右鎖骨下動脈起始異常を伴う解離性胸部大動脈瘤に対するオープンステント併用弓部大動脈人工血管置換術の1例

Total Arch Replacement with Open Stent Grafting for Chronic Dissecting Aortic Aneurysm with Aberrant Right Subclavian Artery：Report of a Case

はじめに　鎖骨下動脈起始異常（ARSA）は大動脈の発生異常であり，その発生頻度は0.53％1）と比較的まれである．鎖骨下動脈起始異常では，Kommerell憩室と呼ばれる瘤や大動脈解離の合併などが報告されており，それらに対する術式もさまざまである．われわれは，右鎖骨下動脈起始異常を伴う解離性大動脈瘤に対してオープンステントグラフト併用弓部置換術を施行した1例を経験したので報告する．

A 59-year-old man was referred to our hospital for surgery for a dissecting aortic aneurysm with an aberrant right subclavian artery （ARSA）. He had a history of surgery for atrial septal defect at the age of 3 and developed Stanford type B aortic dissection at the age of 53. The maximum diameter of the aortic aneurysm was 68 mm, and the entry was located close to the ARSA origin. We established cardiopulmonary bypass using the femoral artery and vein and performed a median re-sternotomy. We performed total arch replacement with the open stent-grafting technique. The ARSA was ligated from the right thoracic cavity. Three arch branches were reconstructed in situ, and the right axillary artery was bypassed with a 9 mm Dacron graft. Six months after that operation, reduction of the false lumen was observed. This strategy is considered to be effective for chronic aortic dissection with ARSA.