198 Table 1a Preoperative patients characteristics (EVH group) Age (y.o) Gender Comorbidity Lesion TASC II Fontaine 51 male HTN, HPL, DM, smoking Lt S

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1 Online publication November 10, 原著 FP endoscopic vein harvest; EVH 要旨 : endoscopic vein harvest EVH femoro-popliteal bypass; FP EVH EVH J Jpn Coll Angiol 2013; 53: Key words: femoro-popliteal bypass, EVH はじめに手術方法 coronary artery bypass graft; CABG endoscopic vein harvest; EVH open harvest open vein harvest; OVH graft quality femoro-popliteal bypass; FP EVH 対象と方法 FP EVH OVH FP 7 7 EVH group OVH group Table 1a 1b doi: /jca EVH Vasoview system MAQUIET Cardiovascular LLC: Wayne, USA VirtuoSaph system TERUMO: Tokyo, Japan frog position saphenous vein graft; SVG SVG EVH Fig. 1 SVG common femoral artery; CFA above knee popliteal artery; AKPA below knee popliteal artery; BKPA SVG SVG CABG preparation 5-0 reversed SVG rooting EVH 2 SVG OVH

2 198 Table 1a Preoperative patients characteristics (EVH group) Age (y.o) Gender Comorbidity Lesion TASC II Fontaine 51 male HTN, HPL, DM, smoking Lt SFA D 2a 73 female HTN, HPL, smoking Rt SFA (ISR) C 2b 72 male HTN, HPL, IHD, smoking Rt SFA D 3 61 male HTN, HPL, IHD, smoking Lt SFA (ISR) C 4 68 male DM, smoking Lt SFA C 2b 71 female HTN, DM, IHD, CVD Lt SFA D 3 60 male HTN, IHD, CRF Lt SFA (ISR) C 3 73 male HTN, DM, smoking Rt SFA D 3 71 female HTN, DM, smoking Rt SFA D 2b 58 female HTN, IHD, CVD, CRF Lt SFA D 2b 77 male HTN, CRF Rt SFA (ISR) D 3 82 male HTN, smoking Lt SFA D 3 HTN, hypertension; HPL, hyperlipidemia; DM, diabetes mellitus; IHD, ischemic heart disease; CVD, cerebral vascular disease; CRF, chronic renal failure; Lt, left; Rt, right; SFA, superficial femoral artery; ISR, in-stent restenosis Table 1b Preoperative patients characteristics (OVH group) Age (y.o) Gender Comorbidity Lesion TASC II Fontaine 70 male HTN, HPL, IHD Lt SFA (ISR) D 4 59 female HTN, DM, CRF Rt SFA D 4 43 male HTN, DM, smoking Rt SFA D 3 70 male HTN, DM Rt SFA (ISR) D 4 71 male DM Rt SFA C 3 76 male HTN, HPL, smoking Rt SFA D 3 79 male HTN Rt SFA D 2b HTN, hypertension; HPL, hyperlipidemia; DM, diabetes mellitus; IHD, ischemic heart disease; CRF, chronic renal failure; Lt, left; Rt, right; SFA, superficial femoral artery; ISR, in-stent restenosis Figure 1 Harvesting SVG from the thigh with EVH system (right side: head). 症例提示 EVH FP AKPA FP CT FP Fig. 2 AKPA BKPA ABI 3 FP in-flow EVH FP BKPA Fig. 3 CT Fig. 4 ABI 0.8 結果 EVH group Vasoview system 2 VirtuoSaph system 10 AKPA 2 BKPA 10 脈管学 Vol. 53

199 Figure 3 Postoperative wound of FP bypass (BKPA, Lt leg).

3 199 Figure 3 Postoperative wound of FP bypass (BKPA, Lt leg). Figure 2 Preoperative enhanced CT shows the occlusion of left SFA and FP bypass. 215±28 CT EVH ±4 OVH group AKPA 2 BKPA 5 206±29 18±4 CT 2 Table 2a 2b group Student t p=0.98 p=0.67 EVH group 18 OVH group 32 CT Figure 4 Postoperative enhanced CT shows the patent SVG. 考察 FP AKPA BKPA AKPA Klinkert 3 eptfe 2 5 AKPA BKPA

4 200 Case Table 2a Postoperative data (EVH group) EVH Distal Operation Hospital pre/post Postoperative device anastomosis time (min) stay (day) ABI complication VirtuoSaph BKPA /0.79 none VirtuoSaph BKPA /0.87 none VirtuoSaph BKPA /0.92 none Vasoview AKPA /0.75 lymphorrhea VirtuoSaph BKPA /0.91 none VirtuoSaph BKPA /0.78 none VirtuoSaph BKPA /0.85 hematoma Vasoview AKPA /0.59 none VirtuoSaph BKPA /0.98 none VirtuoSaph BKPA /0.71 none VirtuoSaph BKPA /0.79 hematoma VirtuoSaph BKPA /0.80 none Case Table 2b Postoperative data (OVH group) Distal Operation Hospital re/post Postoperative anastomosis time (min) stay (day) ABI complication AKPA /0.86 none BKPA /0.60 wound dysraphia AKPA /0.78 none BKPA /0.67 wound dysraphia BKPA /0.72 none BKPA /0.76 none BKPA /0.82 none 4 AKPA BKPA FP OVH OVH group Fontaine 4 in-situ bypass 5 EVH QOL EVH frog position EVH BKPA graft quality OVH EVH 2 mm EVH OVH EVH 6 EVH Vasoview system VituoSaph system 脈管学 Vol. 53

5 EVH FP EVH EVH quality graft EVH EVH SVG preparation group p=0.98 Perrault 2 Judson 7 OVH EVH EVH 18 結語文献 1 Whittemore AD, Belkin M: Infrainguinal bypass. In: Rutherford RB ed. Vascular Surgery, 4th Ed, W.B. Saunders Company, Philadelphia, 2000, Perrault LP, Jeanmart H, Bilodeau L, et al: Early quantitative coronary angiography of saphenous vein grafts for coronary artery bypass grafting harvested by means of open versus endoscopic saphenectomy: a prospective randomized trial. J Thorac Cardiovasc Surg 2004: 127: Klinkert P, Schepers A, Burger DH, et al: Vein versus polytetrafluoroethylene in avobe-knee femoropopliteal bypass grafting: five-years results of a randomized controlled trial. J Vasc Surg 2003; 37: Budd JS, Brennan J, Beard JD, et al: Infrainguinal bypass surgery: factors determining late graft patency. Br J Surg 1990; 77: vein harvesting 1997; 51: Davis Z, Jacobs HK, Zhang M, et al: Endoscopic vein harvest for coronary artery bypass grafting: technique and outcomes. J Thorac Cardiovasc Surg 1998; 116: Williams JB, Peterson ED, Brennan JM, et al: Association between endoscopic vs open vein-graft harvesting and mortality, wound complications, and cardiovascular events in patients undergoing CABG surgery. JAMA 2012; 308: EVH FP EVH QOL The Usefulness of EVH for Femoro-popliteal Bypass Masatoshi Komooka, Shinichi Higashiue, Keiji Matsubayashi, Hisashi Tonda, Norihiko Hiramatsu, and Onichi Furuya Department of Cardiovascular Surgery, Kishiwada Tokusyukai Hospital, Osaka, Japan Key words: femoro-popliteal bypass, EVH During the CABG procedure, we have used Endoscopic Vein Harvest (EVH) to harvest great the saphenous vein of the thigh since January We began using EVH among Femoro-Popliteal bypass (FP bypass) surgical patients from August 2007 and have operated on 12 patients (12 limbs) until December FP bypass with EVH can make surgical wound healing time shorter, so this procedure is very useful for patients. (J Jpn Coll Angiol 2013; 53: ) Online publication November 10, 2013

脈管学55巻7号　pp.105-110

脈管学55巻7号　pp.105-110 Online publication August 10, 2015 105 原著 55 要旨 : 18 29 31 27 87.1 EHIT class 1 class 2, 3 1 J Jpn Coll Angiol 2015; 55: 105 110 Key words: saphenous vein surgery, saphenous vein stump, endovenous heat-induced