遅発性下肢虚血を合併したStanford B型急性大動脈解離に対しハイブリッド手術を行った1例

Hybrid Treatment for Delayed Lower Limb Ischemia and Aortic Dilatation Associated with Stanford Type B Aortic Dissection：Report of a Case

はじめに　臓器灌流障害を伴ったStanford B型大動脈解離に対する胸部ステントグラフト内挿術（TEVAR）によるcentral repairは，非常に理にかなった治療であるが，まれに解離の伸展によりアクセスルートの確保が困難となることがある．われわれは，遠位弓部大動脈径の急速拡大と遅発性の真腔閉塞による下肢虚血を合併したStanford B型大動脈解離に対するTEVARと腹部大動脈人工血管置換術の同時手術を経験したため，報告する．

We report a case of a 65-year-old man, who was transported as an emergency case to our institution because of Stanford type B dissection. He received conservative therapy, but follow-up computed tomography （CT） revealed dilatation of descending aorta and low-enhanced range from abdominal aorta to right common iliac artery due to the expansion of the false lumen on day 11 of hospitalization. So, we attempted to perform debranch thoracic endovascular aortic repair （TEVAR）, but we could not delivery the stentgraft through occluded right iliac artery. Four days later, we performed hybrid surgery of TEVAR and Y-graft replacement with reconstruction of the left renal artery. Postoperative CT showed no endoleak of TEVAR and ankle brachial pressure index （ABI） showed normal level. He was discharged on the 13th postoperative day.