新しいステント付き人工血管を用いた弓部―下行大動脈瘤手術
弓部に病変をもつ大動脈瘤および大動脈解離の手術成績は未だ不良である。我々は市販の平織りポリエステル製人工血管に3連のGianturco stentを内挿したstented graftを作成し、正中切開のみで、かつ短時間の循環停止にて弓部, 下行大動脈瘤を処置しうる新しい術式を考案した。この方法は弓部-下行大動脈瘤に対し、末梢側血管吻合を、従来の縫合を施行することなく、stentによる拡張力で吻合の代用とするものである。この新しい術式を弓部-下行大動脈瘤8例に臨床応用した。年令は平均71才である。循環停止時間は平均30分で、術後2週に施行した胸部CTにて解離性動脈瘤では偽腔の血栓化、真性動脈瘤5...
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| Published in | 人工臓器 Vol. 25; no. 1; pp. 220 - 223 |
|---|---|
| Main Authors | , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
一般社団法人 日本人工臓器学会
25.02.1996
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| Online Access | Get full text |
| ISSN | 0300-0818 1883-6097 |
| DOI | 10.11392/jsao1972.25.220 |
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| Abstract | 弓部に病変をもつ大動脈瘤および大動脈解離の手術成績は未だ不良である。我々は市販の平織りポリエステル製人工血管に3連のGianturco stentを内挿したstented graftを作成し、正中切開のみで、かつ短時間の循環停止にて弓部, 下行大動脈瘤を処置しうる新しい術式を考案した。この方法は弓部-下行大動脈瘤に対し、末梢側血管吻合を、従来の縫合を施行することなく、stentによる拡張力で吻合の代用とするものである。この新しい術式を弓部-下行大動脈瘤8例に臨床応用した。年令は平均71才である。循環停止時間は平均30分で、術後2週に施行した胸部CTにて解離性動脈瘤では偽腔の血栓化、真性動脈瘤5例では人工血管外、瘤内の血栓化を全例において得た。全例にて手術死亡はなかった。本法は短時間の循環停止にて弓部大動脈に人工血管移植が可能となり、手術成績も良好で弓部-下行大動脈領域の術式として有用であると思われる。 |
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| AbstractList | 弓部に病変をもつ大動脈瘤および大動脈解離の手術成績は未だ不良である。我々は市販の平織りポリエステル製人工血管に3連のGianturco stentを内挿したstented graftを作成し、正中切開のみで、かつ短時間の循環停止にて弓部, 下行大動脈瘤を処置しうる新しい術式を考案した。この方法は弓部-下行大動脈瘤に対し、末梢側血管吻合を、従来の縫合を施行することなく、stentによる拡張力で吻合の代用とするものである。この新しい術式を弓部-下行大動脈瘤8例に臨床応用した。年令は平均71才である。循環停止時間は平均30分で、術後2週に施行した胸部CTにて解離性動脈瘤では偽腔の血栓化、真性動脈瘤5例では人工血管外、瘤内の血栓化を全例において得た。全例にて手術死亡はなかった。本法は短時間の循環停止にて弓部大動脈に人工血管移植が可能となり、手術成績も良好で弓部-下行大動脈領域の術式として有用であると思われる。 |
| Author | 平松, 美代子 植田, 隆司 岸, 大輔 加藤, 雅明 吉井, 幸誠 金香, 充範 |
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| References | 7 Bachet J, Guilmet D, Goudot B, Termignon JL, Teodori G, Dreyfus G, brodaty D, Dubois C, Delentdecker P. Cold cerebroplegia; a new technique of cerebral protection during operations on the transverse aortic arch. J Thorac Cardiovasc Surg 102: 85, 1991. 9 Crawford ES, Svenson LG, Coselli JS, Safi HJ, Hess KR. Surgical treatment of aneurysm and/or dissection of the ascending aorta, transverse aortic arch, and ascending aorta and transverse aortic arch. J Thorac Cardiovasc Surg 98: 659, 1989. 15 Chuter TAM. Transfemoral endovascular aortic graft placement. J Vasc Surg 18: 185, 1993. 4 Ergin MA, O'Connor J, Guinto R, Griepp RB. Experience with profound hypothermic and circulatory arrest in the treatment of aneurysm of the aortic arch. J Thorac Cardiovasc Surg 84: 649, 1982. 13 Parodi JC, Palmaz JC, Barone HD. Transfemoral intraluminal graft implantation for abdominal aortic aneurysms. Ann Vasc Surg 5: 491-499, 1991. 14 Parodi JC. Endovascular repair of abdominal aortic aneurysms and other arterial lesions. J Vasc Surg 21: 549, 1995. 11 Kato M, Kaneko M, Ueda T, Kishi D, Yoshii Y, Hiramatsu M, Adachi S: A new Surgical Treatment for Repairing Transverse Arch-Descending Aortic Aneurysm Using a Stent-Reinforced Graft. Jpn J Artif Organs 24 (1): 135-138, 1995 12 Borst HG, Frank G, Schaps D. Treatment of extensive aortic aneurysms by a new multiple-stage approach. J Thorac Cardiovasc Surg 95: 11-13, 1988. 10 Kieffer E, Koskas F, Walden R, Godet G, Le Blevec D, Bahnini A, Bcrtrand M, Fleron MH. Hypothermic circulatory arrest for thoracic aneurysm through leftsided thoracotomy. J Vasc Surg 19 (3) 457-64, 1994. 17 Duke MD, Miller DC, Semba CP, Mitchell RS, Walker PJ, Liddell RP. Transluminal placement of endovascular stent-grafts for the treatment of descending thoracic aortic aneurysm. N Eng J Med 331: 1729-34, 1994. 16 Yusuf SW, Baker DM, Chuter TAM, Whitaker SC, Wenham PW, Hopkinson BR. Transfemoral endoluminal repair of abdominal aortic aneurysm with bifurcated-graft. Lancet 344: 650, 1994. 18 Kato M, Matsuda T, Kaneko M, Ueda T, Kuratani T, Yoshioka Y, Ohnishi K. Experimental Assessment of Newly Deviced Transcatheter Stent-Graft for Aortic Dissection. Ann Thorac Surg 59: 908-15, 1995. 3 Tabayashi K, Ohmi M, Togo T, Miura M, Yokoyama H, Akimoto H, Murata S Ohsaka K, Mohri H. Aortic arch aneurysm repair using selective cerebral perfusion. Ann Thorac Surg 57: 1305, 1994. 2 Kazui T, Kimura N, Yamada O, Komatsu S. Surgical outcome of aortic arch aneurysms using selective cerebral perfusion. Ann Thorac Surg 57 (4): 904-911, 1994. 8 Matsuda H, Nakano S, Shirakura S et al: Surgery for aortic arch aneurysm with selective cerebral perfusion and hypothermic cardiopulmonary bypass. Circulation 80 (Supple 1): 243, 1989. 5 Lansman SL, Raissi S, Ergin MA Griepp RB. Urgent operation for acute transverse aortic dissection. J Thorac Cardiovasc Surg 97: 334, 1989. 1 Miller DC, Mitchell RS, Oyer PE, Stinson EB, Jamieson SW, Shumway NE. Independent determinants of operative mortality for patients with aortic dissections. Circulation 70 (Suppl I): 153-164, 1984. 6 Ueda Y, Mild S, Kusuhara K et al: Surgical treatment of aneurysm or dissection involving the ascending aorta, utilizing circulatory arrest and retrograde cerebral perfusion. J Cardiovasc Surg 31: 553, 1990. |
| References_xml | – reference: 7 Bachet J, Guilmet D, Goudot B, Termignon JL, Teodori G, Dreyfus G, brodaty D, Dubois C, Delentdecker P. Cold cerebroplegia; a new technique of cerebral protection during operations on the transverse aortic arch. J Thorac Cardiovasc Surg 102: 85, 1991. – reference: 12 Borst HG, Frank G, Schaps D. Treatment of extensive aortic aneurysms by a new multiple-stage approach. J Thorac Cardiovasc Surg 95: 11-13, 1988. – reference: 2 Kazui T, Kimura N, Yamada O, Komatsu S. Surgical outcome of aortic arch aneurysms using selective cerebral perfusion. Ann Thorac Surg 57 (4): 904-911, 1994. – reference: 18 Kato M, Matsuda T, Kaneko M, Ueda T, Kuratani T, Yoshioka Y, Ohnishi K. Experimental Assessment of Newly Deviced Transcatheter Stent-Graft for Aortic Dissection. Ann Thorac Surg 59: 908-15, 1995. – reference: 4 Ergin MA, O'Connor J, Guinto R, Griepp RB. Experience with profound hypothermic and circulatory arrest in the treatment of aneurysm of the aortic arch. J Thorac Cardiovasc Surg 84: 649, 1982. – reference: 3 Tabayashi K, Ohmi M, Togo T, Miura M, Yokoyama H, Akimoto H, Murata S Ohsaka K, Mohri H. Aortic arch aneurysm repair using selective cerebral perfusion. Ann Thorac Surg 57: 1305, 1994. – reference: 14 Parodi JC. Endovascular repair of abdominal aortic aneurysms and other arterial lesions. J Vasc Surg 21: 549, 1995. – reference: 6 Ueda Y, Mild S, Kusuhara K et al: Surgical treatment of aneurysm or dissection involving the ascending aorta, utilizing circulatory arrest and retrograde cerebral perfusion. J Cardiovasc Surg 31: 553, 1990. – reference: 9 Crawford ES, Svenson LG, Coselli JS, Safi HJ, Hess KR. Surgical treatment of aneurysm and/or dissection of the ascending aorta, transverse aortic arch, and ascending aorta and transverse aortic arch. J Thorac Cardiovasc Surg 98: 659, 1989. – reference: 5 Lansman SL, Raissi S, Ergin MA Griepp RB. Urgent operation for acute transverse aortic dissection. J Thorac Cardiovasc Surg 97: 334, 1989. – reference: 1 Miller DC, Mitchell RS, Oyer PE, Stinson EB, Jamieson SW, Shumway NE. Independent determinants of operative mortality for patients with aortic dissections. Circulation 70 (Suppl I): 153-164, 1984. – reference: 13 Parodi JC, Palmaz JC, Barone HD. Transfemoral intraluminal graft implantation for abdominal aortic aneurysms. Ann Vasc Surg 5: 491-499, 1991. – reference: 11 Kato M, Kaneko M, Ueda T, Kishi D, Yoshii Y, Hiramatsu M, Adachi S: A new Surgical Treatment for Repairing Transverse Arch-Descending Aortic Aneurysm Using a Stent-Reinforced Graft. Jpn J Artif Organs 24 (1): 135-138, 1995 – reference: 15 Chuter TAM. Transfemoral endovascular aortic graft placement. J Vasc Surg 18: 185, 1993. – reference: 16 Yusuf SW, Baker DM, Chuter TAM, Whitaker SC, Wenham PW, Hopkinson BR. Transfemoral endoluminal repair of abdominal aortic aneurysm with bifurcated-graft. Lancet 344: 650, 1994. – reference: 8 Matsuda H, Nakano S, Shirakura S et al: Surgery for aortic arch aneurysm with selective cerebral perfusion and hypothermic cardiopulmonary bypass. Circulation 80 (Supple 1): 243, 1989. – reference: 17 Duke MD, Miller DC, Semba CP, Mitchell RS, Walker PJ, Liddell RP. Transluminal placement of endovascular stent-grafts for the treatment of descending thoracic aortic aneurysm. N Eng J Med 331: 1729-34, 1994. – reference: 10 Kieffer E, Koskas F, Walden R, Godet G, Le Blevec D, Bahnini A, Bcrtrand M, Fleron MH. Hypothermic circulatory arrest for thoracic aneurysm through leftsided thoracotomy. J Vasc Surg 19 (3) 457-64, 1994. |
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| Snippet | 弓部に病変をもつ大動脈瘤および大動脈解離の手術成績は未だ不良である。我々は市販の平織りポリエステル製人工血管に3連のGianturco stentを内挿したstented graftを作成し、正中切開のみで、かつ短時間の循環停止にて弓部,... |
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| Title | 新しいステント付き人工血管を用いた弓部―下行大動脈瘤手術 |
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