腹部臓器灌流障害を伴う急性大動脈解離に対する静脈グラフトを用いた上行大動脈-上腸間膜動脈バイパスの1例

Superior Mesenteric Artery Bypass Grafting from the Ascending Aorta Using a Saphenous Vein Graft for Treatment of Acute Aortic Dissection with Abdominal Malperfusion：Report of a Case

はじめに　急性大動脈解離において，臓器灌流障害は急性期死亡や合併症の主たる原因となる．腸管虚血では，早期の診断および血行再建が重要である．われわれは，腹部臓器灌流障害を合併したStanford A型急性大動脈解離に対し，central repairに先行して上腸間膜動脈（SMA）バイパス術を行い，救命した1例を経験したので報告する．

A 50-year-old man presented with abdominal pain and numbness in the right leg. He was diagnosed with type A acute aortic dissection with malperfusion of the superior mesenteric artery （SMA） and the right external iliac artery. Before median sternotomy, we made median celiotomy and anastomosed a saphenous vein graft to SMA. After cardio-pulmonary bypass was instituted, perfusion to the saphenous vein graft was started. After the central repair, we selected the vascular graft of the ascending aorta as the inflow of SMA bypass because leading the vein graft to the external iliac artery was difficult due to obesity and intestinal edema. The graft flow was favorable with 100 ml/minute. He was discharged on postoperative day 56 without any abdominal complications. Some reports suggested that early reperfusion improved the outcomes of surgery for acute aortic dissection with mesenteric ischemia. The ascending aorta may be a viable alternative as an inflow of SMA bypass when the iliac artery is inappropriate.