左椎骨動脈大動脈起始を有するStanford A型急性大動脈解離に対して上行弓部大動脈置換オープンステントグラフト内挿術を施行した1例

Total Arch Replacement and Open Stent Grafting for Stanford Type A Acute Aortic Dissection with an Aberrant Left Vertebral Artery：Report of a Case

はじめに　急性大動脈解離や胸部大動脈瘤に対する弓部大動脈手術において，弓部分枝異常を伴う症例の場合，分枝の再建方法や脳灌流方法が問題となる．われわれは左椎骨動脈大動脈起始を有するStanford A型急性大動脈解離例に対して，上行弓部大動脈置換オープンステントグラフト内挿術を施行した1例を経験したので報告する．

A 61-year-old man was referred to our hospital for Stanford type A acute aortic dissection and an emergency operation was planned. In this case, the aberrant left vertebral artery originated directly from the aortic arch. Total arch replacement at the level between the left carotid artery and left aberrant vertebral artery was performed and an open stent graft was deployed in the true lumen of the descending aorta to obtain better distal aortic remodeling. The proximal edge of the nitinol skeleton of the open stent graft was placed distal to the orifice of the left subclavian artery. The left subclavian artery was not reconstructed in the mediastinum but bypassed distally to the left axillary artery so that the left subclavian artery could perfuse the aberrant left vertebral artery through the preserved aortic arch. Patency of all arch branches including the aberrant left vertebral artery was confirmed in postoperative computed tomography （CT） angiography.