腹腔動脈の臓器灌流障害をきたしたStanford B型急性大動脈解離の1例

Acute Type B Aortic Dissection Complicated with Malperfusion of Celiac Artery Alone；Report of a Case

Stanford B型急性大動脈解離の3～18％において臓器灌流障害が起こるとされており1），エントリー閉鎖や開窓，分枝再建などさまざまな治療法が選択される．合併症を有するStanford B型急性大動脈解離に対するステントグラフト治療は，日本循環器学会のガイドラインにおいて推奨度class1，エビデンスレベルBと格上げされ，逆行性A型解離がごくわずか発症するものの，治療成績は向上した．企業性ステ

Malperfusion of the superior mesenteric artery （SMA） in acute type B aortic dissection is potentially fatal. Revascularization should therefore be aggressively considered in a proactive way. However, this is not the case with the celiac artery malperfusion. We present a case of malperfusion of isolated malperfusion of the celiac artery due to acute type B aortic dissection. Although the collateral blood flow from the SMA via the pancreatic arcade was identified, ischemic gastric ulcer and pancreatitis developed later on. At present, there is a general agreement that catheter intervention is the 1st treatment of choice for complicated acute type B aortic dissection. In the present case, however, even a guide wire did not pass through the orifice of the celiac artery and revascularization was not successful.