本邦にて使用可能な企業製デバイスを用いた大動脈瘤ステントグラフト治療の工夫 : デブランチおよびチムニー法とコイル塞栓手技の有効性 Innovative Application of Available Stent Grafts in Japan in Aortic Aneurysm Treatment : Significance of Innovative Debranching and Chimney Method and Coil Embolization Procedure

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著者

    • 福井 大祐 FUKUI Daisuke
    • 信州大学医学部附属病院心臓血管外科 Division of Cardiovascular Surgery, Department of Surgery, Shinshu University School of Medicine
    • 和田 有子 WADA Yuko
    • 信州大学医学部附属病院心臓血管外科 Division of Cardiovascular Surgery, Department of Surgery, Shinshu University School of Medicine
    • 駒津 和宜 KOMATSU Kazunori
    • 信州大学医学部附属病院心臓血管外科 Division of Cardiovascular Surgery, Department of Surgery, Shinshu University School of Medicine
    • 藤井 大志 FUJII Taisi
    • 信州大学医学部附属病院心臓血管外科 Division of Cardiovascular Surgery, Department of Surgery, Shinshu University School of Medicine
    • 大橋 伸朗 OHASHI Noburo
    • 信州大学医学部附属病院心臓血管外科 Division of Cardiovascular Surgery, Department of Surgery, Shinshu University School of Medicine
    • 寺崎 貴光 TERASAKI Takamitsu
    • 信州大学医学部附属病院心臓血管外科 Division of Cardiovascular Surgery, Department of Surgery, Shinshu University School of Medicine
    • 瀬戸 達一郎 SETO Tatsuichiro
    • 信州大学医学部附属病院心臓血管外科 Division of Cardiovascular Surgery, Department of Surgery, Shinshu University School of Medicine
    • 高野 環 TAKANO Tamaki
    • 信州大学医学部附属病院心臓血管外科 Division of Cardiovascular Surgery, Department of Surgery, Shinshu University School of Medicine
    • 天野 純 AMANO Jun
    • 信州大学医学部附属病院心臓血管外科 Division of Cardiovascular Surgery, Department of Surgery, Shinshu University School of Medicine

抄録

【目的】2007年のSG治療開始以降,当科にて施行してきた大動脈瘤に対するSG治療の工夫について検討し報告する.【対象と方法】EVAR 310例・TEVAR 83例の治療成績と,高齢者やハイリスク症例を中心に筆者らが工夫してきたIIA塞栓併用EVAR 94例,ショートネックに対する腎動脈チムニー法併用EVAR 10例,TAAにおけるデブランチングTEVAR 20例,TAAAに対するデブランチングTEVAR(EVAR)3例を術式別に検討した.【結果】全SG治療症例における在院死亡症例は,IIA塞栓併用EVARの肺炎例とTAAにおけるデブランチングTEVARの脳梗塞例を含む3例(0.8%)であった.IIA塞栓併用EVARの4例(4.3%)に術後半年以降の臀筋跛行の残存を認め,3例(3.2%)に虚血性腸炎の合併を認めたが,全例保存的に軽快した.また,LZ 10 mm以下で腎動脈チムニー法を併用したEVAR症例は10例であったが,術後ELや腎動脈閉塞合併症例は遠隔期を含め認めていない.Zone 0をLZとするチムニー法を用いた9例を含む20例の2本デブランチングTEVAR施行のうち,ELの残存しているものは1例(5%)であった.TAAAに対する腹部4分枝をカバーし内臓動脈をバイパスにより再建するSG治療を3例に行い,全例経過良好にて独歩退院となった.【結論】今回検討したSG治療の工夫術式において,外科手技に加えてチムニー法やコイル塞栓術が有効であった.SG治療の工夫により,現在本邦にて使用可能な企業製デバイスを用いて,さらなる低侵襲治療が可能であるものと期待される.

Objective: We here describe our experience with innovative uses of these devices. Patients and methods: We reviewed treatment outcomes of 310 EVAR and 83 TEVAR cases performed between August 2007 and February 2012. We separately assessed results in elderly and high-risk patients who had a novel procedure. This group included 94 patients who underwent EVAR with IIA embolization, 10 patients who had EVAR and a renal artery chimney procedure for a short aortic neck, 20 patients who had two de-branching TEVAR or Chimney method for TAA and 3 patients who had debranching TEVAR for TAAA. Results: Of the 393 patients given SGs, 3 (0.8%) died in the hospital, including 1 patient with pneumonia who underwent EVAR and IIA embolization and 1 patient with a cerebral infarction who had TEVAR. Four patients (4.3%) who were treated with EVAR with IIA embolization presented with residual buttock claudication 6 months postoperatively, and 3 patients (3.2%) had onset of ischemic enteritis; however, in all 7 patients, the condition resolved without additional intervention. In the 10 patients who had EVAR and a renal artery chimney method, the landing zone (LZ) was ≤10 mm, but neither endoleak nor renal artery occlusion was observed perioperatively or during midterm follow-up. Of the 20 patients who had a 2-debranching TEVAR, including 9 in whom the chimney method was used with the LZ in zone 0, 1 (5%) had a residual endoleak. In 3 patients with TAAA, we used SGs to cover 4 abdominal branches and bypassed the visceral artery; the outcomes were good, with all patients being ambulatory at hospital discharge. Conclusion: Among innovative SGs treatments, the debranching procedure and the chimney method using catheterization and the coil-embolization technique provided good outcomes, as used in addition to surgical procedures. Aortic aneurysm treatment will become increasingly noninvasive with the continuing development of more innovative ways to use the SGs currently available in Japan.

収録刊行物

  • 日本血管外科学会雑誌 = The Japanese journal of vascular surgery : official journal of the Japanese Society for Vascular Surgery

    日本血管外科学会雑誌 = The Japanese journal of vascular surgery : official journal of the Japanese Society for Vascular Surgery 21(3), 165-173, 2012-05-01

    特定非営利活動法人 日本血管外科学会

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各種コード

  • NII論文ID(NAID)
    10030954849
  • NII書誌ID(NCID)
    AN10399956
  • 本文言語コード
    JPN
  • 資料種別
    ART
  • ISSN
    09186778
  • データ提供元
    CJP書誌  J-STAGE 
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