頸部内頸動脈狭窄に対するCarotid Endarterectomy（CEA）後に縫合糸断裂により生じた巨大仮性動脈瘤の1治験例

A Surgically Treated Case of Giant Pseudoaneurysm Arising as a Complication Following Carotid Endarterectomy

I．はじめに

　内頸動脈狭窄に対する頸部内頸動脈内膜剥離術（以下CEA）は以前よりその術中，術後の種々の合併症が報告されている．われわれは，CEA施行後1週間と，極めて早期に生じた巨大な仮性動脈瘤（以下PA）をバルーンカテーテルにより出血をコントロールしながら切除し得た1例を経験したので若干の文献的考察を加え報告する．

We reported a case of giant pseudoaneurysm (PA) originating at the left extracranial internal carotidartery after carotid endarterectomy (CEA).

A 60-year-old man underwent CEA for severe stenosis of the left internal carotid artery. A day after theoperation, a left cervical painful and pulsatile mass beneath the operative scar was noticed. Soon after that,the patient showed dyspnea, and intratracheal intubation was carried out. 6 clays after CEA, a painfulswelling reoccurred. A left carotid angiogram visualized a 5X 5cm sized PA in the region of the left carotidbifurcation and demonstrated patency of the two major carotid branches. After a balloon catheter had beeninserted and inflated at the carotid bifurcation, the patient underwent a second operation. The bleedingfrom arteriotomy was well controlled by the inflated balloon catheter at the carotid bifurcation. The con-tinuous SURG1LENE' suture appeared to be disrupted and a saccular PA was found to have arisen froma defect on the lateral surface of the carotid bifurcation. The suture was completely removed and arterio-tomy was closed with a continuous SURGILENER suture again and some single sutures were added. A PA arising as a complication following CEA is rare, but the possibility of PA after CEA should beconsidered in any patient presenting with a painful or/and pulsatile mass in the neck at any time intervalfollowing the operation. Angiography at the early post-op stage is neccesary to rule out the various com-plications after CEA. To control the bleeding, the balloon catheter was thought to be very useful.