長時間左下肢虚血を伴う筋腎代謝症候群を合併したStanford A型急性大動脈解離

Stanford Type A Acute Aortic Dissection with Myonephropathic Mrtabolic Syndrome

長時間の左下肢虚血を伴ったStanford A型急性大動脈解離を発症し，術後のCK最大値が約240,000 U/lの重症MNMS例に対して集学的治療を行い救命しえた．

A 57-year-old man was transferred with sudden onset chest pain and evolving paralysis and numbness in the left leg. Contrast computed tomography （CT） revealed Stanford type A acute aortic dissection from the ascending aorta to bilateral internal and external iliac arteries with blood flow obstruction to the left kidney and left lower limb. Surgery was initiated 10 hours after onset of ischemic symptoms in the leg. Femoro-femoral bypass was carried out first, and we ensured sufficient phlebotomy from the ischemic limb during reperfusion and continuous hemodiafiltration to prevent myonephropathic metabolic syndrome. Total aortic arch replacement was then performed. Our treatment strategy was effective in this case of Stanford type A aortic dissection with prolonged lower limb ischemia. Although left hip disarticulation was subsequently required due to intractable infection, the patient became able to walk with an artificial limb after post-rehabilitation.