術中診断によりハイブリッドで治療できた梅毒性大動脈瘤の1例

Hybrid Two-stage Repair of Syphilitic Aortic Aneurysm, Total Arch Replacement and Thoracic Endovascular Aortic Repair；Report of a Case

はじめに　梅毒性大動脈瘤は現代ではまれな疾患である．しかし，近年梅毒患者は増加しているとの統計がある．また未治療の梅毒患者のおよそ10％が大動脈関連疾患を発症すると考えられている1）．われわれが経験した症例は梅毒感染の経路も時期も不明であった．梅毒性動脈瘤は術前に確定診断ができれば治療方針を立てることが可能である．しかし本例では感染性動脈瘤も視野に入れた対応を要したため，術中所見と合わせて最終的な診断を行った．まれではあるが今後経験する可能性のある梅毒性大動脈瘤の治療経験を文献的な考察を合わせて報告する．

Syphilitic aortic aneurysm is seldom seen in the antibiotic era. Statistically the number of patients is increasing today and 10％ of them seem to develop syphilitic aortitis. A 59-year-old male visited the emergency room due to chest discomfort and general fatigue. Treponema pallidum latex agglutination （TPLA） and rapid plasma reagin （RPR） were both strongly positive on blood tests. White blood cell counts and C-reactive protein elevation were also found. He couldn’t figure out how or when he was suffering from syphilis. He needed to undergo a hybrid 2-stage surgery urgently, Total arch replacement and thoracic endovascular aortic repair （TEVAR）, because his thoracic aortic aneurysm was growing more rapidly. No complication has occurred during or after surgery. Computed tomography after surgery showed successful exclusion of the thoracic aneurysm. It is important not to forget that syphilis is one of the causes of aortic aneurysm.