人工血管を使用し二期的に遠位弓部瘤治療を行った2例

Hybrid Repair of Distal Arch Aortic Aneurysm：Total Aortic Arch Repair with the Lupiae Vascular Graft and Thoracic Endovascular Aortic Repair；Report of Two Cases

はじめに　遠位弓部の大動脈瘤に対する弓部大動脈人工血管置換術は，末梢側吻合部の位置が深い場合，手技としての難易度が高く，侵襲も大きいものとなる．末梢側吻合を容易にするための手段として左開胸を行う方法もあるが，正中切開に比較して周術期死亡率が上昇するとの報告1）もあり，可能であれば正中切開が望ましいと考えられる．近年では血管内治療の発展により，frozen elephant trunk （FET）を用いた弓部置換やdebranch手技を併用した胸部ステントグラフト挿入術（thoracic endovascular aortic repair ：TEVAR）が行われ，より低侵襲に遠位弓部瘤治療が可能となってきている．しかしながら，特にFETではステント留置長が長くなるため，脊髄虚血による対麻痺リスクの上昇などが懸念されている．われわれは，人工血管Lupiae（テルモ社，東京）を用いた弓部置換術とTEVARにより，二期的に遠位弓部瘤治療を行い良好な成績を得た2例を経験したので報告する．

Surgical treatment for distal arch aortic aneurysm is generally invasive, and there is no definitive approach for it. We report 2 cases of men who was admitted for the treatment of aortic aneurysm. First case is a 78-year-old man. Two saccular aneurysm were observed on distal aortic arch and descending aorta by contrast-enhanced computed tomography. Two staged-repair was performed with using the Lupiae vascular graft and thoracic endovascular aortic repair（TEVAR）. The postoperative course was uneventful, and he was discharged on day 21 after 1st operation. Second case is a 68-year-old man. Dessecting aneurysm was observed on distal aortic arch and descending aorta 3 months after incidence of type B aortic dissection. Two staged-repair was performed with using the Lupiae vascular graft and TEVAR. However, additional TEVAR was performed for enlargement of descending aorta half a year after 1st operation. Two staged-repair using Lupiae vascular graft and TEVAR was useful for alleviating a burden of a patient and avoiding paraplegia.