10．動脈吻合法（大動脈，中動脈，解離血管・人工血管を含む）

Arterial Anastomosis （Aorta, Middle Artery, Dissected Vessels, and Artificial Vessels）

上行大動脈人工血管置換術は大動脈外科における基本術式である．ポイントとしては，吻合部断端形成を含めた吻合法である．通常，真性大動脈瘤と急性大動脈解離では大動脈の脆弱性が異なり，吻合法はまったく異なる．大動脈遮断下に行うか，open distal法で行うか，吻合順や人工血管の種類やone pieceあるいはtwo pieceの人工血管で行うかなど，事前に十分な手術戦略を立てて手術に臨む必要がある．

Ascending aortic replacement is a basic procedure in aortic surgery. The crucial factor is the anastomosis method, including the anastomosis site formation. The anastomosis method is usually completely different between true aneurysms and acute aortic dissection because of the difference in the fragility of the aorta. It is necessary to prepare a surgical strategy well preoperatively, such as whether to perform the anastomosis under aortic clamping or by the open distal method, the order of anastomosis, the type of prosthesis, and whether to use a one-piece or two-piece prosthesis. In recent years, advances in surgical adhesives, extracorporeal circulation, and anastomosis methods have improved the surgical outcomes of aortic aneurysms. To further enhance the outcomes, it is desirable to improve the outcomes in shaggy aortic cases with many atheromas, very elderly patients, and patients with extensive aneurysms.