胸部ステントグラフト内挿術後にエンドテンションから瘤破裂をきたした胸腹部大動脈瘤の1例

Rupture without Bleeding Secondary to Endotension After Thoracic Endovasular Aneurysm Repair：Report of a Case

はじめに　ステントグラフト治療後の瘤破裂はもっとも悲惨な合併症の一つである．通常，エンドリーク（EL）といわれる血液の漏れが関係しているが，中には明らかなELなく瘤拡大する例が報告されており，エンドテンション（ET）と呼ばれている1）．われわれは胸部ステントグラフト内挿術（TEVAR）後に明らかなELを認めずに瘤が拡大し，さらに破裂をきたした症例を経験したので報告する．

We report a rare case of rupture without bleeding secondary to endotension after thoracic endovascular aneurysm repair. An 82-year-old woman had undergone multiple thoracic endovascular aortic repairs for a distal arch aneurysm. Due to the aneurysm enlargement, stent graft was eventually placed from the ascending aorta to just above the celiac artery after axillo-axillo-common carotid artery bypass. Postoperative computed tomography （CT） revealed no endoleak （EL）. However, arch aneurysm sac continued to expand without ELs. Furthermore, thoracoabdominal aneurysm was enlarged. She was referred to our hospital because of severe chest pain while we considered open repair. CT demonstrated aneurysm enlargement and massive hematoma, suggesting rupture. Therefore, an open repair was performed by thoracotomy. Interestingly, we found that there was no EL, indicating endotension-induced aneurysm rupture. Her aorta was partially replaced with vascular prosthesis. Second intervention should be performed to prevent critical complications if the aneurysm is expanding even without obvious EL.