自己血液から作製した灌流液による血管グラフトの術中灌流・保存

Use of Heparinized Autologous Blood for Intraoperative Rinsing and Storage of Vascular Grafts

Ⅰ．緒　　言

　High flow bypassは標準的脳神経外科手術手技になりつつある．その際のグラフトの術中灌流・保存液としては通常ヘパリン化生理食塩水（ヘパリン生食）にアルブミンなどを添加して使用することが多いと思われる．一方で遊離血管グラフトをわれわれより日常的に使用しその使用の歴史も長いと思われる心臓血管外科では，現在グラフトの術中灌流・保存液としてアルブミン製剤は使用しておらず，自己血液（自己血）から作製した灌流保存液を使用している施設が多いようである．文献上も自己血から作製した灌流保存液の有効性が報告されていることから^5,7,8,12)，われわれも現在血管グラフトを使用する際の術中灌流・保存液にアルブミン製剤は使用せず，自己血をヘパリン生食で希釈したものを用いている．その方法と有効性について報告する．

　In cerebral revascularization surgery in Japan, the preferred solution for rinsing and intraoperative storage of saphenous vein or radial artery grafts is a heparinized saline solution with albumin. On the other hand, most cardiac surgeons routinely use solutions of heparinized autologous blood during surgery. Here we used the latter type of solution for cerebral revascularization surgery and evaluated its efficacy.

　Patients and methods：Since December 2011, we have used heparinized autologous blood for saphenous vein grafts during cerebral revascularization surgery. For this, 20mL of the whole blood was obtained from an arterial line；this blood was then mixed with 20mL of a heparinized saline solution containing 500IU of heparin and 40mg of papaverine hydrochloride. The saphenous vein was harvested using standard procedures and immersed in the autologous blood solution just before implantation.

　Results：Between December 2011 and March 2013, six revascularizations using saphenous vein grafts were performed using this solution. None of the anastomoses presented complications related to revascularization procedures, and all grafts were clearly present postoperatively.

　Discussion：There is still no evidence that the storage in autologous blood is superior to the use of a saline solution with albumin. However, the national health insurance does not cover the use of albumin products, which carries an additional cost. Furthermore, the autologous blood medium is a red-colored solution that indicates the presence of unfavorable graft leaks when the wall of the graft turns red.

　Conclusion：We recommend the use of heparinized autologous blood for intraoperative rinsing and storage grafts.