チムニーテクニックを併用した胸部ステントグラフト内挿術後のエンドリークに対する人工血管置換術の1例

Total Aortic Arch Replacement for TypeⅠEndoleak after Thoracic Endovascular Aortic Repair using the Chimney Graft Technique：Report of a Case

はじめに　胸部大動脈瘤に対する胸部ステントグラフト内挿術（TEVAR）にはさまざまな治療選択があり，時代により変遷してきた．経験が蓄積されているが，それとともに経年変化に対しての加療が必要になる症例が増加してきている．

Here we report a case of total aortic arch replacement for typeⅠendoleak after thoracic endovascular aortic repair （TEVAR） using the concomitant chimney graft technique. An 81-year-old man was admitted with sudden back pain. Six years prior, he had undergone TEVAR for treatment of a distal aortic arch aneurysm. Preoperative computed tomography revealed an 80-mm-diameter arch aneurysm and typeⅠendoleak. The back pain was caused by impending aneurysmal rupture；therefore, urgent total arch replacement was performed. One stent was cut from the main endograft and anastomosed to its distal side. The bare metal stent in the left common carotid artery was removed and reconstructed at a healthy distal artery. Postoperative computed tomography revealed no endoleak of the aneurysm, and the patient’s postoperative course was uneventful.