Vein Graftを使用した閉塞性前大脳動脈に対する血行再建術の2例

STA-ACA Anastomosis with Interposed Vein Graft; A case report

I．はじめに

　主幹脳動脈の閉塞性疾患に対する浅側頭動脈（STA）—中大脳動脈（MCA）吻合術は臨床上，一般的な血行再建術の一つである．しかしながら，本邦における前大脳動脈（ACA）に対する再建術は文献上，散見されるに過ぎず確立された術式はない．今回，われわれはvein graftを用いたSTA-ACA吻合術を2症例に行い良好な結果を得たので，閉塞性ACA病変の血流再建術におけるvein graftの有用性および問題点につき文献的考察を加えて報告する．

We report our experience with the use of three saphenous vein grafts for treating advanced occlusive cerebrovascular disease in the anterior cerebral artery (ACA) in two patients. Superficial temporal artery (STA) -ACA anastomosis with interposed vein graft is thought to be indicated for patients who have STA of insufficient length to anastomose to the ACA.

Vein graft has already been demonstrated to be ap-plicable in extracranial-intracranial artery bypass, as well as in aorto-coronary bypass. Two factors consi-dered to be essential for successful revascularization are technical proficiency, including protection from drying, smooth approximation of vessels, and proper orienta-tion of the graft, and the relative size of donor and reci-pient vessels.

Because the vein graft must be anastomosed with the proximal ACA to reduce the size discrepancy between vessels, prolonged interruption of circulation during suturing is inevitable. Our operative results suggest that anastomosis to a superficial branch of the ACA just distal to the interhemispheric fissure seems to be pre-ferable to anastomosis using vein graft, and we recom-mend the option of vein graft only when the STA can-not be used.