静脈片による頭蓋内外バイパス手術の経験—閉塞静脈片に対する修復術

EC-IC Bypass Surgery Using A Long Vein Graft: Reconstructive procedures for the occluded long vein grafts

I．はじめに

　long vein graftを用いた頭蓋内外（EC-IC）バイパス手術は高流量バイパスとして近年その利用が高まっている^2,3,6-10）．しかし，本バイパス手術は手技が複雑であり，技術的ミスから設置したvein graftが狭窄または閉塞する機会が少なくない^12）．私どもは術中の技術的ミスが原因で発生したvein graftの狭窄・閉塞に対して修復術を行い，バイパスを再建し得たので，症例を呈示するとともに，vein graft狭窄・閉塞の原因とそれらの修復術について検討したので報告する．

EC-IC bypass using a long vein graft has an advan-tage creating a large amount of blood flow immediately after the anastomosis, but on the other hand, disadvan-tage of relatively frequent incidence of the vein graft occlusion.

In this report, we present three kinds of reconstruc-tive operative procedures for the stenotic or occluded long vein grafts.

Type A : A long vein graft bypass between external carotid and posterior cerebral artery was found occluded intraoperatively by the thrombosis occurred where the vein graft was injured during harvesting.