下肢虚血を合併した逆行性Stanford A型急性大動脈解離に対する胸部ステントグラフト内挿術の1例

Thoracic Endovascular Aortic Repair for Retrograde Stanford Type A Acute Aortic Dissection Complicated by Lower Limb Iischemia：Report of a Case

おわりに　本例のような逆行性Stanford A型急性大動脈解離に合併した下肢虚血に対して，偽腔が血栓閉塞していて上行大動脈および偽腔の拡大を合併していなければ，TEVARは治療の選択肢となる可能性があると考えられた．

A 71-year-old male patient has been receiving medication for hypertension. He awoke with thoracic back pain and called an ambulance. He complained of chest-back pain and numbness in his lower limbs when he visited our hospital. A contrast-enhanced computed tomography （CT） scan revealed a retrograde Stanford type A acute aortic dissection with an entry tear in the distal arch of the aorta. The true lumen was highly stenosed from the distal arch aorta to the abdominal aorta, and lower limb malperfusion was observed. Emergency cardiopulmonary surgery could not be performed on this day because of our operating room’s system；thus, we performed zone 3 thoracic endovascular aortic repair to relieve the lower limb ischemia. The patient was discharged home on postoperative day 18 without stent graft-induced new entry or retrograde type A dissection.