IgG4関連胸部大動脈瘤術後に生じた吻合部仮性動脈瘤

Anastomotic Pseudoaneurysms after Graft Replacement for IgG4-related Thoracic Aortic Aneurysm

Immunoglobulin G4（IgG4）関連疾患は血清IgG4高値と病変組織での顕著なIgG4陽性形質細胞の浸潤，線維増生を特徴とする全身性疾患群である1）．われわれは，IgG4関連胸部大動脈瘤に対する手術2）後に，複数の吻合部仮性動脈瘤をきたした症例を経験したので報告する．

We report a case of pseudoaneurysms at the anastomotic sites after prosthetic graft replacement for Immunogloblin G4 （IgG4）-related thoracic aortic aneurysm. A 69-year-old male patient underwent ascending and aortic arch replacement and open stent graft insertion. Five months after the surgery, pseudoaneurysms at the anastomosis to the brachiocephalic artery and to the left common carotid artery developed, and urgency surgery was performed. The right common carotid artery, the right subclavian artery, and the left common carotid artery were individually reconstructed with grafts, and the anastomoses were wrapped with grafts. In IgG4-related aneurysms, complete resection of the diseased tissue and reinforcement of the anastomosis, such as anastomotic wrapping, are important to prevent anastomotic site failure. While serum IgG4 had normalized after the first surgery, C-reactive protein （CRP） remained elevated until the reoperation. Thus, CRP is considered one of the biomarkers for disease activity in IgG4-related vascular disease.