Online publication November 10, 2013 197 原 著 FP endoscopic vein harvest; EVH 要旨 : 2005 1 endoscopic vein harvest EVH 2007 8 femoro-popliteal bypass; FP EVH 2012 12 12 12 EVH J Jpn Coll Angiol 2013; 53: 197 201 Key words: femoro-popliteal bypass, EVH はじめに 手術方法 1 2005 1 coronary artery bypass graft; CABG endoscopic vein harvest; EVH open harvest open vein harvest; OVH graft quality 2 2007 8 femoro-popliteal bypass; FP EVH 対象と方法 2007 8 2012 12 FP EVH 12 12 OVH FP 7 7 EVH group 9 3 68.1 51 82 OVH group 6 1 66.9 43 79 Table 1a 1b doi: 10.7133/jca.13-00027 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 2013 5 28 2013 9 24
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 82 10 FP AKPA 2012 11 FP 2012 12 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). Figure 2 Preoperative enhanced CT shows the occlusion of left SFA and FP bypass. 215±28 CT EVH 2 1 17±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
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 210 14 0.66/0.79 none VirtuoSaph BKPA 245 14 0.53/0.87 none VirtuoSaph BKPA 185 14 /0.92 none Vasoview AKPA 190 20 0.57/0.75 lymphorrhea VirtuoSaph BKPA 198 20 0.38/0.91 none VirtuoSaph BKPA 248 14 0.59/0.78 none VirtuoSaph BKPA 215 20 /0.85 hematoma Vasoview AKPA 211 23 0.15/0.59 none VirtuoSaph BKPA 235 12 0.68/0.98 none VirtuoSaph BKPA 200 20 /0.71 none VirtuoSaph BKPA 265 21 /0.79 hematoma VirtuoSaph BKPA 175 11 /0.80 none Case Table 2b Postoperative data (OVH group) Distal Operation Hospital re/post Postoperative anastomosis time (min) stay (day) ABI complication AKPA 169 14 /0.86 none BKPA 240 20 0.35/0.60 wound dysraphia AKPA 190 22 0.55/0.78 none BKPA 225 20 /0.67 wound dysraphia BKPA 239 17 0.52/0.72 none BKPA 200 19 0.29/0.76 none BKPA 180 12 0.54/0.82 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 2 2013 5 16 脈管学 Vol. 53
201 2005 1 EVH FP EVH 2007 8 2012 12 12 12 EVH quality graft 20 30 EVH EVH SVG preparation 30 40 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, 998 1018 2 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: 1402 1407 3 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: 149 155 4 Budd JS, Brennan J, Beard JD, et al: Infrainguinal bypass surgery: factors determining late graft patency. Br J Surg 1990; 77: 1382 1387 5 vein harvesting 1997; 51: 797 801 6 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: 228 235 7 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: 475 484 EVH FP 12 12 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 2005. 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 2012. 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: 197 201) Online publication November 10, 2013