最近の人工血管の動向 ─大口径人工血管を中心に─

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1 Hitoshi OGINO 1. はじめに arteriosclerosis obliterans ASO 2. 人工血管の必要条件 1) 3. 人工血管代用血管の分類表 1 biologic graft synthetic graft 1) textile non-textile Dacron expanded polytetrafluoloethylene eptfe 1)Dacron 製 knitted woven 著者連絡先 hogino@tokyo-med.ac.jp Dacron 1956 DeBakey 60 porosity 1980 coating knitted Dacron 3 2)ePTFE 製 non-textile graft 2) 1972 Soyer 3) Dacron seroma 5 seroma 3) 合成高分子素材グラフト 4) 組織工学グラフト Shin oka 147

2 表 1 synthetic graft Textile woven/knitted Dacron velour biologically coated Non-textile Teflon eptfe Polyurethane bioabsorbable biologic graft Allograft arterial homograft venous allograft umbilical vein Xenograft bovine/canine carotid Fibrocollagenous tubes autogenous heterogenous eptfe: expanded polytetrafluoloethylene 表 2 Location Knitted Dacron Woven Dacron eptfe Auto. artery Auto. vein Allo-graft Thoracic Aorta a P A a Ruptured Aneurysm A P A a Infrarenal Aorta P a A a a Aorta visceral bypass A a A P P Femoro-popliteal bypass A A P A Femoro-tibial bypass A P A Axillo-femoral bypass P P Femoro-femoral bypass a P Extrathoracic bypass P A Arteriovenous shunt A P Venous replacement A A P A, a, alternate; Auto, autologous; P, preferred. 4) 4. 市販人工血管の用途 1) 口径 Dacron 6 40 mm eptfe 3 mm 5/6 mm 2) 使用部位 1) 表 2 Dacron woven Dacron knitted Dacron 1),5) knitted Dacron eptef Dacron Dacron Dacron 5. 特殊な専用グラフト 1) ステントグラフト Dacron eptfe 148

3 表 3 TEVAR Zenith TX2, TX2 PF, TXD TAG, Conformable TAG Talent, Valiant Relay Plus Najuta COOK Medical GORE Medtronic Bolton medical 2011, 2012, , , Woven eptfe Woven Woven eptfe Stainless steel Nitinol Nitinol Nitinol Stainless steel SG mm SG mm Delivery sheath Fr 20, 22 18, 20, 22, 24 22, 24, 25 22, 23, 24, 25, 26 21, 22, 23 eptfe, expanded polytetrafluoloethylene; SG, stent graft. 表 4 EVAR Zenith Flex C3 Excluder Endurant AorFix AFX Cook Gore Medtronic Lombard Endologix Woven eptfe Woven Polyester duraply multilayer eptfe Stainless steel Nitinol Nitinol Nitinol Cobalt chromium alloy mm 22, 24, 26, 28, 30, 23, 26, 28.5, 31, 35 23, 25, 28, 32, 36 24, 27, 31 22, 25, 28 32, 36 cm 8.2, 9.5, 9.6, 11.1, 12, 13, 14, 15, 16, 12.4, 14.5, , 9.6, 11.1, , 7, 8, 9, 10, 11, , 12.5, 13.1, 14.0, , 18 20, 23, 26 16, 18 18, F N.A. 18.6, 20.4 N.A. N.A. 9, 19 F / eptfe, expanded polytetrafluoloethylene Parodi 6) Z 2007 thoracic endovascular aortic repair TEVAR endovascular aortic repair EVAR 表 3 TEVAR TEVAR EVAR TEVAR 7) 50 EVAR 表 4 EVAR open conversion 2) フローズンエレファントトランク ( 図 1) open stent graft OSG 8) Frozen elephant trunk FET 9),10) 149

図 1 Frozen elephant trunk E-vita open Thoraflex hybrid Cronus Frozenix 表 5 Frozen elephant trunk Cronus E-vita open Plus Thoraflex Hybrid Frozenix MicroPort Medical Jotec Terumo-Vascutek Japan

4 図 1 Frozen elephant trunk E-vita open Thoraflex hybrid Cronus Frozenix 表 5 Frozen elephant trunk Cronus E-vita open Plus Thoraflex Hybrid Frozenix MicroPort Medical Jotec Terumo-Vascutek Japan Lifeline Coating woven Conichrome Nitinol Nitinol Nitinol FET 2, 4, 6, 8, 9, 10, 11, 12, 15 cm 13, 15, 16 cm 10, 15 cm 6, 9, 12 cm FET mm mm mm mm Guidewire system 表 5 11),12) A B Aortic remodeling A B TEVAR FET TEVAR 3) 分枝グラフト )Valsalva グラフト Valsalva David reimplantation 13) Yacoub remodeling Bentall 150

Body/ Collar Skirt height max. Skirt size mm diameter mm mm 24 24 32 1.33 26 26 34 1.31 28 28 36 1.29 30 30 38 1.

5 Body/ Collar Skirt height max. Skirt size mm diameter mm mm 図 2 図 2 Collar Skirt, Body 3 ventricular-arterial junction VAJ sinotubular junction STJ Valsalva Skirt 30 J Graft SHIELD NEO VALSALVA 6. おわりに Dacron eptfe 利益相反の開示文献 1) Kempczinski RF: Vascular conduits: An overview. Rutherford Vascular Surgery, ed by Rutherford RB, W.B. Saunders, Phiradelphia, ) Matsumoto H, Hasegawa T, Fuse K, et al: A new vascular prosthesis for a small caliber artery. Surgery 74: , ) Soyer T, Lempinen M, Cooper P, et al: A new venous prosthesis. Surgery 72: , ) Shin oka T, Matsumura G, Hibino N, et al: Midterm clinical result of tissue-engineered vascular autografts seeded with autologous bone marrow cells. J Thorac Cardiovasc Surg 129: , ) Schroeder TV, Eldrup N, Just S, et al: Dilatation of aortic grafts over time: what to expect and when to be concerned. Semin Vasc Surg 22: , ) Parodi JC, Palmaz JC, Barone HD: Transfemoral intraluminal graft implantation for abdominal aortic aneurysms. Ann Vasc Surg 5: 491-9, ) Committee for Scientific Affairs, The Japanese Association for Thoracic Surgery, Masuda M, Okumura M, Doki Y, et al: Thoracic and cardiovascular surgery in Japan during 2014: Annual report by The Japanese Association for Thoracic Surgery. Gen Thorac Cardiovasc Surg 64: , ) Kato M, Kuratani T, Kaneko M, et al: The results of total arch graft implantation with open stent-graft placement for type A aortic dissection. J Thorac Cardiovasc Surg 124: , ) Usui A, Fujimoto K, Ishiguchi T, et al: Cerebrospinal dysfunction after endovascular stent-grafting via a median sternotomy: the frozen elephant trunk procedure. Ann Thorac Surg 74: S1821-4, ) Karck M, Chavan A, Hagl C, et al: The frozen elephant trunk technique: a new treatment for thoracic aortic aneurysms. J Thorac Cardiovasc Surg 125:1550-3, ) Di Bartolomeo R, Di Marco L, Armaro A, et al: Treatment of complex disease of the thoracic aorta: the frozen elephant trunk technique with the E-vita open prosthesis. Eur J Cardiothorac Surg 35: 671-5, ) Uchida N, Shibamura H, Katayama A, et al: Operative strategy for acute type a aortic dissection: ascending aortic or hemiarch versus total arch replacement with frozen elephant trunk. Ann Thorac Surg 87: 773-7, ) De Paulis R, De Matteis GM, Nardi P, et al: Opening and closing characteristics of the aortic valve after valve-sparing procedures using a new aortic root conduit. Ann Thorac Surg 72: ,

人工血管の現状とステントグラフトへの応用

人工血管の現状とステントグラフトへの応用人工臓器最近の進歩 1 2 1 2 Mugiho TAKEUCHI, Toru KURATANI 1. はじめに 1993 2006 2. 人工血管開発の歩み 1950 1952 Voorhees 1) N 著者連絡先 565-0871 2-2 E-mail. mugihotakeuchi@surg1.med.osaka-u.ac.jp 1959 1960 Wesolowski gossamer