鈍的外傷性大動脈破裂に対してチムニー法を併施した胸部ステントグラフト内挿術の1例

Thoracic Endovascular Aneurysm Repair Using the Concomitant Chimney Technique for Blunt Thoracic Aortic Injury：Report of a Case

はじめに　鈍的胸部大動脈損傷（blunt thoracic aortic injury：BTAI）は多発外傷を併発し，高い死亡率を呈する病態である1，2）．BTAIに対する胸部ステントグラフト内挿術（thoracic endovascular aortic repair：TEVAR）の有効性が報告されている3）ものの，その際の左鎖骨下動脈に対する処置に関しては議論の余地がある4）．

Blunt thoracic aortic injury （BTAI） is associated with high morbidity and mortality. Recently, minimally invasive thoracic endovascular aortic repair （TEVAR） has been reported to be a safe surgical treatment for acute BTAI. Here, we report the success of TEVAR using the concomitant chimney technique for BTAI. A 70-year-old man in shock was referred to our emergency room following a traffic accident. Computed tomography （CT） scan demonstrated multiple rib fractures, hemothorax, and BTAI. According to the severity of BTAI as classified by the Society for Vascular Surgery （SVS） guidelines, the patient was diagnosed with grade 4 free rupture. We performed TEVAR twice because of the endoleak；however, this method saved the patient’s life. The use of the chimney technique to preserve the patency of the left subclavian artery is beneficial because the majority of BTAI cases occur in the aortic isthmus from a pathophysiological perspective.