緊急胸部ステントグラフト内挿術で救命した特発性大動脈破裂

Emergent Endovascular Treatment of Spontaneous Rupture of the Thoracic Aorta

特発性大動脈破裂は明らかな外傷，大動脈瘤，大動脈解離を伴わない大動脈の破裂であり，予後不良でまれな疾患である1）．われわれは，緊急胸部ステントグラフト内挿術（TEVAR）で救命した特発性大動脈破裂の2例を経験したので報告する．

Spontaneous rupture of the thoracic aorta is a rare disease with a poor prognosis without obvious trauma, aortic aneurysm and aortic dissection. We report 2 cases of successful endovascular aortic repair for spontaneous rupture of the thoracic aorta.

Case 1：A 79-year-old man was referred to our hospital complaining of general fatigue. He returned home without any obvious abnormalities in blood tests and computed tomography （CT）. The patient was aware of dizziness and fluttering in the early morning the next day, and was transported to the hospital by shock vital. CT showed rupture of descending aorta, so we performed emergent thoracic endovascular aortic repair （TEVAR）. Postoperatively, the patient progressed without paraplegia and was transferred to other hospital on the 15th day of hospital for the purpose of rehabilitation.

Case 2：A 87-year-old woman was admitted to hospital with suspected pyelonephritis, but his respiratory status was gradually exacerbated. CT showed a rupture of the thoracic aorta at the distal arch. Ten days ago, CT showed no findings suggestive of aneurysm and dissection at the same site of aorta. We performed emergency TEVAR. She was removed from mechanical ventilation on the 4th postoperative day. We are continuing rehabilitation treatment now.