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One hundred and thirty-four patients with vasoocclusive diseases were retrospectively tested for three kinds of antiphospholipid antibody (aPL). The mean age at onset of the disease in 58 patients with aPL was 43 years old. Seventeen, 11, and 9 patients were positive for the aCL IgA, IgM, and IgG isotypes, respectively. The rates of anti-phospholipid syndrome (APS) in patients with arterial (n=94), venous (n= 31), or both arterial and venous (n=9) occlusion were 45%, 29%, and 78%, respectively. The rates of APS in patients with autoimmune disease (n=13), thromboangiitis obliterans (TAO) (n= 36), arteriosclerosis obliterans (ASO) with lower leg involvement (n=8) or aortic arch syndrome (n=5), Raynaud's syndrome (n=15), aortitis syndrome (n= 13), ischemic heart disease (IHD) with young onset (n =12), and bilateral leg deep venous thrombosis (DVT) (n=10) were 77%, 46%, 13%, 80%, 40%, 62%, 33%, and 70%, respectively. The cumulative patency rate for reconstructive surgery in patients (n=13) with aCL was found to be considerably lower than that in those without aCL (n=13). From these results it was concluded that IgA was the most valuable aCL isotype for the diagnosis of APS and that aPL should be examined in patients with double-vessel occlusion, autoimmune disease, bilateral leg DVT, aortic arch syndrome, TAO, Raynaud's syndrome, or IHD with young onset. Furthermore, prophylaxis for graft failure is more strongly recommended for patients with aCL than for those without it.

1991年12月までの過去18年間に教室で10例の大動脈弓分枝動脈瘤に対して外科的治療を行った. 年齢は17～82歳 (平均55歳) 男性8例, 女性2例であった. 成因は, 動脈硬化5例, 胸郭出口症候群2例, 炎症性 (ベーチェット病) 1例, 外傷1例, 医原性1例と多彩であった. 主訴は, 頸部や鎖骨上窩の腫瘤が大部分で, その他には胸部異常陰影や胸痛なども認めた. 破裂2例 (1例は腕頭動脈瘤, 1例は鎖骨下動脈瘤), 上肢急性動脈閉塞症1例も認めた. 病変部位は, 鎖骨下動脈5例, 内頸動脈2例, 総頸動脈1例, 外頸動脈1例, 腕頭動脈1例であった. 術式は, 瘤切除+血行再建術を原則として行い, 現在までのところ, 腕頭動脈瘤破裂の出血死と炎症性内頸動脈瘤のグラフト閉塞以外の経過は良好である. 本症はかなり頻度の少ない疾患ではあるが, 破裂や血栓閉塞・塞栓などを合併することもあり可及的すみやかに手術することが望ましい.

To evaluate the relationship between maximum venous outflow (MVO) of the leg and development of deep vein thrombosis (DVT), venous occlusion plethysmography (VOP) using a Mercury strain gauge was carried out in 56 unilateral DVT patients. The data from these patients were compared with those obtained from several control groups. Then, the relationship between plethysmographic and 9 clinical variables was statistically analysed in the normal legs of these patients. The mean MVO of the normal legs of these patients was significantly higher than that of the affected legs, but it was significantly lower than those of normal controls and patients with mild congestive heart disease. However, it was similar to those in patients with lymphedema and obese men. A decrease in the MVO of the normal legs of these patients was noted in older females with femoral vein obstruction of the left leg, with a shorter number of days from the onset of symptoms or with higher values for the obesity index and calf circumference. Significant correlations between the MVO and the obesity index (r=-0.59), venous capacitance (VC, r=0.49) and the number of days from the onset of symptoms (r=0.40) were found in the normal right legs of these patients (n=40). In the normal left legs (n=16), on the other hand, significant correlations were found between the MVO and the VC (r=0.65) and the MVO and age (r=-0.65). The MVO of the normal legs of these patients was predicted from clinical variables by multivariate analysis, and a multiple correlation coefficient of 0.64 was achieved using 4 variables (F-value>2); i.e. the obesity index, the side of venous obstruction, the number of days from the onset of symptoms and calf circumference. From these results, we concluded that in the normal right legs of these patients, the MVO was more closely related to the obesity index than to the VC or the number of days from the onset of symptoms. In the normal left legs, however, the MVO was influenced by another factor; i.e. the iliac compression syndrome, which might become more apparent with age. Finally, it was concluded that a decrease in the MVO of the normal legs could increase the occurrence of DVT.

The graft patency of bypass surgery to or distal to the popliteal artery for 29 lower extremities with thromboangiitis obliterans (TAO) and for 67 lower ex tremities with arteriosclerosis obliterans (ASO) and six factors influencing graft patency were studied and a new method of scoring distal runoff determined from angiographic findings was employed. Early graft occlusion (EGO, < one month) was found only in lower extremi ties with distal runoff of 5 or less and more frequently in patients with TAO than in those with ASO, although distal runoff in TAO patients (n=29) was signifi cantly less than that in ASO. Among TAO patients with distal runoff of 5 or less, EGO (n = 7) was found only in those without concomitant lumbar sympathectomy (CLS), but the dif ference in distal runoff between patients with EGO and those without it was not significant. From these results, it was concluded that: (1) EGO in patients with TAO is probably due to poor distal runoff with high constrictivity and (2) CLS for such patients could improve EGO, which, in turn, would result in a better cumula tive patency rate.

Patients with combined coronary and carotid artery stenosis have a significantly higher mortality or morbidity after the separate or staged operation. A 60-year-old man with severe stenosis in the origin of left common carotid artery, subclavian artery and three-vessel coronary artery disease was admitted for unstable angina pectoris. He had a history of cerebral infarction and occasional amaurosis fugax. Simultaneous brachiocephalic to left common carotid artery bypass grafting using PTFE graft and 3-aortocoronary saphenous vein bypass grafting were performed successfully under deep hypothermic cardiopulmonary bypass. Concomitant cerebral and coronary revascularization under hypothermic cardiopulmonary bypass appeared to be a logical approach, allowing dual protection of the brain and the myocardium.