外傷性大動脈損傷と急性大動脈解離合併例に対するオープンステントグラフト併用上行弓部大動脈人工血管置換術

Total Arch Replacement with Frozen Elephant Trunk for Treatment of Traumatic Aortic Injury with Stanford Type A Aortic Dissection

外傷性大動脈損傷とStanford A型急性大動脈解離の併発はまれであり，かつ重篤な状態である．われわれは，オープンステントグラフト（OSG）法を用いた上行弓部大動脈人工血管置換術を行い，救命することができた症例を経験したので報告する．

An 83-year-old woman was injured in a traffic accident. Enhanced computed tomography （CT） showed aortic injury on the isthmus, Stanford type A aortic dissection and intracranial hemorrhage. Neurological deficit was not noted. We immediately started to lower the blood pressure, and her hemodynamic status remained stable. Although intracranial bleeding had not worsened on the next day, a false lumen of the aortic arch was newly enhanced on CT. Emergency total arch replacement with frozen elephant trunk was performed under deep hypothermia and selective cerebral perfusion. Intraoperative angiography showed no endoleak at the descending aorta. Postoperative course was uneventful, and the patient was discharged on the 21st postoperative day. This procedure is useful for aortic injury involving the ascending aorta and the arch.