胸骨ワイヤーにより人工血管破裂をきたしたと考えられた1例

Rupture of Artificial Blood Vessel by a Sternal Wire：Report of a Case

はじめに　胸部大動脈人工血管置換術後の遠隔期において吻合部からの仮性動脈瘤は時に遭遇するが，非吻合部からの仮性動脈瘤形成はきわめてまれである．われわれは，上行大動脈置換術後に胸骨ワイヤー接触に起因すると思われる人工血管破裂を生じ緊急手術を行った症例を経験したので，文献的考察を交えて報告する．

Formation of a pseudoaneurysm due to blood leakage from the anastomotic site of the vascular graft in large-diameter vessels is often seen, but formation of a pseudoaneurysm from the non-anastomotic site is extremely rare. A 68-year-old woman presented with a history of double valve replacement for combined valvular disease at 37 years old and hemiarch replacement for thoracic aortic dilatation at 65 years old. She visited the emergency room with a 2-week history of chest pain. Contrast-enhanced computed tomography （CT） revealed a 5-cm-diameter pseudoaneurysm and extravasation from the ascending aorta, so emergency surgery was performed. Around the ascending aorta area, we confirmed bleeding from a 5-mm dehiscence in the non-anastomotic part of the graft prosthesis, so hemostasis was performed with a cross-stitch mattress suture over a felt strip. Initially, the cause of the pseudoaneurysm was unknown, but re-examination of CT images from after the previous hemiarch replacement confirmed contact between the sternal wire and graft prosthesis. The wire was thus considered to have caused damage and bleeding. The patient was discharged from the hospital with a good postoperative course and is being followed-up in the outpatient department.