脊髄へ連続する分節動脈を温存した胸部下行および胸腹部大動脈手術

Preservation of the Spinal Perfusion Artery during Descending Thoracic and Thoracoabdominal Aortic Surgery

胸部下行および胸腹部大動脈手術の重篤な合併症である脊髄虚血傷害の予防にさまざまな努力がなされてきた1～4）．前根髄動脈（anterior radiculomedullary artery5））を介して脊髄へ血液を供給する分節動脈（SPA3））を温存することの効果は意見が分かれるところである6～9）．われわれは，SPAの術前同定が手術戦略決定上有用であった3例を報告する．

This is a 3-case report of successful descending thoracic and thoracoabdominal aortic surgery by preserving the spinal perfusion artery （SPA） identified preoperatively. In Case 1, an 85-year-old woman, computed tomography （CT） showed Crawford type Ⅴ thoracoabdominal aortic aneurysm （TAAA：60 mm） and a SPA originated from L2. In Case 2, a 76-year-old man, CT revealed type Ⅳ TAAA （58 mm） and a SPA originated from Th11. In Case 3, a 74-year-old man, CT detected an infectious pseudoaneurysm （44 mm） in the descending thoracic aorta with 2 SPAs originating from Th10 and L2. The ranges of graft replacement were Th7-Th12, Th12-L4, and Th8-Th10, respectively, while preserving all SPAs. All patients recovered well without postoperative neurological deficits. Although the protective effect of the SPA preservation against the spinal cord ischemia is still controversial, preoperative identification of the SPA was useful for planning a surgical strategy for descending thoracic and thoracoabdominal aortic repair surgery.