縦隔型気管支動脈瘤に対し部分体外循環下に下行大動脈と合併切除した1例

Mediastinal Bronchial Artery Aneurysm Resected together with the Descending Aorta under the Partial Extracorporeal Circulation；Report of a Case

はじめに　気管支動脈瘤（BAA）はまれな疾患であるが，破裂例ではしばしば致命的な経過をたどる．われわれは乳癌術前精査の際に発見された縦隔型BAAに対し，部分体外循環を用いて下行大動脈と合併切除し良好な経過を得たので報告する．

Bronchial artery aneurysm （BAA） is quite rare, but its rupture is often lethal. Once it is found, treatments should be aggressively considered. A 67-year-old woman was diagnosed to have a 26 mm mediastinal BAA on computed tomography （CT） which was performed for screening. CT revealed a very short inflow vessel of the BAA and arteriovenous fistula at the outflow. Considering these features of the aneurysm, endovascular interventions deemed difficult and surgery was carried out. Because of the fragility, the aneurysm was resected together with the descending aorta and the graft replacement was performed under partial extracorporeal circulation. The patient has no untoward event for 1 year postoperatively. Although most recent reports advocate endovascular interventions, we think surgical treatment is a variable option in selected patients. Careful evaluation for each BAA case would be essential to determine the treatment strategy.