大動脈腸骨動脈閉塞性疾患を合併した重症大動脈弁狭窄症に対し腹部大動脈人工血管置換術を同時施行した経カテーテル大動脈弁留置術の1例

Simultaneous Repair for Aorto-iliac Occlusive Disease and Transcatheter Aortic Valve Implantation；Report of a Case

はじめに　大動脈弁狭窄症（AS）はほかの動脈硬化性疾患を合併していることが多く，ASに対する治療戦略上，問題となることがある．われわれは，大動脈腸骨動脈閉塞性疾患（AIOD）を合併した高齢者重症ASに対し，Y型人工血管左脚をアクセスルートとして，経カテーテル大動脈弁留置術（TAVI）を施行した1例を経験したので報告する．

A 79-year-old womam presented with severe aortic stenosis （AS） and aorto-iliac occlusive disease （AIOD）. The distal end of her abdominal aorta was occluded with severe calcification. Simultaneous Y-grafting of the terminal abdominal aorta and transcatheter aortic valve implantation （TAVI） using the left limb of a Y-shaped artificial graft as an access route were planned. After proximal and distal anastomoses of the abdominal aorta and the right common iliac artery （CIA） using the Y-shaped artificial graft, TAVI was performed through the left limb of the artificial graft. The technique was similar to that used for transfemoral TAVI. Subsequently, the left limb of the graft was anastomosed to the left CIA. The patient’s postoperative course was unremarkable, without heart failure or lower limb ischemia. This option serves as an effective access route for TAVI in patients with AIOD.