大動脈解離術後の灌流障害に対し胸部ステントグラフト内挿術を要した1例

Transthoracic Endovascular Aortic Repair for Malperfusion after Ascending Aortic Replacement for Stanford Type A Acute Aortic Dissection；Report of a Case

はじめに　Stanford A型急性大動脈解離に内臓動脈の循環障害（灌流障害）を併発する頻度は数％程度であり，術後の合併症および死亡の危険因子となっている．一方で，大動脈解離術後早期に灌流障害をきたして追加手術が必要になることがある．術後早期では周囲組織との癒着が強固であることがあり，追加手術自体のリスクは非常に高い．われわれは，術後早期に胸部ステントグラフト内挿術（TEVAR）を施行した症例を経験したので報告する．

A 53-year-old man was presented with Stanford type A acute aortic dissection. We first performed emergency ascending aortic replacement under selective cerebral perfusion with moderate hypothermia. He developed abdominal pain after the surgery. Six days after the 1st surgery, computed tomography revealed that the new entries were located in the distal anastomosis site and the distal aortic arch, and the true lumen of the aorta was obstructed by the false lumen and stenosis. Visceral malperfusion was diagnosed and emergent total debranching thoracic endovascular aortic repair （TEVAR） was planned. One proximal covered stentgraft and 2 distal bare stents were deployed.