広範囲胸部大動脈瘤に対し上行大動脈アクセスによる胸部ステントグラフト挿入術を併用した弓部大動脈人工血管置換術の1例

Total Arch Replacement with Concomitant Thoracic Endovascular Aortic Repair Via the Ascending Aorta for Extended Thoracic Aneurysm；Report of a Case

はじめに　われわれは弓部大動脈瘤，解離性下行大動脈瘤および動脈管開存症（PDA）を合併した66歳の患者に対し，まず上行大動脈経由で胸部ステントグラフト挿入術（TEVAR）を施行し，引き続き全弓部人工血管置換術（total arch replacement：TAR）および動脈管閉鎖術を行って良好な結果を得たので報告する．

The patient was a 66 year-old male. Computed tomography （CT） angiography showed a huge aneurysm（120 mm） in the aortic arch and chronic type B aortic dissection（45 mm） in the descending aorta. Echocardiography showed patent ductus arteriosus （PDA）. Because of pulmonary hypertension due to PDA, it was considered unacceptable to put him under general anesthesia twice. We performed thoracic endovascular aortic repair （TEVAR） via the ascending aorta and total arch replacement （TAR） simultaneously to prevent paraplegia. After establishment of cardiopulmonary bypass （CPB）， a stent graft was inserted via the ascending aorta to cover the dissection site of descending aorta, the aorta was opened under circulatory arrest, and PDA was suture closed. Another stent graft whose two proximal rows of Z-stent was removed, was inserted to descending aorta via the ascending aorta landing on the previous stent graft. The proximal end of this stent graft was anastomosed to the distal end of the prosthetic arch graft and arch branches were reconstructed as usual. The postoperative course was uneventful.