腹部大動脈瘤に及んだStanford B型急性大動脈解離に対して胸部ステントグラフト内挿術と腹部大動脈人工血管置換術を同時施行した1例

Thoracic Endovascular Aortic Repair and Abdominal Aorta Replacement to Treat Stanford Type B Acute Aortic Dissection Extending through an Abdominal Aortic Aneurysm；Report of a Case

はじめに　急性大動脈解離と真性腹部大動脈瘤（AAA）は異所性に合併することが多い1）．一方，急性大動脈解離がAAAに及んだ症例ではAAA破裂の危険性が高く，術式，手術方針，手術時期などが問題となる1，2）．われわれは，最大径72 mmのAAAに及んだStanford B型急性大動脈解離に対して，大動脈解離発症20日目に胸部ステントグラフト内挿術（TEVAR）と腹部大動脈人工血管置換術を同時施行し，良好な経過が得られたので報告する．

A 69-year-old man developed sudden-onset chest and back pain and was brought to our hospital. Enhanced computed tomography （CT） revealed acute Stanford type B aortic dissection extending from the distal aortic arch to a 72 mm abdominal aortic aneurysm （AAA）. The acute phase was managed by antihypertensive therapy, and the patient was followed up. Twenty days after the onset of aortic dissection, entry closure of aortic dissection by thoracic endovascular aortic repair and abdominal aorta replacement were performed simultaneously. Aorta remodeling was confirmed by postoperative CT, and the patient’s postoperative course was uneventful. In the treatment of patients with acute aortic dissection and AAA, surgical intervention timing and strategy must be considered carefully.