右側大動脈弓を伴うKommerell憩室に対するdebranching胸部ステントグラフト内挿術の1例

Debranching and Endovascular Repair for Kommerell’s Diverticulum with Right-sided Aortic Arch；Report of a Case

はじめに　Kommerell憩室を伴う右側大動脈弓はまれな疾患である．病変部へのアプローチとして胸部正中切開や左開胸の報告がなされてきたが，近年ステントグラフトでの良好な治療報告が散見されるようになってきた1）．われわれは右側大動脈弓を伴うKommerell憩室に対してde‑branching胸部ステントグラフト内挿術（de‑branching TEVAR）を施行し，良好な結果を得たので報告する．

Right-sided aortic arch （RAA） is a rare congenital disorder. A 87-year-old man with chest pain was diagnosed with a right-sided aortic arch and Kommerell’s diverticulum by computed tomography （CT）. The diverticulum had a maximum diameter of 57 mm, and surgical intervention was chosen because of the possibility of rupture and dissection. We performed thoracic endovascular aortic repair （TEVAR） with a commercially available device, consisting of bypass grafting of the supra-aortic branches. The postoperative courses were uneventful. The patient was discharged from the hospital in good clinical condition. Postoperative CT showed complete exclusion of the diverticulum without endoleak and device migration. Debranching TEVAR for Kommerell’s diverticulum was safe and effective.