弓部大動脈人工血管置換術と順行性ステントグラフト内挿術を同時施行した破裂性胸部大動脈瘤

Ruptured Thoracic Aortic Aneurysm Treated with Total Arch Replacement and Direct Transaortic Thoracic Endovascular Aortic Repair

遠位弓部が長く，急峻な角度で下行大動脈へ移行するような遠位弓部大動脈瘤の破裂に対し，われわれは胸部ステントグラフト内挿術（TEVAR）用のデバイスをオープンステント法として用いて弓部大動脈人工血管置換術（TAR）と併用した症例を経験した．本術式のようにTEVAR用のデバイスを用いることは有用であったため，報告する．

Open stent grafting is an effective technique in surgery for treating-ruptured aortic aneurysms in the distal aortic arch, but it is not always applied as it depends on the shape of the aneurysm. In this case, the aneurysm was long in the distal aortic arch and sharply angulated into the descending aorta；thus, it was anticipated that an off-the-shelf open stent graft would not cover the ruptured area. Therefore, we used a stent graft device for thoracic endovascular aortic repair as an open stent and succeeded in saving the patient’s life.