弓部大動脈人工血管置換術後腕頭動脈内留置ステントグラフトによる人工血管穿孔

Vascular Prosthesis Perforation Caused by a Stent Graft Inserted into the Innominate Artery after Total Aortic Arch Replacement

人工血管置換術後の遠隔期合併症に人工血管穿孔がある．近年，耐久性の向上した人工血管では物理的な刺激が原因となった破綻の報告が散見されるが1～3），大動脈に留置したステントグラフトと人工血管の接触が原因となった報告は少ない．われわれは，弓部大動脈人工血管置換術後に腕頭動脈から弓部大動脈人工血管内に留置したステントグラフトによる人工血管穿孔の1例を報告する．

The patient was a 60-year-old woman who underwent thoracoabdominal aorta replacement for type B aortic dissection three years ago and aortic root replacement and total aortic arch replacement due to asymptomatic type A aortic dissection two years previously. Her clinical course was uneventful until follow-up computed tomography （CT） disclosed anastomotic insufficiency in the innominate artery and left main coronary artery stenosis owing to hematoma. Emergent percutaneous coronary intervention and stent graft insertion into the innominate artery were performed successfully. Seven months later, however, CT scan revealed a perforation in the posterior wall of the artificial graft damaged by the edge of the implanted stent graft. The patient underwent open surgery and perforation of artificial graft was sutured and redundant stent graft edge was resected. Artificial graft damage by stent graft placement is rare to date, but may increase in the future in accordance with broader application of endovascular treatment.