冠状動脈バイパス術および上行大動脈-両側大腿動脈バイパス術後の遠隔期合併症の1例

Localized Stenosis in a Non-anastomotic Site of the Ascending Aorta to Bifemoral Bypass Graft：Report of a Case

はじめに　虚血性心疾患（IHD）と閉塞性動脈硬化症（ASO）に対して，冠状動脈バイパス術（CABG）と上行大動脈-両側大腿動脈バイパス術の同時手術を施行し，その有効性を本誌で報告した1）．その後，われわれは術後の遠隔期合併症として人工血管非吻合部の狭窄に対する治療を経験したので報告する．

An 85-year-old man received simultaneous coronary artery bypass grafting （CABG） and the ascending aorta to bifemoral bypass with a Dacron graft 11 years ago. He suffered from intermittent claudication. Angiography demonstrated a localized stenosis in a non-anastomotic site, straight portion of the graft. He received percutaneous transluminal angioplasty. The right ankle-brachial pressure index （ABI） improved from 0.58 to 0.74 and left ABI improved from 0.52 to 0.71. One year later, intermittent claudication appeared again, right ABI decreased to 0.53 and left ABI decreased to 0.52. Computed tomography （CT） demonstrated restenosis at the same portion of the graft. A re-do operation was performed, stenotic portion was removed and replaced by a new ePTFE graft. No restenosis was seen three years after the second operation. We thought that repeated temporary compression of the graft might have led to a clot formation in the non-anastomotic site.