弓部大動脈分枝異常を伴う遠位弓部大動脈瘤に対する開窓型ステントグラフトによる血管内治療の1例

Endovascular Treatment Using the Fenestrated Stent Graft for Distal Aortic Arch Aneurysm with Aortic Arch Vessel Anomalies；Report of a Case

はじめに　遠位弓部大動脈瘤の治療は開胸による人工血管置換術が第一選択であるが，症例によっては血管内治療も考慮される．われわれは，腕頭動脈と左総頸動脈が共通幹を形成するbovine arch（BA）と左椎骨動脈大動脈起始（ILVA）の二つの弓部大動脈分枝異常（破格）を伴う遠位弓部大動脈瘤に対し，カワスミNajuta胸部ステントグラフトシステム（川澄化学工業社，東京：以下，Najuta）を使用し良好な結果を得たので報告する．

We herein present a case of distal aortic arch aneurysm associated with the bovine arch and the isolated left vertebral artery （ILVA）. Incorporating 2 fenestrations, we successfully performed an endovascular repair using the commercially available Najuta fenestrated stent graft system. During surgery, the Najuta was deployed in the aorta so as to allow for the proximal fenestration to be aligned with the orifice of the 1 branch of the aortic arch, and the distal fenestration with the orifice of the ILVA and that of left subclavian artery. Postoperatively, the patient’s recovery went well without any cerebral complications, and in a subsequent computed tomography （CT）, the patency of all aortic arch vessels and absence of endoleaks was confirmed. For cases of distal aortic arch aneurysm associated with arch anomalies, the endovascular treatment using the Najuta system is not only simple but also reliable in preserving blood flow to the brain and upper extremities.