{"created":"2023-05-25T05:25:44.615798+00:00","id":4221,"links":{},"metadata":{"_buckets":{"deposit":"35a90d18-87ae-4404-b711-033c0aff4c91"},"_deposit":{"created_by":17,"id":"4221","owners":[17],"pid":{"revision_id":0,"type":"depid","value":"4221"},"status":"published"},"_oai":{"id":"oai:yamagata.repo.nii.ac.jp:00004221","sets":["29:31:100:101"]},"author_link":["13286","13293","13295","13301","13302","13285","13288","13300","13291","13296","13298","13294","13299","13287","13289","13290","13297","13292"],"item_3_alternative_title_18":{"attribute_name":"その他の言語のタイトル","attribute_value_mlt":[{"subitem_alternative_title":"Distal Bypass in Patients with Critical Limb Ischemia using Coronary Artery Bypass Technique"}]},"item_3_alternative_title_19":{"attribute_name":"タイトル（ヨミ）","attribute_value_mlt":[{"subitem_alternative_title":"カシ ドウミャク distal bypass ノ クフウ : カンドウミャク バイパス シュギ ノ オウヨウ"}]},"item_3_biblio_info_6":{"attribute_name":"書誌情報","attribute_value_mlt":[{"bibliographicIssueDates":{"bibliographicIssueDate":"2017-08-10","bibliographicIssueDateType":"Issued"},"bibliographicIssueNumber":"2","bibliographicPageEnd":"118","bibliographicPageStart":"115","bibliographicVolumeNumber":"35","bibliographic_titles":[{"bibliographic_title":"山形大学紀要. 医学 : 山形医学"},{"bibliographic_title":"Bulletin of the Yamagata University. Medical science : Yamagata medical journal","bibliographic_titleLang":"en"}]}]},"item_3_description_42":{"attribute_name":"資源タイプ","attribute_value_mlt":[{"subitem_description":"論文(Article)","subitem_description_type":"Other"}]},"item_3_description_5":{"attribute_name":"内容記述","attribute_value_mlt":[{"subitem_description":"　Distal bypassの手術手技は冠動脈バイパス術(CABG)と共通点を有する。今回、CABG手技を応用したdistal bypassと内視鏡下の大伏在静脈（SVG）採取を行った症例を提示する。症例は、重症虚血肢（CLI）の72歳、女性で、左下肢の安静時痛、下腿皮膚潰瘍および足趾壊死を認めた。左浅大腿動脈から膝窩動脈の閉塞に対し、distal bypassを施行した。内視鏡下に約３cmの皮膚切開創から、大腿全長と下腿1/2長のSVGを採取した。SVG剥離後の皮下トンネルにSVGを導き、深大腿動脈に6-0ポリプロピレン糸の連続縫合で端側吻合した。後脛骨動脈へのSVG吻合は心拍動下CABGと同様の手技で行った。後脛骨動脈はテーピング、遮断ともに行わず、ビーバーメスで血管前壁の小範囲を剥離、切開した後、シャントチューブを挿入した。7-0ポリプロピレン糸を用い、SVGのtoe ３針、heel １針（パラシュート法）でSVGを後脛骨動脈に引き寄せ、側面を連続縫合した。CO2ブロワーを使用し、吻合中の無血視野を確保した。術後は下腿潰瘍の治癒とともに足趾の壊死部分の境界が明瞭化し、引き続き足趾切断を施行し、大切断を回避した。CABGで培った経験と技術はdistal bypassに応用可能であり、低侵襲な内視鏡下SVG採取と相俟ってCLI症例におけるdistal bypassの成績向上に寄与すると考えられた。","subitem_description_type":"Other"}]},"item_3_full_name_2":{"attribute_name":"著者(ヨミ)","attribute_value_mlt":[{"nameIdentifiers":[{"nameIdentifier":"13291","nameIdentifierScheme":"WEKO"}],"names":[{"name":"ウチダ, テツロウ"}]},{"nameIdentifiers":[{"nameIdentifier":"13292","nameIdentifierScheme":"WEKO"}],"names":[{"name":"ハマサキ, アズミ"}]},{"nameIdentifiers":[{"nameIdentifier":"13293","nameIdentifierScheme":"WEKO"}],"names":[{"name":"クロダ, ヨシノリ"}]},{"nameIdentifiers":[{"nameIdentifier":"13294","nameIdentifierScheme":"WEKO"}],"names":[{"name":"ヤマシタ, アツシ"}]},{"nameIdentifiers":[{"nameIdentifier":"13295","nameIdentifierScheme":"WEKO"}],"names":[{"name":"ハヤシ, ジュン"}]},{"nameIdentifiers":[{"nameIdentifier":"13296","nameIdentifierScheme":"WEKO"}],"names":[{"name":"サダヒロ, ミツアキ"}]}]},"item_3_full_name_3":{"attribute_name":"著者別名","attribute_value_mlt":[{"nameIdentifiers":[{"nameIdentifier":"13297","nameIdentifierScheme":"WEKO"}],"names":[{"name":"Uchida, 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