右側大動脈弓および左鎖骨下動脈孤立症を伴う広範囲胸部大動脈瘤に対する二期的手術の1例

Staged Hybrid Repair of Extensive Thoracic Aortic Aneurysm with Right Aortic Arch and Isolated Left Subclavian Artery：Report of a Case

はじめに　右側大動脈弓は発生頻度が0.05～0.1％とされるまれな先天性疾患である．われわれは右側大動脈弓に左鎖骨下動脈孤立症を伴う成人の広範囲胸部大動脈瘤に対して二期的手術を施行し，良好な結果を得ることができたので，文献的考察を加えて報告する．

A 69-year-old male was referred to our hospital due to extensive thoracic aortic aneurysm with right aortic arch and isolated left subclavian artery. We chose staged hybrid repair to avoid the risk of spinal cord injury and bilateral recurrent nerve paralysis. First, ascending aorta replacement with elephant trunk and reconstruction of the cervical branches were underwent. Second, we performed the thoracic endovascular aortic repair for aortic arch and descending aortic aneurysm. The postoperative course was satisfactory and, computed tomography （CT） showed successful aortic repair without any type of endoleak. He was discharged on the ninth day after the second operation. To our knowledge, this is the first report of surgical repair for an aortic aneurysm with right aortic arch and isolated subclavian artery.