右鎖骨下動脈損傷を伴う外傷性胸部下行大動脈破裂に対するステントグラフト挿入術の1例

Endovascular Repair of Traumatic Injury to the Descending Aorta and the Right Subclavian Artery；Report of a Case

はじめに　鈍的外傷性大動脈損傷（blunt aortic injury：BAI）の多くは受傷現場で死亡にいたるが，1/4程度が病院へ搬送可能な状態と考えられている1）．本邦においてBAIの症例報告は少なく，われわれはBAIに鎖骨下動脈損傷を合併したまれな症例を救命しえたので，文献的考察を加えて報告する．

A 32-year-old man leaping down from the 3rd floor of his house got injured and was transferred to our center. Pseudoaneurysm at the aortic isthmus as well as pelvic and lower limb fractures were observed by computed tomography （CT） scan. Thoracic endovascular aortic repair（TEVAR）of the thoracic aorta was performed from zone 2, followed by external skeletal fixation. Postoperative chest X-ray revealed right hemothorax, and CT scan showed active bleeding from the right subclavian artery in addition to splenic artery pseudoaneurysm. A 10×60 mm covered stent was deployed at the right subclavian artery and coiling of the splenic artery was performed. He was discharged without complication. The timing and procedures of surgery are difficult to decide in treatment of aortic injury with multiple trauma, TEVAR makes quick control of bleeding possible by less invasive approach. Moreover, endovascular approach to the subclavian artery avoides median sternotomy.