腹部大動脈閉塞症に対してステント治療が有用であった2例

Primary Stenting for a Focal Lesion of the Infrarenal Aorta

要旨

　症例1：49歳，男性．1年前より100mぐらいの歩行で下肢の痛みを自覚するようになった．安静にて症状が消失することから様子をみていたが，症状の増悪を認め精査加療目的にて当院入院となった．腹部血管造影で腎動脈下腹部大動脈に完全閉塞を認めた．病変部にPalmazステントを留置して終了した．

　症例2：68歳，男性．2年前より畑仕事で両側下肢疲労感が出現するようになった．その後症状増悪し，50mぐらいの歩行で下肢の痛みを自覚するようになった．精査加療目的にて当院入院となった．腹部血管造影で腎動脈下腹部大動脈に高度狭窄を認めた．Palmazステントを留置して終了した．

　いずれの症例も術後合併症を認めず，自覚症状とAnkle Brachial Index(ABI)の改善を認めた．術後経過は良好で，症状の再燃を認めていない．腎動脈下の局所的腹部大動脈病変に対して，ステント治療は有用な治療法となりうると考えられた．

　Endovascular procedures are frequently used as alternatives to surgical bypass in aortic atherosclerotic lesions. We report two rare cases of chronic total occlusion of the infrarenal aorta treated with the implantation of an endoluminal stent. The patients were a 49-year-old man, and a 68-year-old man. They presented with severe bilateral claudication. Angiography revealed total occlusion and severe stenosis of the infrarenal abdominal aorta and normal iliac and femoropopliteal vessels. Initially, endovascular treatment was technically and clinically successful in both patients. Palmaz stent was deployed in the infrarenal aortic lesions for both cases. Completion angiography showed successful recanalization of the aorta without any complication and with satisfactory distal flow. Palpable distal pulses were restored, and the patient's symptoms were alleviated. They remained asymptomatic after aortic stent implantation. Primary stenting may be considered a viable alternative to conventional surgery in properly selected patients with a focal lesion in the infrarenal aorta.