右側大動脈弓に合併したKommerell憩室に対するfrozen elephant trunk併用全弓部大動脈人工血管置換術の1例

Total Arch Replacement using the Frozen Elephant Trunk for Kommerell Diverticulum with Right Aortic Arch：Report of a Case

はじめに　右側大動脈弓（RAA）に左鎖骨下動脈起始異常（ALSCA）を伴うKommerell憩室（KD）はまれな疾患で，無症状なことも多い．われわれは，嚥下困難を伴う症例に対して，frozen elephant trunk（FET）を併用した全弓部大動脈人工血管置換術（TAR）を施行したので報告する

A 42-year-old woman with dysphagia was referred to our hospital. Computed tomography （CT） revealed Kommerell diverticulum （KD） associated with right aortic arch （RAA） and aberrant left subclavian artery （ALSCA）. We performed total arch replacement （TAR） using a frozen elephant trunk （FET） technique. We ligated ALSCA at the distal portion of the KD after perfusing from a 8 mm tubular graft from left axillar artery. We inserted a FET from the ascending aorta to avoid locating the non-stented portion at the steep-angled site of RAA. Postoperatively dysphagia disappeared and CT scan showed complete exclusion of KD without leakage of the stent graft and successful reconstruction of the arch. The TAR and FET technique is an effective procedure for KD with RAA and ALSCA.