STA-MCA吻合術の吻合血管の開存に影響する因子

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A consecutive series of 60 cases of STA-MCA anastomosis were experienced in our service and the patency rate was 91.5% by angiographic proof. Namely, less than 10% cases had revealed poor patency. There are many factors which influence the shunt patency in bypass surgery. These are as follows: 1. Method of STA preparation, 2. Temporary clip, 3. Transient postoperative vascular occlusion, 4. Anastomotic angle between donor- and recipient artery, 5. Diameter of donor and recipient artery, 6. Intimal dissection of STA, 7. Duration of interception of blood supply with temporary clip and intraoperative perfusion pressure of the brain, 8. Formation of bony window, 9. Blood coagulability or other factors which exercise an important hydrodynamic effect to the blood stream. Most of these factors have already been studied in some aspects, so it is reported chiefly about the item 4 in this paper. The change of blood flow when a donor artery is anastomosed to a recipient artery with angle theta on forward blood flow, is shown, theoretically, in next three expressions. (1) (2) (3) Number one is the expression of balance in momentum. Number two is the equation of kinetic energy. Number three is the equation of continuity. From (1), (2), (3), (4) Consequently, one could assume that ￡13 is a function of the ratio of Q2 to Q3, (5) From another experimental model, if A2=A and θ<45°, one could treat k as 0, therefore, (6) From expression six, it is easily understood that if theta is within 30°,Q3 becomes a fairly large amount. From the facts described above, it may be safely said that if one wishes to ensure the shunt patency of the bypass, one ought to anastomose the donor artery to the recipient artery with an angle within 30°of the adjacent artery which is responsible for the flood flow.
The Japanese Society on Surgery for Cerebral Strokeの論文

STA-MCA吻合術の吻合血管の開存に影響する因子

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