オープンステントグラフト法による全弓部大動脈置換術後遠位端からの再解離の1例

Distal Stent Graft-induced New Entry after Total Arch Replacement for the Aortic Dissection：Report of a Case

はじめに　大動脈解離に対するオープンステントグラフト（OSG）留置による合併症として，近年，ステントグラフトの遠位端に新たなエントリーが発生するdistal stent graft-induced new entry（distal SINE）が注目されている．われわれは，Stanford B型大動脈解離に対し全弓部大動脈置換術（TAR）＋OSG留置を施行され，distal SINEによる再解離を発症した症例を経験したので，若干の文献的考察を加えて報告する．

A 73-year-old man after total arch replacement with open stent graft （OSG） technique for Stanford type B aortic dissection was found to have expanding descending aortic aneurysm. Contrast-enhanced computed tomography （CT） showed distal stent graft-induced new entry （distal SINE）. We successfully performed additional thoracic endovascular aortic repair （TEVAR）. The determinants of distal SINE are reported to be excessive distal oversizing and spring back force on the distal end of the stent graft, which might make the stress for descending aorta. We also found that the angle between distal end of the stent graft and the horizontal line of the body was changed. The angle when distal SINE occurred was smaller than that of when it was placed. Appropriate size selection and positioning of stent graft might reduce the risk of distal SINE events.