弓部大動脈人工血管置換術におけるfrozen elephant trunkを用いた末梢側吻合の工夫―delayed deployment法

Devising a Technique for Distal Anastomosis During Total Arch Replacement Using the Frozen Elephant Trunk Technique：Delayed Deployment Technique

弓部大動脈人工血管置換術は人工血管や吻合方法の進歩により成績が改善傾向にはあるものの，末梢側吻合部は深く視野のわるい中で脆弱な血管に吻合を行う必要があること，低体温による凝固機能低下などの要因により，いまだ出血が多くなり止血困難となりやすい手術の一つである．その吻合方法の工夫の一つとしてfrozen elephant trunk（FET）法が開発され，現在は企業製品も発売され広く使われている1）．

Frozen elephant trunk （FET） technique is an effective procedure used to repair aortic arch aneurysm and aortic dissection. We modified FET technique in order to reduce bleeding, which we named “delayed deployment technique.” This procedure is performed in the following manner：

1. A tube graft is anastomosed to the proximal descending aorta using open distal method.

2. A FET is deployed within the tube graft and the descending aorta.

3. Proximal end of the inner FET and the outer tube graft is trimmed at the same position.

4. A four-branched graft is anastomosed to doubly layered distal grafts.

Since the FET is directly connected to the arch graft, anastomotic site in the proximal descending aorta can be free from direct blood flow. In addition, stent portion of the FET supports the aortic anastomosis from inside. We believe this method is useful for hemostasis.