肺血栓塞栓症を合併した膝窩静脈瘤の1手術例

A Surgical Case of Popliteal Venous Aneurysm with Pulmonary Embolism

要旨

　膝窩静脈瘤(popliteal venous aneurysm)は重篤な肺血栓塞栓症の原因となることがあり外科治療が考慮されるべき疾患である．症例は67歳女性．呼吸苦を主訴に受診．造影CT検査で肺血栓塞栓症と診断され，さらに下肢造影CT検査で瘤内に血栓を伴う右膝窩静脈瘤を認めた．直ちに抗凝固療法を開始したが，2週間後の造影CT検査で，膝窩静脈本幹に血栓の進展を認めた．一時留置型下大静脈フィルターを挿入し，全身麻酔下に膝窩静脈瘤切除，静脈内血栓摘出，静脈再建術を行った．瘤内血栓を伴った膝窩静脈瘤は高率に肺血栓塞栓症を合併するため手術適応とすべきである．術式の報告は様々であるが，今回，静脈再建後の経過は良好であり報告する．

　Popliteal venous aneurysm(PVA)can often cause serious pulmonary embolism and is the disease that surgical resection should be considered. A 67-year-old woman was admitted to our hospital with acute dyspnea. Computed tomography(CT)showed pulmonary embolism and a right PVA with the thrombus in the saccular aneurysm. She received anticoagulant therapy immediately, but a CT two weeks later showed that the thrombus in the saccular aneurysm had progressed to the popliteal vein. After insertion of a temporary inferior vena cava filter, resection of the saccular aneurysm, thrombectomy, and venous reconstruction was performed. The patient's postoperative course was good without recurrence of venous aneurysm or pulmonary embolism.