嚢状中膜壊死を認めた浅大腿動脈瘤破裂の1例

A Case of Ruptured Aneurysm of the Superficial Femoral Artery Caused by Atherosclerosis and Cystic Medial Necrosis

　症例は70歳，女性．左大腿部の拍動性腫瘤，左大腿部痛，発熱で発症した．CRP 18.5mg／dlと上昇，血沈（1時間値）128 mmと亢進していた．血管造影で左浅大腿動脈に75×55mmの造影剤の貯留を認めたため，左浅大腿動脈瘤と診断した．手術は瘤の中枢側と末梢側で浅大腿動脈を遮断し，瘤を切開した後，瘤壁と血栓を摘出した．浅大腿動脈は自家大伏在静脈で再建した．病理診断は動脈硬化性の浅大腿動脈瘤破裂であり，感染性動脈瘤ではなかった．また，瘤壁には一部に囊状中膜壊死を認めた．末梢動脈瘤に囊状中膜壊死を認めるのは稀であり，文献的考察を加え報告した．

A 70-year-old woman complained of a palsatile mass and pain in the left medial thigh. Angiography demon-strated an aneurysm in the left superficial femoral artery, 75 mm in diameter. The course was rapid and an emergency operation was performed. The operation consisted of resection of the aneurysm and replacement of the superficial femoral artery with a saphenous vein graft. The pathological examination revealed a ruptur-ed superficial femoral artery aneurysm caused by ather-osclerosis and cystic medial necrosis. The author is aware of only one previously reported case of superficial femoral artery aneurysm caused by cystic medial ne-crosis. It is considered that this is a very rare case in view of its etiology. Post-operative course was unevent-ful and there were no aneurysms at other sites.