溶血性貧血を伴う上行大動脈置換人工血管の屈曲に対するステントグラフト内挿術の1例

Thoracic Endovascular Aortic Repair for Ascending Aortic Graft Flexion with Hemolytic Anemia：Report of a Case

はじめに　心臓手術後の溶血性貧血（hemolytic anemia：HA）はよく知られた合併症で，1960〜1970年台には古い世代の人工弁置換術後の15％に発症していた1）が．大動脈手術後にはまれ2）である．

A 63-year-old man, who underwent urgent ascending aortic replacement for Stanford type A acute aortic dissection 8 years before, was presented with consciousness loss. Hemolytic anemia （hemoglobin 6.5 g/dl, LDH 1,477 U/l, total bilirubin 3.8 mg/dl） was diagnosed. Contrast-enhanced computed tomography （CT） scans revealed severe flexion and stenosis of the replaced ascending aortic graft with intraluminal protrusion of the lesser curvature progressing as compared with 8 years before. Thoracic endovascular aortic repair, i.e. stent-graft implantation into the ascending aortic graft, under rapid pacing was successfully performed. The graft flexion/stenosis was slightly improved, and the intraluminal protrusion of the lesser curvature was covered by the stent graft. Anemia was completely resolved. Endovascular repair for graft flexion/stenosis bringing hemolytic anemia is far less invasive than redo aortic replacement and may be a useful therapeutic tool in limited cases.