[原著］合併する末梢動脈硬化性病変に対し同時手術を施行した冠状動脈バイパス手術症例の検討

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Patients with peripheral arteriosclerotic vascular disease undergoing coronary artery bypass grafting (CABG) present a management problem. Here we present a report of the benefits of combined surgery on coexistent coronary artery disease (CAD) and peripheral artenosclerotic vascular lesions. CABG combined with peripheral revascularization was performed in 22 (4.4%) of 497 patients who underwent CABG in our hospital. These patients were classified into 2 groups, according to the lesions of peripheral arteriosclerotic vascular disease. Group A patients (n=12) had innominate or carotid atherosclerosis, whilst group B patients (n=10) had lower extremity vascular disease. In group A, the mean patient age was $65.4 \pm 8.0$ years, and 9 patients had left main trunk lesions. CABG was performed immediately following carotid artery reconstruction. One patient experienced new neurological symptoms after the operation, and there was 1 operative death. There was no significant difference in the period of respiratory care between the patients who underwent combined surgery and those who received CABG alone. In group B, the mean patient age was $63.1 \pm 12.7$ years. CABG was performed with subsequent extremity revascularization in 6 patients. However, in 2 patients with severe CAD and 2 re-do CAD patients, extremity revascularization was performed first to facilitate intra aortic balloon pumping or femoro-femoral bypass. One patient died of low output syndrome. A high incidence of peripheral arteriosclerotic vascular disease has previously been reported with CAD, and thus detailed preoperative evaluation is necessary. The results of this clinical study indicate that it is feasible to combine peripheral vascular disease repair with CABG for some patients.
琉球医学会,Ryukyu Medical Associationの論文

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