下行大動脈人工血管置換術後30年目に吻合部瘤をきたした1例

An Anastomotic Aneurysm Thirty Years After Open Surgery of the Descending Thoracic Aorta：Report of a Case

はじめに　胸部大動脈瘤に対する人工血管置換術は，本邦では1986年時点で約1,200例施行されている1）．長期生存例では吻合部瘤も発生しうる．われわれは，下行大動脈人工血管置換術施行から30年後に末梢側吻合部瘤をきたした1例を経験した．胸部ステントグラフト内挿術（TEVAR）で良好な結果を得たので報告する．

An 86-year-old man was hospitalized urgently to our department because of his worsening hemoptysis. He had undergone open thoracic aortic grafting for the Stanford type B chronic aortic dissecting aneurysm 30 years earlier. Contrast enhanced computed tomography （CT） revealed the distal anastomotic aneurysm, leakage of the contrast medium around the distal anastomotic site. We urgently performed thoracic endovascular aneurysm repair （TEVAR） for the distal anastomotic aneurysm. TEVAR was done under local anesthesia because of his poor respiratory condition due to hemoptysis. He recovered well without hemoptysis. Patients after open aortic surgery are expected to survive longer. Thus, special attention should be paid to the occurrence of anastomotic aneurysms.