アルブミン使用接着剤使用後に発症した急性大動脈解離術後遠隔期の巨大吻合部瘤の1例

Giant Anastomotic Aneurysm Associated with Albumin/Glutaraldehyde Sealant as a Late Complication after Acute Aortic Dissection Surgery：Report of a Case

はじめに　組織接着剤は大動脈解離手術における偽腔の閉鎖ならびに縫合線の補強・止血に広く使用され，手術成績の向上に大きく寄与してきたが，合併症も報告されている．われわれは，急性大動脈解離の手術時の断端形成にBioGlue（CryoLife社，Kennesaw）を使用し，術後1年3ヵ月で中枢吻合部，末梢吻合部に巨大吻合部瘤を認め，再上行大動脈置換術を行った症例を経験したので報告する．

A 74-year-old woman was taken to our hospital with a chief complaint of chest and back pain. She was diagnosed with Stanford type A acute aortic dissection and underwent ascending aortic replacement. Fifteen months after surgery, a giant anastomotic aneurysm was found at the proximal and distal anastomoses on chest computed tomography （CT）, and reoperation was indicated. Following sternal re-entry, anastomotic dehiscence was found where BioGlue, albumin/glutaraldehyde sealant, had been applied during the previous surgery, and caused aneurysm. Severe postoperative adhesion precluded extensive surgery, and redo replacement of the ascending aorta was carried out. Histopathological examination revealed extensive necrosis of smooth muscle cells in the aortic wall at the anastomotic site and a marked inflammatory cell infiltration around the aortic wall and the artificial graft, and association of BioGlue use was suggested. The use of appropriate tissue adhesives to reinforce the dissected aortic wall is important, as well as careful long-term follow-up.