頸動脈部分閉塞症に対する代用血管移植術の経験

EXPERIENCE IN CLINICAL APPLICATION OF BLOOD VESSEL SUBSTITUTE IN THE PARTIAL INTERNAL CAROTID ARTERY OCCLUSION

I．まえがき

　頸動脈閉塞症の治療は，血管外科の発達に伴い，姑息的な治療法から積極的な血行再建の方向に向いつつある。治療成療も，欧米の報告では，部分閉塞症の場合特に優秀である。わが国においても，清水ら^1）の報告以来本症の報告が増加しつつあり，さほど珍しい疾患ではなくなつたが，その外科的治療については，報告例が少なく，治療時期の遅いことや，特発性閉塞症である場合が多いことから，まだ成績が悪い現状である。われわれは内頸動脈起始部の動脈硬化性部分閉塞症に対し，罹患部を切除し，代用血管の移植に成功した。本邦における頸動脈閉塞症に対する外科治療の成功例は，木本ら^2）の血栓内膜別除術＋自家静脈patchの報告例を最初とするが，本症に対する代用血管移植の成功例は本報告が最初である。その概要を報告し，文献的考察を加えてみたいと思う。

A 72-year-old man came to this hospital having noticed a small swelling in the left side of his neck about a month and a half previously, complaining of heavy feeling in his head. Percutaneous left carotid angiogram showed partial obstruction of the left internal carotid artery at the origin. On the opposite side the internal carotid artery was found to be slightly kinked, but no obstruction was observed. The patient was associated with hypertension and arteriosclerosis. Metas'test of a week's duration was made before operation to asses the effect of left carotid compression for fear of worsening his defect. Transient compres-sion of carotid artery showed increased carotid sinus syndrome such as accelerated respiration, dizziness, pressure in the chest and so forth, but failed to show fainting and failing vision.

A left internal carotid arterectomy was performed under general anesthesia. When opend, it was felt that the left internal carotid artery was occluded at its origin. A circumscribed atherosclerotic plaque at the origin of the left internal carotid artery was excised and Tetron Graft Kmitted Tube used as blood vessel substitude was inserted between the common carotid and the internal carotid artery. It tooked as long as 40 minutes to perform this kind of procedure, though it is hoped that the procedure should be made under hypothermia within 5-30 minutes.

At the stenosis, the resected blood vessel was reduced in calibre (1.5mm.). Histologically, it was reported as "intimal atherosclerotic plaque".

After surgical intervention, Heparin and Warfarin were given for 12 days to prevent thrombosis.

Re-examination of the left carotid angiography 3 weeks following surgery disclosed clearly that the direction of blood flow in the substitutive blood vessel was normal.

In the seven months period following surgery there has been no further incident. The patient is much improved and heavy feeling in the head has disap-peared. Carotid pulses are normal to palpation.

In Japan, the etiologic agent is considered to be due more frequently to spontaneous cccusion than to arteriosclerosis.

According to Kimoto, he succeeded in performing an autoplastic graft that is taken from the patient's own vein and used to take the place of a removed artery.

In an attempt to improve the therapeutic approch, we tried to use the blood vessel substitute instead of the patient's own vein and this has met with success. There is now no doubt that curative treatment of this type is satisfactory.