Stanford A型急性大動脈解離術後のオープンステントグラフト狭窄に対する胸部ステントグラフト内挿術の1例

Endovascular Therapy for Kinking of an Open Stent Graft after Stanford Type A Acute Aortic Dissection Repair：Report of a Case

はじめに　弓部大動脈置換術におけるJ Graft Frozenix（以下，Frozenix：日本ライフライン社，東京）の有用性が報告1）される一方，合併症も散見される2）．われわれは，Stanford A型急性大動脈解離術後にFrozenixの狭窄をきたした症例を経験したので報告する．

This is the case of 50s female with Stanford type A acute aortic dissection who underwent emergent total arch replacement. The aortic arch was transected just distal to the left subclavian artery, followed by the insertion of J Graft Frozenix into the descending aorta. No blood pressure gradient was observed between the radial and femoral arteries immediately after the operation. Nevertheless, intermittent claudication was observed after a week. Ankle-brachial index （ABI） measurement was calculated at 0.7 in both legs. Computed tomography （CT） revealed a kinking of the non-stented part of the endograft. Subsequently, thoracic endovascular aortic repair （TEVAR） was performed. As a result, ABI measurement normalized and lower limb pain disappeared. Three years after, CT showed that the endograft expanded satisfactorily. In deployment of J Graft Frozenix, the non-stented part should be kept as short as possible. For kinking, TEVAR should be considered the initial treatment option.