特発性血小板減少性紫斑病を伴った弓部大動脈瘤に対して2枝debranching胸部ステントグラフト内挿術を施行した1例

Two-debranching Thoracic Endovascular Aortic Repair for Thoracic Aortic Aneurysm Complicated by Idiopathic Thrombocytopenic Purpura；Report of a Case

はじめに　特発性血小板減少性紫斑病（ITP）は，血小板を標的とした自己抗体による血小板の産生障害と破壊亢進のため，血小板数が減少する自己免疫疾患である．薬剤抵抗性の場合，治療法として脾臓摘出が行われる．われわれは，脾臓摘出後も血小板減少時に尿路出血を繰り返す胸部大動脈瘤症例に対して胸部ステントグラフト内挿術（TEVAR）を行い，良好に経過したので報告する．

Idiopathic thrombocytopenic purpura （ITP） is an autoimmune disease in which the number of platelets decreases due to auto-antibodies against platelets. We report that thoracic endovascular aortic repair （TEVAR） was successfully performed for a thoracic aortic aneurysm complicated by ITP. The patient was a man of 77 years of age. He had a history of splenectomy due to ITP. He was admitted to our hospital with an aneurysm of the aortic arch that enlarged to a maximum minor axis of 63 mm. An operation was planned. Because of ITP, it was judged that replacement of the aortic arch using a cardio-pulmonary pump would be associated with a high risk of bleeding. Thus, 2-debranching TEVAR was selected and performed with no hemorrhagic complications. He was discharged from the hospital on the 12th day after surgery. We believe that 2-debranching TEVAR is effective for reducing perioperative bleeding in patients with ITP.