多発性囊胞腎に合併したStanford A型急性大動脈解離

Stanford Type A Acute Aortic Dissection Associated with Polycystic Kidney Disease

常染色体優性多発性囊胞腎（autosomal-dominant polycystic kidney disease：ADPKD）の腎外合併症として脳動脈瘤が代表的であるが，急性大動脈解離はあまり知られていない．われわれは，ADPKD患者に発症したStanford A型急性大動脈解離の1例を経験したので，文献的考察を加えて報告する．

Whereas cerebral aneurysm is a well-known consequence of autosomal dominant polycystic kidney disease （ADPKD）, acute aortic dissection has been rarely reported. A patient was a 44-year-old male with a diagnosis of ADPKD, who had previously undergone transcatheter arterial embolization for a renal cyst hemorrhage. He presented with sudden onset of back pain, which got worse at emergency service. Contrast-enhanced computed tomography （CT） revealed Stanford type A acute aortic dissection. The patient subsequently underwent partial aortic arch replacement with a vascular graft under circulatory arrest. His postoperative course was complicated by pneumonia and required ventilation support for a week. Peak creatinine level was 3.28 mg/dl, but hemodialysis was not required. Patients with ADPKD should be considered a high-risk cohort of aortic dissection.