嚥下困難を伴う右鎖骨下動脈起始異常に対するオープンステントグラフト併用全弓部大動脈置換術の1例

Total Arch Replacement with Open Stent Grafting Technique for an Aberrant Subclavian Artery Cousing Dysphagia；Report of a Case

はじめに　右鎖骨下動脈起始異常は左大動脈弓の約0.5％にみられると報告1，2）されている．起始部は瘤化してKommerell憩室を形成することが多い．われわれは，有症状の右鎖骨下動脈起始異常に対し，オープンステントグラフト併用全弓部大動脈人工血管置換術を施行した1例を経験したので報告する．

An aberrant right subclavian artery （ARSCA） is a relatively rare congenital anomaly of the aortic arch branches. A 63-year-old man suffered from dysphagia, and was referred to our hospital. Computed tomography （CT） revealed an aortic aneurysm （Kommerell’s diverticulum） and ARSCA which routed behind the esophagus. We performed total arch replacement with the open stent-grafting technique via median sternotomy. ARSCA was anastomosed to 1 branch of the arch graft at the right side of the trachea, which released esophageal compression. Postoperatively dysphagia disappeared and CT scan indicated successful reconstruction of the distal arch and ARSCA. The open stent-grafting technique is considered to be effective for aortic disease with ARSCA.