腸管虚血を伴うStanford A型急性大動脈解離に対する治療戦術

Optimal Management of Stanford Type A Acute Aortic Dissection with Mesenteric Malperfusion

腸管虚血を伴うStanford A型急性大動脈解離はいまだ予後不良であり，確立された治療戦術はない．昨今ではendovascular repair（fenestration/stenting）とcentral repairのハイブリッド治療も散見されるが，実施にあたってはハイブリッド手術室などのハード面や，インターベンションを行う医師などのソフトの面でも制約があり，どの施設でも可能なわけではない．

The optimal management of Stanford type A accute aortic dissection （TAAAD） with mesenteric malperfusion （TAAADwM） is controversial. Our strategy of TAAADwM is open superior mesenteric artery （SMA） bypass prior to aortic repair, if we suspect TAAADwM on computed tomography （CT） scan, whatever other findings might be or not. The need of treatment of mesenteric malperfusion prior to aortic repair is not always linked with digestive symptom, lactate, intraoperative finding. The mortality of 14 patients with TAAADwM was 21.4％, which was an allowable result. Our strategy might be proper at instances of, allowable time for management of open SMA bypass, unnecessarily of endovascular treatment, confirming an enteric property and ability to respond to a rapid hemodynamic change.