短いelephant trunkにより生じた遠位弓部大動脈瘤急速拡大の1例

Rapid Expansion of Distal Aortic Arch Aneurysm with the Short Elephant Trunk；Report of a Case

はじめに　胸部大動脈手術におけるelephant trunk（ET）法は，1983年にBorstら1）により報告されて以降，広く汎用されている．ET法の合併症として，長いETによる脊髄虚血などの報告があるが，短いETによる合併症の報告はまれである．われわれは，急性大動脈解離術後に短いETの影響で遠隔期遠位弓部大動脈の急速拡大および大動脈気管支瘻を生じた症例を経験した．

A 78-year-old female patient was introduced to our hospital with chief complaint of massive hemoptysis. She had a history of total arch replacement using a short elephant trunk for acute Stanford type A aortic dissection 3 years before. A contrast-enhanced computed tomography （CT） revealed kinking of the short elephant trunk and distal aortic arch aneurysm which caused aortobronchial fistula. She was treated by emergency thoracic endovascular aortic repair and long-term administration of antibiotics. Three years later, distal aortic arch aneurysm disappeared by CT and there was no recurrence of hemoptysis. This is the aortic aneurysm was considered to be caused by the short elephant trunk.