Stanford A型急性大動脈解離術後にコンパートメント症候群をきたし救肢した1例

Compartment Syndrome After Stanford Type A Acute Aortic Dissection Surgery：Report of a Case

はじめに　大血管手術や再開胸手術では大腿動脈送血も選択される．まれではあるが，送血路と同側の下肢虚血によるコンパートメント症候群をきたし1～3），筋腎代謝症候群（MNMS）にいたり，死にいたることもある．また，下肢切断を要し，著しい身体機能の低下をきたしうる．われわれは，急性大動脈解離術後に下腿コンパートメント症候群をきたし，救肢した1例を経験したので報告する．

A 53-year-old man presented to the emergency department with chest and back pain. Contrast-enhanced computed tomography （CT） revealed a Stanford type A acute aortic dissection with a pseudo-lumen occlusion. On the same day, the patient underwent emergent aortic arch replacement with frozen elephant trunk. When introducing cardiopulmonary bypass, arterial cannula was inserted into the right femoral artery. The day after surgery, swelling of the right lower leg appeared with CK and intramuscular compartment pressure elevation. Thus, the patient was diagnosed with compartment syndrome and decompressive fasciotomy was performed. Although there was no preoperative blood flow disturbance in the lower extremities on preoperative CT, lower limbs ischemia happened. Necrotic muscles in his right leg required debridement, but amputation was not needed. The patient was discharged unaided utilising orthotics on the day 120. In muscular, young male patients, care should be taken in the method of blood delivery.