左椎骨動脈起始異常を伴う慢性解離性大動脈瘤に対するステントグラフト内挿術の1例

Thoracic Endovascular Repair for Chronic Aortic Dissection with Aberrant Origin of the Left Vertebral Artery；Report of a Case

はじめに　胸部大動脈疾患に対する胸部ステントグラフト内挿術（TEVAR）は，デバイスの進歩と手術手技の向上によって適応が拡大し，わが国においても年々増加傾向にある1）．一方で，左椎骨動脈（LVA）起始異常を有する症例における血行再建の必要性については，いまだ一定の見解が得られていない．われわれはLVAが弓部大動脈より直接起始した慢性大動脈解離に対して，LVAの転置により血流温存を図った症例を経験したので報告する．

We herein report a case of thoracic endovascular aortic repair （TEVAR） for chronic aortic dissection with an aberrant left vertebral artery （LVA） originating from the aortic arch. A 51-year-old man with a medical history of Stanford type B acute aortic dissection 2 years ago was transferred to our institution for the treatment of an aortic expansion. Computed tomography showed a large entry just distal to the takeoff of the left subclavian artery and a dilated dissected thoracic aorta. A left cervical incision over the anterior border of the sternocleidomastoid was made, and the LVA was identified. The proximal LVA was ligated and anastomosed to the left common carotid artery in an end-to-side fashion. After completion of the carotid-subclavian bypass, TEVAR was performed in the usual fashion. The postoperative course was uneventful without stroke or spinal cord injury. At the 1-year follow-up, the false lumen had shrunk and the LVA remained patent.