内腸骨動脈から行った外傷性大動脈損傷に対する胸部ステントグラフト挿入術の1例

Thoracic Endovascular Aortic Repair for Traumatic Aortic Injury with Internal Iliac Approach；Report of a Case

はじめに　近年，胸部や腹部の大動脈瘤に対する治療としてステントグラフト挿入術が頻用されているが，症例によっては狭小なアクセスルートが問題となる．われわれは，外傷性胸部大動脈損傷に対する胸部ステントグラフト挿入術（TEVAR）で，内腸骨動脈を離断してアクセスルートに使用し，良好な結果を得たので若干の文献的考察を加えて報告する．

A 40-year-old female was injured in a car accident while driving. Computed tomography confirmed a dissection localized to the distal aortic arch and hematoma around the area. Severe liver damage with surrounding extravasation was also confirmed. Furthermore, multiple rib fractures and lumbar spine fracture were apparent. Thoracic endovascular aortic repair （TEVAR） was performed after transcatheter arterial embolization to treat the liver injury. As both the iliac and femoral arteries were narrow, the internal iliac artery was transected peripherally and used as an access route. This method does not require complex procedures such as artificial vascular anastomosis for vascular repair in the event of injury. Therefore, it may be considered as an option when access from the femoral artery is difficult.