骨付き有茎法で剝離採取した左内胸動脈を用いた冠状動脈バイパス術

Coronary Artery Bypass Grafting Using a Left Internal Thoracic Artery Harvested by the “Bony Pedicled Method”

冠状動脈バイパス術（CABG）においては，ほとんどの症例で左前下行枝（LAD）へのバイパスグラフトは内胸動脈（ITA）が使用されており，一般的な剝離デバイスにより問題なく剝離採取されている．しかし，ごくまれにITA剝離採取が困難な症例に遭遇することがある．われわれは左内胸動脈（LITA）が肋骨・肋軟骨に強固に癒着し，通常のデバイスでは剝離困難であったため，「骨付き有茎法」でLITAを剝離採取し，LADへのバイパスに使用したCABG 3例を経験したので報告する．

A detailed report how to dissect an internal thoracic artery （ITA） from severe adhesion of thoracic bone tissue is not seen. We herein report the “bony pedicled method” as a novel technique for harvesting ITA graft in difficult case, such as severe adhesion to the costosternal portion. Case 1 was a 70-year-old man who had three-vessel-disease （3VD）. Case 2 was a 69-year-old man who had unstable angina pectoris （UAP） due to severe 3VD. Case 3 was a 68-year-old man who had UAP due to left main trunk and double-vessel-disease. We planned coronary artery bypass grafting （CABG） using a left internal thoracic artery （LITA） grafts in these 3 cases. In their operative findings, LITAs had severe adhesion to the costosternal portions, so we dissected these portions using the “bony pedicled method” to avoid injury to the LITA grafts. We harvested the LITA grafts without any complications and performed their CABG as preoperative planning. Their postoperative courses were uneventful. All bypasses, including the LITA-left anterior descending artery （LAD） bypass in the 3 cases were patent on postoperative three dimensional computed tomography （3D-CT）. The “bony pedicled method” is an appropriate method for harvesting ITA graft without injury in case which graft harvesting is difficult due to adhesion to the costosternal portion.