気管支拡張症による喀血に対する胸部ステントグラフト内挿術の2例

Usefulness of Thoracic Endovascular Aortic Repair for the Treatment of Massive Hemoptysis Due to Bronchiectasis；Report of Two Cases

血痰・喀血をきたす疾患には，肺結核・肺非結核性抗酸菌症・肺アスペルギルス症のような呼吸器感染症，気管支拡張症ならびに肺癌などが含まれ，原因が特定されない特発性喀血症もある．通常，喀血の治療は気管支動脈塞栓術（BAE）を施行するが，われわれはBAEが困難な2例に対して胸部ステントグラフト内挿術（TEVAR）が有効であったのでここに報告する．

Massive hemoptysis caused by bronchiectasis threatens life, so early bronchial arterial embolization （BAE） is needed. In case 1, a 80-year-old female complained of hemoptysis and back pain caused by bronchiectasis and Stanford type B aortic dissection. In case 2, a 78-year-old male had history of the surgery of descending thoracic aortic aneurysm and bronchiectasis combined with aortopulmonary fistula. Both cases in bronchiectasis with massive hemoptysis were difficult to perform BAE due to complicated with acute aortic dissection and aortopulmonary fistula. We applied Thoracic endovascular aortic repair （TEVAR） to these cases by its occlusive effects of the orifice of bronchial artery and collateral flow from intercostal arteries. Their postoperative courses were satisfactory without hemoptysis. We suggest that TEVAR can become the one of the option for the treatment of massive hemoptysis that is not indicated to BAE.