein popliteal-tibial artery bypass for limb-threatening ischemia: a reassessment. Am J Surg 1995;170:251-255. – reference: 13) Schanzer A, Owens CD, Conte MS, et al. Superficial femoral artery percutaneous intervention is an effective strategy to optimize inflow for distal origin bypass grafts. J Vasc Surg 2007;45:740-743. – reference: 2) Cantelmo NL, Snow JR, Menzoian JO, et al. Successful vein bypass in patients with an ischemic limb and a palpable popliteal pulse. Arch Surg 1986;121:217-220. – reference: 6) Mills JL, Gahtan V, Fujitani RM, et al. The utility and durability of vein bypass grafts originating from the popliteal artery for limb salvage. Am J Surg, 1994;168: 646-651. – reference: 11) Wengerter KR, Yang PM, Veith FJ, et al. A twelve-year experience with the popliteal-to-distal artery bypass: the significance and management of proximal disease. J Vasc Surg 1992;15:143-151. – reference: 5) Brown PS Jr, McCarthy WJ, Yao JST, et al. The popliteal artery as inflow for distal bypass grafting. Arch Surg 1994;129:596-602. – reference: 9) Biancari F, Kantonen I, Albäck A, et al. Popliteal-to-distal bypass grafts for critical leg ischaemia. J Cardiovasc Surg 2000;41:281-286. – reference: 10) Albers M, Romiti M, Brochado-Neto FC, et al. Meta-analysis of popliteal-to-distal vein bypass grafts for critical ischemia. J Vasc Surg 2006;43:498-503. – reference: 12) Schneider PA, Caps MT, Ogawa DY, et al. Intraoperative superficial femoral artery balloon angioplasty and popliteal to distal bypass graft: an option for combined open and endovascular treatment of diabetic gangrene. J Vasc Surg 2001;33:955-962. |
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| Snippet | 【背景】重症虚血肢に対する下腿・足部動脈バイパス術の流入動脈を膝窩動脈とする妥当性につき，われわれの経験を中心に検討した．【対象と方法】2003年より2008年に経験した... Background: The aim of this study was to evaluate graft patency and limb salvage rates of popliteal-to-distal bypass for patients with critical limb ischemia.... |
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| SubjectTerms | Critical limb ischemia Percutaneous transluminal angioplasty Peripheral arterial disease Popliteal-to-distal bypass Superficial femoral artery 浅大腿動脈 経皮的血管拡張術 膝窩－下腿・足部動脈バイパス術 重症虚血肢 閉塞性動脈硬化症 |
| Title | 重症虚血肢に対する膝窩－下腿・足部動脈バイパス術の妥当性に関する検討 |
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| ispartofPNX | 日本血管外科学会雑誌, 2009/11/25, Vol.18(7), pp.659-665 |
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