全弓部人工血管置換術後遠隔期に併発した上行大動脈真性瘤

True Ascending Aortic Aneurysm Late after Total Arch Replacement

近年めざましい進歩を遂げた弓部真性大動脈瘤に対する人工血管置換術において，術後遠隔期における中枢側吻合部での血管合併症はまれとされる．われわれは，全弓部人工血管置換術（TAR）後遠隔期に併発した上行大動脈真性瘤の1例を経験したため報告する．

An aortic aneurysm was incidentally diagnosed in a 75-year-old woman during a thorough examination for other diseases. She had a history of total arch replacement （TAR） for aortic arch aneurysm 17 years previously. Contrast-enhanced computed tomography （CT） revealed a proximal aortic aneurysm with a maximum diameter of 67 mm protruding to the lateral side. She was treated by elective ascending aortic replacement. The resected aneurysm was not a pseudoaneurysm, but a true aneurysm. The etiology of this aneurysm might be long-term hemodynamic stress from the left ventricle and inadequate blood pressure control in addition to the anatomical position of the proximal residual aorta after first surgery. Therefore, to prevent aneurysm formation, it is important to replace the ascending aorta as proximally as possible at first surgery and to continue strict postoperative blood pressure control.