弓部大動脈置換術後の胸骨侵食を伴う人工血管非吻合部仮性瘤

Non-anastomotic Pseudoaneurysm of a Prosthetic Graft with Sternal Erosion after Total Aortic Arch Replacement

人工血管非吻合部仮性瘤は，まれではあるが遠隔期の合併症として散見される．われわれは，真性弓部大動脈瘤に対する弓部大動脈人工血管置換術後に生じた，胸骨侵食を伴う人工血管分枝の非吻合部仮性瘤に対し，血管内治療を施行して良好な結果を得たので，文献的考察を加えて報告する．

An 82-year-old man underwent total aortic arch replacement with a 24 mm Triplex four-branched graft for aortic arch aneurysm. After two years, he was diagnosed with pseudoaneurysms due to bleeding from a non-anastomotic site of the branch graft to the left common carotid artery and minor leakage from a distal anastomotic site of the main graft. A self-expandable Fluency covered stent and cTAG thoracic endograft were used for the aneurysm. After four years, he was referred to our hospital with a complaint of pulsatile swelling of the anterior chest wall. Contrast enhanced computed tomography （CT） revealed a pseudoaneurysm arising from a non-anastomotic site of the branch graft to the left common carotid artery, which extended into the anterior chest wall and the skin through the sternum. He underwent emergency endovascular repair using a Niti-S ComVi covered stent. The postoperative course was uneventful. Postoperative CT showed shrinkage of the pseudoaneurysm. The patient was discharged and required no reintervention during the follow-up.