下肢虚血および腹部臓器虚血を起こしたStanford A型急性大動脈解離

Stanford Type A Acute Aortic Dissection with Leg Ischemia and Visceral Ischemia

下肢虚血に加えて非常にまれな肝梗塞，虚血性胆囊炎および十二指腸虚血を発症したStanford A型急性大動脈解離の患者に対して，胆囊摘出術と血行再建術によるmalperfusionの治療を先行し，後日上行弓部大動脈置換術およびフローズンエレファントトランク法を行い救命したため，若干の文献的考察を加えて報告する．

A 52-year-old man developed Stanford type A acute aortic dissection and suffered severe pain in the back and the chest, and numbness of the left lower limb. Contrast-enhanced computed tomography （CT） revealed occlusion of the left iliac artery due to dissection. The celiac artery was also obstructed and the superior mesenteric artery was severely narrowed, but there was no clear sign of organ ischemia. Endovascular treatment in the iliac artery was performed, but the patient complained of right upper abdominal pain 6 hours after the procedure. Serum liver enzyme levels were significantly elevated. Repeat contrast-enhanced CT revealed liver infarction, ischemic cholecystitis, and duodenal ischemia due to decreased collateral flow. We immediately carried out cholecystectomy and revascularization of the celiac and superior mesenteric arteries using a saphenous vein. The patient underwent central repair for aortic dissection several days after recovery of liver function, and was discharged uneventfully 24 days later.