血行再建術, とくに合併症と代用血管の現況について

Abstract

Three hundred and eighty patients with various peripheral arterial occlusive diseases have been encountered at our department during the last 15 years. The most frequent clinical entity among them were thromboangitis obliterans (TAO), 145 cases and arteriosclerosis obliterans (ASO), 125 cases. Arterial occlusion in TAO occurs usually at the peripheral level of the limb artery where the conventional reconstructive surgery is hardly applied. On the contrarily, reconstructive surgery was able to apply to the most cases of ASO. Thus it was applied to 38 cases, or 26 per cent in TAO and 78 cases, or 64 per cent in ASO.Results of reconstructive surgery (38 cases, 43 limbs and 52 operations in TAO, and 78 cases, 91 limbs and 100 operations in ASO) were analysed with special reference to operative procedures and complications. Results in TAO were not so favorable. Early patency rates of thromboendarterectomy (TEA), prosthetic graft bypass and autogenous vein bypass in TAO were 41 per cent, 33 per cent and 65 per cent, respectively, Late patency rates were 23 per cent, 0 per cent and 48 per cent, respectively. Those figures are well contrasted with the figures in ASO groups where early patency rate was 85 per cent and late patency rate was 69 per cent. Difference of results among the procedures is not so apparent, TEA and prosthetic graft bypass procedures proved to be unfavorable in TAO. Vein bypass was the single procedure applicable to obtain resonable results.Most frequent complications were early thrombosis which occured 14 per cent in ASO and 46 per cent in TAO. Late occlusions were observed 16 per cent in ASO and 20 per cent in TAO. Infection was complicated in 3.3 per cent. Anastomotic aneurysm was observed in 2.6 per cent.