左椎骨動脈大動脈起始の灌流および再建法

Perfusion Methods and Reconstruction Techniques for Performing Aortic Arch Surgery with Isolated Left Vertebral Artery

左椎骨動脈大動脈起始（ILVA）は，左椎骨動脈（LVA）が左総頸動脈（LCCA）と左鎖骨下動脈（LSCA）間の大動脈から直接起始するバリエーションである．内野らが自施設の患者に対して造影CTで検討した報告ではILVAの発生率は3.6％であった1）．ILVAを有する弓部大動脈手術の際は脳灌流や再建法に工夫が必要である．

In our institution, when we perform aortic arch surgery with isolated left vertebral artery using an extracorporeal circulation, we select an interposed saphenous vein graft technique. This technique has a relatively short clamping time and allows for selective cerebral perfusion and flexible choice of reconstruction site. Although other techniques, such as an island reconstruction, have been reported, we do not perform it often due to its longer ischemic time of the left vertebral artery. On the other hand, we use a direct reconstruction technique in cases where an extracorporeal circulation is not used. This direct reconstruction technique in cases of isolated left vertebral artery could reduce the time and number of clamping it.