Tetsuzo Hirayama

Coronary revascularization with arterial conduits collateral to the lower limb

A 62-year-old man with left main coronary artery disease had coronary artery bypass grafting. Angiography disclosed total occlusion of the left common iliac artery. The left internal thoracic artery and the left inferior epigastric artery were well developed as collateral pathways to the left external iliac artery. With concomitant femoro-femoral crossover bypass, these two large arterial conduits were harvested and grafted to the coronary artery.

Six year experience with wrinkled ePTFE vascular prostheses for arteriosclerosis obliterans

From November 1986 to January 1993, 97 wrinkled ePTFE prosthetic vascular grafts were implanted in 90 peripheral arterial reconstructions for 87 patients with arteriosclerosis obliterans (ASO) (79 men and 8 women). Grafts used in this series were 54 Vitagraft and 33 Technograft. Initial results for a period of as long as 6 years are summarized here. Forty-four (45.3%) grafts were implanted anatomically, and the remaining were extra-anatomically routed. The mean age of patients in the anatomic bypass group was 64.7 years, and that of patients in the other group was 71.4 years. Twenty-three (43.3%) grafts in the extra-anatomic group were anastomosed sequentially. Mean follow-up periods for each group were 32.4 months and 30.9 months, respectively. None of nine late deaths during the follow-up period was graft related. There was one primary obstruction in the anatomic group; in the extra-anatomic groups, primary graft occlusion occurred in four grafts. In addition, one perigraft seroma and one pseudoaneurysm requiring surgical repair were seen. Cumulative event free ratio for this group was 80.8% at 72 months. These results reveal that the wrinkled ePTFE graft is clinically applicable to arterial reconstruction for ASO with satisfactory long-term patency, even in extra anatomic sequential bypasses.

Internal Felt-reinforced Patch-plasty for Dissecting Aortic Aneurysm.

解離性大動脈瘤11例 (I型4例, II型1例, III型5例および弓部限局解離1例) に対して entry 閉鎖を目的としたフェルト内挿補強パッチ形成術を試案した. 血流遮断時間は平均84±19分で, 解離腔内にもフェルトを挿入した初期の1例を除き entry 部の完全閉鎖が得られた. III型の1例を遠心ポンプ離脱直後の不整脈にて失ったが, 術式に起因した死亡はみられなかった. 術後1か月以上の経過において, 解離腔はI型およびII型で上行部に, III部では下行部に血栓閉鎖が得られ, 弓部解離例は完全閉鎖した. 術後平均16か月の経過で全例良好な社会生活を送っている. 本法は, 解離性大動脈瘤における entry 閉鎖を目的とした簡便かつ確実な術式であり, 症例により試みるべきものと考える.