上行弓部大動脈内巨大血栓に対するisolation 法を用いた弓部大動脈置換術の1例

Total Arch Replacement Using Isolation Technique for Giant Thrombus in Ascending Aorta and Aortic Arch：Report of a Case

はじめに　瘤化を伴わない大動脈内血栓は比較的まれな疾患であり，末梢塞栓症の原因として重要である．われわれは，右上肢急性動脈閉塞症を契機に発見された上行弓部大動脈内巨大血栓に対してisolation法を用いた弓部大動脈置換術を行い，良好な結果を得たため報告する．

We report a case of giant thrombus in the ascending aorta and the aortic arch, and our successful treatment. A 52-year-old man was referred to our department for coldness and numbness of the right upper arm and hand for several days. Contrast enhanced computed tomography revealed thrombosis of the right brachial artery and a giant thrombus in the ascending aorta and the aortic arch. Three days after the revascularization of the right upper limb by thrombectomy, we performed total arch replacement with frozen elephant trunk using “isolation technique” which is reported to be useful to prevent embolic stroke during total arch replacement in patients with shaggy aorta. In this technique brain circulation was isolated by establishing selective cerebral perfusion before starting systemic perfusion. Postoperative course was uneventful and no recurrent thrombosis has been observed for a year with anticoagulant therapy. We advocate that this technique is also useful in the presence of thrombus in the ascending aorta and the aortic arch.