Stanford A型急性大動脈解離術後の腕頭動脈吻合部仮性瘤をステントグラフト内挿術で治療した1例

Pseudoaneurysm at the Brachiocephalic Artery Anastomosis After Acute Aortic Dissection Surgery Treated with Endovascular Stent Grafting：Report of a Case

はじめに　急性大動脈解離術後の腕頭動脈吻合部仮性瘤に対して胸部ステントグラフト内挿術（TEVAR）で治療した症例について，若干の文献的考察を加えて報告する．

We report a case of endovascular stent grafting for a pseudoaneurysm at the brachiocephalic artery anastomosis after acute aortic dissection surgery. A 48-year-old male underwent total arch replacement for Stanford type A acute aortic dissection. One month postoperatively, thoracic endovascular aortic repair （TEVAR） was performed to treat true lumen narrowing due to residual dissection. Two months after the initial surgery, he was emergently admitted with anterior chest pain. Close examination revealed a pseudoaneurysm at the brachiocephalic artery anastomosis, forming a mediastinal hematoma. Endovascular stent grafting was performed after creating a right axillary artery-to-right common carotid artery bypass. The stent graft successfully covered the pseudoaneurysm and the dissected segment of the right common carotid artery. The patient had no neurological complications, and postoperative contrast-enhanced computed tomography （CT） confirmed patency of the bypass and exclusion of the pseudoaneurysm. Endovascular stent grafting is a minimally invasive and effective treatment, achieving both pseudoaneurysm exclusion and entry closure.