下咽頭癌・食道癌に対する放射線治療後に発生した左鎖骨下動脈閉塞の1例

Carotid-subclavian Bypass for Radiation-induced Subclavian Artery Occlusion；Report of a Case

はじめに　放射線照射領域の遅発性動脈狭窄あるいは閉塞であるradiation-induced vasculopathy（RIV）は，放射線治療後の長期生存患者に脳梗塞などの重篤な虚血性合併症を引き起こしうる病態であり，頭頸部癌をはじめとする種々の癌症例で報告されている．われわれは，下咽頭癌・食道癌の放射線治療後に鎖骨下動脈に高度の閉塞性病変をきたした1例を経験したので報告する．

A male patient underwent radiation therapy for hypopharyngeal cancer and esophageal cancer at the age of 58 years without recurrence. At the age of 63 years, he started to experience fatigue, numbness of the left upper limb and dizziness. The symptom gradually worsened and he was admitted to our hospital for further investigation. By computed tomography scan and angiography, the subclavian artery （SCA） occlusion and a patent left vertebral artery with retrograde flow were revealed （subclavian steal syndrome）. Subclavian artery occlusion could not be recanalized by percutaneous transluminal angioplasty. He underwent carotid-subclavian bypass. His symptoms clearly improved. Postopertive course was uneventful and no further symptoms developed after surgery.