冠状動脈バイパス術後の弓部大動脈瘤に対するオープンステントグラフト内挿術の1例

Open Stent Grafting for Aortic Arch Aneurysm in a Patient with Fuctional Coronary Bypass Grafts：Report of a Case

はじめに　冠状動脈バイパス術（CABG）後の弓部大動脈瘤への外科治療は，開存グラフトの温存を考慮したうえでの術式の選択が必要とされる．われわれは，過去にCABGを施行し6年後に急速な増大を示した弓部大動脈瘤に対し，再胸骨正中切開でオープンステントグラフト内挿術を施行し，良好な結果を得たので報告する．

Treating a thoracic aortic aneurysm （TAA） after coronary artery bypass （CABG） surgery requires an appropriate surgical procedure to preserve the bypass grafts. We present a case of open stent grafting. The patient was a 71-year-old man with a history of CABG. Chest computed tomography （CT） revealed a saccular-shaped aortic aneurysm in the aortic arch with diameter of 56 mm. Coronary angiography revealed the LIMA and SVG grafts were patent. The chest was opened via re-midsternotomy. After a circulatory arrest was induced at 30 ℃ with cerebral perfusion, the anterior surface of the arch was incised in a hemi-circumferencial mannar between the left common carotid and left subclavian arteries. The stent graft was inserted into the aortic arch and was deployed. The proximal side of the graft was then trimmed, and the posterior aortic wall and the graft were continuously anastomosed, the aortic incision was continuously closed involving anterior side of the graft. Finally, the left axillary artery was reconstructed. The patient’s postoperative course was uneventful and he was discharged on postoperative day 10. A open stent grafting via an aortotomy was useful in the surgery for TAA after CABG.