自家静脈及び人口血管による小動脈血行再建術に関する実験的研究 : aorto-coronary bypassへの応用
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概要
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The purpose of this experimental study was to investigate whether the artificial vascular prosthesis could be applied in clinical use for aorto-coronary bypass grafting or not. Reconstruction was performed in small caliber arteries such as the femoral and the coronary arteries with autogenous saphenous vein and artificial vascular prosthesis using 94 mongrel dogs. Thereafter pathologycal findings and patency rate of them were observed periodically. Sauvage graft (double velour knitted dacron filamentous vascular prosthesis) and Goretex graft (Expanded polytetrafluoroethylene vascular graft : pore size 30μ) were used as artificial prostheses. And 5-0 Nylon was utilized as suture materials. Venous and artificial grafts were interposed in the position of the femoral artery. And aortocoronary bypass was performed under intraluminal shunting to maintain distal coronary perfusion. Subsequently, following results were obtained. 1) The patency rate of 1 week after interposition at the site of the femoral artery was 75% in vein, 64% in Sauvage, and 80% in Goretex grafts. 2) Intraluminal shunting method was useful technique during aorto-coronary bypass because of suppling satisfactory blood flow to the distal part of the ligated coronary artery during anastomosis under beating heart. 3) Blood flow could be measured on the site of them by application of electromagnetic flowmeter when Sauvage and vein grafts were used, except for Goretex. 4) The infiltration of the blood through Sauvage graft and formation of pseudointima could be microscopically observed in the early postoperative period. But these findings were found about 1 month later in case with Goretex graft than that with Sauvage graft. 5) The patency rate of 3 hours after aorto-coronary bypass was 75% in vein, 58% in Sauvage, and 73% in Goretex grafts without any anticoagulation. 6) It could be concluded that Sauvage and Goretex grafts were useful materials for the reconstruction of the small caliber artery and could be used in clinical cases. However, the autogenous vein graft should be selected as materials of the first choice for the reconstruction of the small caliber artery. Goretex and Sauvage grafts were chosed for this operation when it was not desireble for use.
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