Yuichi Izumi

PLANTAR OR DORSALIS PEDIS ARTERY BYPASS IN BUERGER'S DISEASE

The peripheral type of Buergers disease is unresponsive to conservative therapy when accompanied by multisegmental occlusion at the level of the ankle. Between November 1983 and April 1993, we performed 15 bypasses below the ankle for this type of thromboangiitis obliterans in 13 patients (mean age 45.7 years), including four females. Ten patients had intractable toe ulcers with severe pain, and five had foot-threatening ischemia or disabling foot claudication. Eleven patients were heavy smokers, two were passive smokers, and six had a history of sympathectomy. All patients had occlusion of the three main crural arteries or both of the tibial arteries at the ankle. Of the 15 bypasses, 10 were to the medial or lateral plantar arteries, two were to the common plantar artery, and three were to the dorsalis pedis artery. There were three early and three late graft failures. The causes of early graft failure were thrombosis at the site of cross-clamping, anastomosis to a diseased segment, and arterial spasm. The three late failures (>3 months) were due to disease progression in patients who continued to smoke, whereas all grafts remained patent and functioned well in patients who stopped smoking. Because patients with thromboangiitis obliterans are relatively young and active, early healing of ulcers and restoration of normal limb function are important objectives in their treatment. Bypass to the foot arteries can provide an excellent outcome, although special techniques and postoperative cessation of smoking are essential for success.

Axillocoronary bypass in a patient with a severely atherosclerotic aorta

We report an axillocoronary bypass in a 70-year-old man with a severely atherosclerotic, calcified aorta. The patient had insulin-dependent diabetes mellitus and had 2-vessel coronary artery disease with a lesion in the left main coronary artery. He underwent an axillary artery-circumflex artery bypass with a saphenous vein graft combined with a bypass of the left internal thoracic artery to the left anterior descending artery without aortic cross-clamping. An easy, safe procedure, axillocoronary bypass is a viable option in coronary artery bypass grafting for patients with severely atherosclerotic, calcified aortas.

A Case of Localized Abdominal Aortic Dissection Suspected to Have Simultaneously Occurred with an Idiopathic Esophageal Rupture

症例は47歳男性.平成13年2月13日特発性食道破裂の診断で緊急食道破裂部縫合閉鎖が当院外科で施行された.術後腹部CTで腎動脈下大動脈から右総腸骨動脈までの解離が認められた.大動脈の最大径は3.0cm,右総腸骨動脈の最大径は2.5cmで偽腔は開存していた.手術は右後腹膜経路でアプローチ,腎動脈下で大動脈を遮断し瘤壁を切開したところ右前方に偽腔が存在しエントリーまたはりエントリーと思われる交通孔が3ヵ所存在した.腎動脈下大動脈から両側腸骨動脈までY型人工血管で置換を行った.術後経過は良好で術後15日目に退院した.本症例では食道破裂時以外に強い疼痛の既往がないことなどから特発性食道破裂と同時に腹部限局大動脈解離が発症した可能性が考えられた.