10. 血管炎合併症例と周術期管理

Surgical Management for Cardiac and Aortic Lesion Caused by Arteritis

血管炎は血管そのものに炎症を認める疾患の総称であり，その障害部位は多臓器にわたり臨床像も多様である．なかでも血管炎による大動脈瘤や冠状動脈病変，大動脈弁閉鎖不全症は予後を規定する重要な病変であり，外科的治療に求められる役割は大きい．本稿では血管炎の外科治療における要点について，当院での治療経験もふまえて報告する．

Arteritis is an inflammatory disease of the vessel walls, resulting in vascular damage and a wide variety of clinical symptoms and multisystem disorders. Because aneurysmal disease, coronary disease, and aortic insufficiency affect patient prognosis, surgical intervention plays an important role. Preoperatively, systemic vessels, cardiac function, and other major organs should be evaluated. Regarding the surgical technique, reinforcement of the anastomosis to the fragile aortic wall is important to prevent pseudoaneurysmal formation and prosthetic valvular detachment. As aortic root replacement, we have been applying the modified Bentall procedure with a “double fixation technique” and obtained desirable outcomes. Although endovascular repair for aneurysmal disease is one of the treatment options, its long-term efficacy remains uncertain. Postoperative control of inflammation with corticosteroids and/or immunosuppressive agents is also important for long-term management. Pseudoaneurysmal formation and prosthetic valvular detachment may occur progressively over a long period of time. To prevent these complications, strict follow-up with imaging and inflammation control should be performed.