血行再建を工夫し胸部ステントグラフト挿入術を行ったStanford B型慢性大動脈解離

Transposition of the Left Subclavian Artery Before a Thoracic Endovascular Aortic Repair for Type B Aortic Dissection

Zone 2（Z2）に留置する胸部ステントグラフト内挿術（TEVAR）を行う際に左鎖骨下動脈（SCA）の再建の必要性は，さまざまな議論がされている．また，左SCAの血行再建には人工血管を用いるバイパス術を行うことが多い．われわれは左SCAを離断し，左総頸動脈（CCA）へ端側吻合（transposition法）を行った症例を経験したので報告する．

We encountered a patient who had undergone a transposition procedure, which encompassed the performance of subclavian-common carotid arterial end-to-side anastomosis before a thoracic endovascular aortic repair （TEVAR） when carrying out Stanford type B aortic dissection. A 50-year-old man was admitted to our hospital with a diagnosis of chronic Stanford type B aortic dissection that tended to expand. Transposition was performed in advance of zone 2 TEVAR. Lymphorrhea was observed under the skin following surgery. A decreasing tendency for lymphorrhea was confirmed at six months following the operation. Coil embolization was performed after the occurrence of a type I leak following TEVAR；the leak was repaired successfully during the procedure. No ischemic symptoms in the upper left limb or any cerebral complications were observed, demonstrating the safety of the transposition method. The transposition method can be the first choice for revascularization of the left subclavian artery because it requires only one incision, no anticoagulant drugs, and is expected to maintain patency for a long period.