Stanford B型急性大動脈解離を合併した右鎖骨下動脈起始異常を伴うKommerell憩室に対する手術の1例

Surgical Treatment for Kommerell’s Diverticulum and Aberrant Right Subclavian Artery with Stanford Type B Acute Aortic Dissection：Report of a Case

はじめに　Kommerell憩室は大動脈弓部の発生異常により生じ，鎖骨下動脈起始異常を伴うことが多い．Kommerell憩室の約半数に破裂や解離を生じるとされるが，非常にまれな疾患であり，治療方針や手術戦略は標準化されていない．われわれは，Stanford B型急性大動脈解離を発症した右鎖骨下動脈起始異常を伴うKommerell憩室に対して，frozen elephant trunk（FET）法を用いた全弓部置換術を行い，良好な治療結果を得たため報告する．

Kommerell’s diverticulum with an aberrant subclavian artery is a rare congenital aortic arch anomaly. Therefore surgical indication and strategy are not well established. A 43-year-old man was referred to our hospital with a chief complaint of chest and back pain. Contrast-enhanced computed tomography （CT） scan revealed Kommerell’s diverticulum and aberrant right subclavian artery （ARSA） with Stanford type B acute aortic dissection. Aortic dissection involved Kommerell’s diverticulum and ARSA. We performed total arch replacement with frozen elephant trunk technique and ARSA embolization. The postoperative course was uneventful. Contrast-enhanced CT scan revealed thrombosed Kommerell’s diverticulum and closure of the primary tear. This surgical approach would be an effective treatment option for Kommerell’s diverticulum with an aberrant subclavian artery.