7．解剖学的理解に基づいた大腿動静脈，腋窩動脈の露出法

Exposure of Femoral Artery and Vein and Axillary Artery Based on Anatomical Knowledge

大腿動静脈は心臓血管外科分野において，外科および経皮的手技を含めてもっとも循環にアプローチしやすく，特に体外循環のアクセスルートとしてもっとも使用機会の多い血管である．また血管内治療の台頭に伴い，経皮的手技が確実に増加傾向にある中，穿刺部トラブルをはじめ，われわれ外科医がシンプルかつスマートにアプローチし対応しなければならない時代でもある．一方で，関節領域の硬化性病変に対する血行再建術は，いまだに外科治療の優位性は揺るぎなく，鼠径部以下の血行再建術についても，大腿動脈の露出，大腿静脈および大伏在静脈に対する柔軟な手技は必須の技術といえる．腋窩動脈に対するアプローチは，人工心肺確立のほか，debranching胸部ステントグラフト挿入術（TEVAR）で扱う機会が確実に増えており，大腿動静脈とともにアプローチしやすい動脈としてその露出法の理解は必須と考える．解剖を理解のうえ，良好な術野を確保し手術に臨んでほしい．

Femoral artery and veins and axillary artery are one of the major vessels in the human body which are easily accessible to circulation. Therefore, these vessels are usually used for cardiac and aortic surgeries to establish extracorporeal circulation through surgical as well as percutaneous technique. Additionally, with increasing a minimally invasive fashion for treatment of cardiac and aortic diseases, these accessible arteries are frequently manipulated, for example transcatheter aortic valve implantation, de‑branching thoracic endovascular aortic repair and endovascular aneurysm repair. Thus, exposure of the vessels is a basic procedure in this field；cardiac and vascular surgeons need understanding anatomical knowledge of the arteries and the surrounding structures, such as muscles and nerves. Especially, it becomes frequent for surgeons to see a bleeding complication with the increasing endovascular therapy and a calcified and atherosclerotic artery due to peripheral artery disease；these situations increase difficulty of femoral artery exposure. Deep understanding of anatomical knowledge helps to obtain good surgical exposure. We hope that it describes some useful improvements to surgical technique and anatomical understanding of cardiac and vascular surgeons.