内臓動脈瘤に対する当科の治療戦略—手術治療(外科的手術，血管内治療)と保存的治療の予後
要 旨：【目的】当科の内臓動脈瘤に対する治療戦略の妥当性を検討した．【対象と方法】2001～2012年6月に内臓動脈瘤43例48瘤(腎動脈瘤17瘤，脾動脈瘤20瘤，腹腔動脈瘤3瘤，上腸間膜動脈瘤6瘤，下膵十二指腸動脈瘤1瘤，肝動脈瘤1瘤)を経験した．瘤径20 mm以上，有症状，仮性瘤，上腸間膜動脈分枝瘤を治療対象とし，それ以外を経過観察とした．例外として20 mm前半のeggshellを呈する腎動脈瘤2瘤，脾動脈瘤1瘤は経過観察とした．血管内治療(endovascular treatment; EVT)を第一選択とし，血行再建を要す場合や解剖学的にEVT不適の場合は外科的手術(open su...
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| Published in | 日本血管外科学会雑誌 Vol. 22; no. 3; pp. 633 - 639 |
|---|---|
| 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
25.04.2013
日本血管外科学会 |
| Subjects | |
| Online Access | Get full text |
| ISSN | 0918-6778 1881-767X |
| DOI | 10.11401/jsvs.22.633 |
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| Abstract | 要 旨：【目的】当科の内臓動脈瘤に対する治療戦略の妥当性を検討した．【対象と方法】2001～2012年6月に内臓動脈瘤43例48瘤(腎動脈瘤17瘤，脾動脈瘤20瘤，腹腔動脈瘤3瘤，上腸間膜動脈瘤6瘤，下膵十二指腸動脈瘤1瘤，肝動脈瘤1瘤)を経験した．瘤径20 mm以上，有症状，仮性瘤，上腸間膜動脈分枝瘤を治療対象とし，それ以外を経過観察とした．例外として20 mm前半のeggshellを呈する腎動脈瘤2瘤，脾動脈瘤1瘤は経過観察とした．血管内治療(endovascular treatment; EVT)を第一選択とし，血行再建を要す場合や解剖学的にEVT不適の場合は外科的手術(open surgery; OS)を施行した．【結果】8瘤にOS，9瘤にEVTを施行した．OSは腎動脈瘤2瘤に瘤切除・血行再建術，脾動脈瘤3瘤に瘤切除，瘤切除・血行再建術，瘤切除・脾摘術，上腸間膜動脈瘤2瘤に瘤切除・血行再建術，下膵十二指腸動脈瘤に瘤切除を施行した．EVTは腎動脈瘤3瘤，脾動脈瘤5瘤，肝動脈瘤1瘤にコイル塞栓術を施行した．早期合併症はEVTの穿刺部仮性瘤1例のみで，晩期合併症はOS，EVTいずれも認めず，全例が完全社会復帰した．経過観察とした31瘤は，初診時13.1±3.3 mmに対して最終確認時13.5±3.7 mmと有意な瘤径増大はなかった(p=0.12, 観察期間43±19カ月)．OS，EVTの累積生存率は5年100%，8年75%，経過観察症例は5年92%，8年92%で，いずれも瘤関連死亡はみられなかった．【結論】OS，EVTおよび経過観察症例はいずれも良好な経過であり，現在の治療戦略は妥当と思われた． |
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| AbstractList | 「要旨」: 【目的】当科の内臓動脈瘤に対する治療戦略の妥当性を検討した. 【対象と方法】2001～2012年6月に内臓動脈瘤43例48瘤(腎動脈瘤17瘤, 脾動脈瘤20瘤, 腹腔動脈瘤3瘤, 上腸間膜動脈瘤6瘤, 下膵十二指腸動脈瘤1瘤, 肝動脈瘤1瘤)を経験した. 瘤径20mm以上, 有症状, 仮性瘤, 上腸間膜動脈分枝瘤を治療対象とし, それ以外を経過観察とした. 例外として20mm前半のeggshellを呈する腎動脈瘤2瘤, 脾動脈瘤1瘤は経過観察とした. 血管内治療(endovascular treatment; EVT)を第一選択とし, 血行再建を要す場合や解剖学的にEVT不適の場合は外科的手術(open surgery; OS)を施行した. 【結果】8瘤にOS, 9瘤にEVTを施行した. OSは腎動脈瘤2瘤に瘤切除・血行再建術, 脾動脈瘤3瘤に瘤切除, 瘤切除・血行再建術, 瘤切除・脾摘術, 上腸間膜動脈瘤2瘤に瘤切除・血行再建術, 下膵十二指腸動脈瘤に瘤切除を施行した. EVTは腎動脈瘤3瘤, 脾動脈瘤5瘤, 肝動脈瘤1瘤にコイル塞栓術を施行した. 早期合併症はEVTの穿刺部仮性瘤1例のみで, 晩期合併症はOS, EVTいずれも認めず, 全例が完全社会復帰した. 経過観察とした31瘤は, 初診時13.1±3.3mmに対して最終確認時13.5±3.7mmと有意な瘤径増大はなかった(p=0.12, 観察期間43±19カ月). OS, EVTの累積生存率は5年100%, 8年75%, 経過観察症例は5年92%, 8年92%で, いずれも瘤関連死亡はみられなかった. 【結論】OS, EVTおよび経過観察症例はいずれも良好な経過であり, 現在の治療戦略は妥当と思われた. 要 旨：【目的】当科の内臓動脈瘤に対する治療戦略の妥当性を検討した．【対象と方法】2001～2012年6月に内臓動脈瘤43例48瘤(腎動脈瘤17瘤，脾動脈瘤20瘤，腹腔動脈瘤3瘤，上腸間膜動脈瘤6瘤，下膵十二指腸動脈瘤1瘤，肝動脈瘤1瘤)を経験した．瘤径20 mm以上，有症状，仮性瘤，上腸間膜動脈分枝瘤を治療対象とし，それ以外を経過観察とした．例外として20 mm前半のeggshellを呈する腎動脈瘤2瘤，脾動脈瘤1瘤は経過観察とした．血管内治療(endovascular treatment; EVT)を第一選択とし，血行再建を要す場合や解剖学的にEVT不適の場合は外科的手術(open surgery; OS)を施行した．【結果】8瘤にOS，9瘤にEVTを施行した．OSは腎動脈瘤2瘤に瘤切除・血行再建術，脾動脈瘤3瘤に瘤切除，瘤切除・血行再建術，瘤切除・脾摘術，上腸間膜動脈瘤2瘤に瘤切除・血行再建術，下膵十二指腸動脈瘤に瘤切除を施行した．EVTは腎動脈瘤3瘤，脾動脈瘤5瘤，肝動脈瘤1瘤にコイル塞栓術を施行した．早期合併症はEVTの穿刺部仮性瘤1例のみで，晩期合併症はOS，EVTいずれも認めず，全例が完全社会復帰した．経過観察とした31瘤は，初診時13.1±3.3 mmに対して最終確認時13.5±3.7 mmと有意な瘤径増大はなかった(p=0.12, 観察期間43±19カ月)．OS，EVTの累積生存率は5年100%，8年75%，経過観察症例は5年92%，8年92%で，いずれも瘤関連死亡はみられなかった．【結論】OS，EVTおよび経過観察症例はいずれも良好な経過であり，現在の治療戦略は妥当と思われた． |
| Author | 森景, 則保 佐村, 誠 末廣, 晃太郎 山下, 修 村上, 雅憲 濱野, 公一 |
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| References | 17)Abbas MA, Stone WM, Fowl RJ, et al. Splenic artery aneurysms: two decades experience at Mayo clinic. Ann Vasc Surg 2002;16:442-449. 13)Henke PK, Cardneau JD, Welling TH, et al. Renal artery aneurysms: a 35-year clinical experience with 252 aneurysms in 168 patients. Ann Surg 2001;234:454-462; discussion 462-463. 4)Rockman CB, Maldonado TS. Splanchnic Artery Aneurysms. Rutherford's Vascular Surgery. 7th ed. Cronenwett JL and Johnston KW eds. Philadelphia: Saunders Elsevier; 2010. p. 2140-2155. 18)Jiang J, Ding X, Su Q, et al. Therapeutic management of superior mesenteric artery aneurysms. J Vasc Surg 2011;53:1619-1624. 25)木村知恵里，安達秀雄，山口敦司，他．腹腔動脈閉塞と上腸間膜動脈狭窄を伴った未破裂下膵十二指腸動脈瘤の1手術例．日血外会誌 2009;18:691-694. 26)Grotemeyer D, Duran M, Park EJ, et al. Visceral artery aneurysms-follow-up of 23 patients with 31 aneurysms after surgical or interventional therapy. Langenbecks Arch Surg 2009;394:1093-1100. 1)Kasirajan K, Greenberg RK, Clair D, et al. Endovascular management of visceral artery aneurysm. J Endovasc Ther 2001;8:150-155. 10)Carmeci C, McClenathan J. Visceral artery aneurysms as seen in a community hospital. Am J Surg 2000;179:486-489. 8)Hirsch AT, Haskal ZJ, Hertzer NR, et al. ACC/AHA 2005 Practice Guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): a collaborative report from the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease): endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular Nursing; TransAtlantic Inter-Society Consensus; and Vascular Disease Foundation. Circulation 2006;113: e463-654. 6)Stanley JC, Wakefield TW, Graham LM, et al. Clinical importance and management of splanchnic artery aneurysms. J Vasc Surg 1986;3:836-840. 27)Pulli R, Dorigo W, Troisi N, et al. Surgical treatment of visceral artery aneurysms: a 25-year experience. J Vasc Surg 2008;48:334-342. 14)Pfeiffer T, Reiher L, Grabitz K, et al. Reconstruction for renal artery aneurysm: operative techniques and long-term results. J Vasc Surg 2003;37:293-300. 23)Rossi M, Rebonato A, Citone M, et al. Common hepatic artery aneurysm successfully treated with a celiac axis stent graft. Two years of follow up. Eur J Radiol Extra 2010;75:125-128. 28)Huang YK, Hsieh HC, Tsai FC, et al. Visceral artery aneurysm: risk factor analysis and therapeutic opinion. Eur J Vasc Endovasc Surg 2007;33:293-301. 12)Lakin RO, Bena JF, Sarac TP, et al. The contemporary management of splenic artery aneurysms. J Vasc Surg 2011;53:958-964; discussion 965. 22)de Ruiter-Derksen GL, Bruijnen RC, Joosten F, et al. Endovascular treatment of a hepatic artery aneurysm causing chronic abdominal pain; a case report. Ann Hepatol 2010;9:104-106. 24)Bageacu S, Cuilleron M, Kaczmarek D, et al. True aneurysms of the pancreaticoduodenal artery: successful non-operative management. Surgery 2006;139:608-616. 2)Abbas MA, Fowl RJ, Stone WM, et al. Hepatic artery aneurysm: factors that predict complications. J Vasc Surg 2003;38:41-45. 16)Agrawal GA, Johnson PT, Fishman EK. Splenic artery aneurysms and pseudoaneurysms: clinical distinctions and CT appearances. AJR Am J Roentgenol 2007;188:992-999. 19)Suzuki K, Mori Y, Komada T, et al. Stent-graft treatment for bleeding superior mesenteric artery pseudoaneurysm after pancreaticoduodenectomy. Cardiovasc Intervent Radiol 2009;32:762-766. 3)Stone WM, Abbas M, Cherry KJ, et al. Superior mesenteric artery aneurysms: is presence an indication for intervention? J Vasc Surg 2002;36:234-237; discussion 237. 15)English WP, Pearce JD, Craven TE, et al. Surgical management of renal artery aneurysms. J Vasc Surg 2004;40:53-60. 20)Jenssen GL, Wirsching J, Pedersen G, et al. Treatment of a hepatic artery aneurysm by endovascular stent-grafting. Cardiovasc Intervent Radiol 2007;30:523-525. 9)Carr SC, Mahvi DM, Hoch JR, et al. Visceral artery aneurysm rupture. J Vasc Surg 2001;33:806-811. 7)髙橋英雄，小林裕之，田村 亮，他．当院における腹部内臓動脈瘤破裂9例の検討．日臨外会誌 2009;70:2303-2308. 11)Panayiotopoulos YP, Assadourian R, Taylor PR. Aneurysms of the visceral and renal arteries. Ann R Coll Surg Engl 1996;78:412-419. 5)Stanley JC, Thompson NW, Fry WJ. Splanchnic artery aneurysms. Arch Surg 1970;101:689-697. 21)Carrafiello G, Rivolta N, Fontana F, et al. Combined endovascular repair of a celiac trunk aneurysm using celiac-splenic stent graft and hepatic artery embolization. Cardiovasc Intervent Radiol 2010;33: 352-354. |
| References_xml | – reference: 24)Bageacu S, Cuilleron M, Kaczmarek D, et al. True aneurysms of the pancreaticoduodenal artery: successful non-operative management. Surgery 2006;139:608-616. – reference: 27)Pulli R, Dorigo W, Troisi N, et al. Surgical treatment of visceral artery aneurysms: a 25-year experience. J Vasc Surg 2008;48:334-342. – reference: 7)髙橋英雄，小林裕之，田村 亮，他．当院における腹部内臓動脈瘤破裂9例の検討．日臨外会誌 2009;70:2303-2308. – reference: 22)de Ruiter-Derksen GL, Bruijnen RC, Joosten F, et al. Endovascular treatment of a hepatic artery aneurysm causing chronic abdominal pain; a case report. Ann Hepatol 2010;9:104-106. – reference: 25)木村知恵里，安達秀雄，山口敦司，他．腹腔動脈閉塞と上腸間膜動脈狭窄を伴った未破裂下膵十二指腸動脈瘤の1手術例．日血外会誌 2009;18:691-694. – reference: 8)Hirsch AT, Haskal ZJ, Hertzer NR, et al. ACC/AHA 2005 Practice Guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): a collaborative report from the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease): endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular Nursing; TransAtlantic Inter-Society Consensus; and Vascular Disease Foundation. Circulation 2006;113: e463-654. – reference: 26)Grotemeyer D, Duran M, Park EJ, et al. Visceral artery aneurysms-follow-up of 23 patients with 31 aneurysms after surgical or interventional therapy. Langenbecks Arch Surg 2009;394:1093-1100. – reference: 12)Lakin RO, Bena JF, Sarac TP, et al. The contemporary management of splenic artery aneurysms. J Vasc Surg 2011;53:958-964; discussion 965. – reference: 10)Carmeci C, McClenathan J. Visceral artery aneurysms as seen in a community hospital. Am J Surg 2000;179:486-489. – reference: 20)Jenssen GL, Wirsching J, Pedersen G, et al. Treatment of a hepatic artery aneurysm by endovascular stent-grafting. Cardiovasc Intervent Radiol 2007;30:523-525. – reference: 23)Rossi M, Rebonato A, Citone M, et al. Common hepatic artery aneurysm successfully treated with a celiac axis stent graft. Two years of follow up. Eur J Radiol Extra 2010;75:125-128. – reference: 21)Carrafiello G, Rivolta N, Fontana F, et al. Combined endovascular repair of a celiac trunk aneurysm using celiac-splenic stent graft and hepatic artery embolization. Cardiovasc Intervent Radiol 2010;33: 352-354. – reference: 14)Pfeiffer T, Reiher L, Grabitz K, et al. Reconstruction for renal artery aneurysm: operative techniques and long-term results. J Vasc Surg 2003;37:293-300. – reference: 17)Abbas MA, Stone WM, Fowl RJ, et al. Splenic artery aneurysms: two decades experience at Mayo clinic. Ann Vasc Surg 2002;16:442-449. – reference: 4)Rockman CB, Maldonado TS. Splanchnic Artery Aneurysms. Rutherford's Vascular Surgery. 7th ed. Cronenwett JL and Johnston KW eds. Philadelphia: Saunders Elsevier; 2010. p. 2140-2155. – reference: 11)Panayiotopoulos YP, Assadourian R, Taylor PR. Aneurysms of the visceral and renal arteries. Ann R Coll Surg Engl 1996;78:412-419. – reference: 28)Huang YK, Hsieh HC, Tsai FC, et al. Visceral artery aneurysm: risk factor analysis and therapeutic opinion. Eur J Vasc Endovasc Surg 2007;33:293-301. – reference: 6)Stanley JC, Wakefield TW, Graham LM, et al. Clinical importance and management of splanchnic artery aneurysms. J Vasc Surg 1986;3:836-840. – reference: 9)Carr SC, Mahvi DM, Hoch JR, et al. Visceral artery aneurysm rupture. J Vasc Surg 2001;33:806-811. – reference: 3)Stone WM, Abbas M, Cherry KJ, et al. Superior mesenteric artery aneurysms: is presence an indication for intervention? J Vasc Surg 2002;36:234-237; discussion 237. – reference: 1)Kasirajan K, Greenberg RK, Clair D, et al. Endovascular management of visceral artery aneurysm. J Endovasc Ther 2001;8:150-155. – reference: 5)Stanley JC, Thompson NW, Fry WJ. Splanchnic artery aneurysms. Arch Surg 1970;101:689-697. – reference: 13)Henke PK, Cardneau JD, Welling TH, et al. Renal artery aneurysms: a 35-year clinical experience with 252 aneurysms in 168 patients. Ann Surg 2001;234:454-462; discussion 462-463. – reference: 2)Abbas MA, Fowl RJ, Stone WM, et al. Hepatic artery aneurysm: factors that predict complications. J Vasc Surg 2003;38:41-45. – reference: 16)Agrawal GA, Johnson PT, Fishman EK. Splenic artery aneurysms and pseudoaneurysms: clinical distinctions and CT appearances. AJR Am J Roentgenol 2007;188:992-999. – reference: 19)Suzuki K, Mori Y, Komada T, et al. Stent-graft treatment for bleeding superior mesenteric artery pseudoaneurysm after pancreaticoduodenectomy. Cardiovasc Intervent Radiol 2009;32:762-766. – reference: 15)English WP, Pearce JD, Craven TE, et al. Surgical management of renal artery aneurysms. J Vasc Surg 2004;40:53-60. – reference: 18)Jiang J, Ding X, Su Q, et al. Therapeutic management of superior mesenteric artery aneurysms. J Vasc Surg 2011;53:1619-1624. |
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| Snippet | 要 旨：【目的】当科の内臓動脈瘤に対する治療戦略の妥当性を検討した．【対象と方法】2001～2012年6月に内臓動脈瘤43例48瘤(腎動脈瘤17瘤，脾動脈瘤20瘤，腹腔動脈瘤3瘤，上... 「要旨」: 【目的】当科の内臓動脈瘤に対する治療戦略の妥当性を検討した. 【対象と方法】2001～2012年6月に内臓動脈瘤43例48瘤(腎動脈瘤17瘤, 脾動脈瘤20瘤, 腹腔動脈瘤3瘤, 上... |
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| SubjectTerms | 内臓動脈瘤 外科的手術 血管内治療 |
| Title | 内臓動脈瘤に対する当科の治療戦略—手術治療(外科的手術，血管内治療)と保存的治療の予後 |
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| ispartofPNX | 日本血管外科学会雑誌, 2013/04/25, Vol.22(3), pp.633-639 |
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