偽腔に留置せざるをえなかった胸部ステントグラフト内挿術の1例

Thoracic Endovascular Aortic Repair （TEVAR） Deployed into the False Lumen：Report of a Case

はじめに　胸部大動脈疾患に対する胸部ステントグラフト内挿術（TEVAR）は，その低侵襲性から近年症例数が増加しており，急性期における大動脈解離の遠隔期拡大予防を目的としたpreemptive TEVARも増加している．ただし慢性期では真腔が狭小化した症例も散見され，ステントグラフトのオーバーサイズはdistal stentgraft induced new entry（SINE）の発生に寄与するとされる．われわれは，真腔が閉塞していたため偽腔にステントグラフトを留置し，治療しえたので報告する．

A 73-year-old man had Stanford type B acute aortic dissection 11 years before. He had underwent thoracoabdominal aortic replacement due to thoracoabdominal aneurysm nine years before and hemi-arch aortic replacement due to Stanford type A acute aortic dissection four years before. We performed surgery because the dissecting aortic aneurysm in the distal arch has enlarged. We selected thoracic endovascular aortic repair （TEVAR） because of reoperation, but the true lumen of the descending aorta was highly narrowed, we had to deploy stent-grafts into the false lumen. Since the proximal and distal parts of endovascular thoracic stent-grafts were deployed into the previously implanted Dacron grafts, we could deploy them without vascular injury. If both proximal and distal parts of stent-grafts can be deployed into vascular prosthesis, deploying the stent-grafts into the false lumen may be a feasible option.