Shaggy aortaを伴う広範な胸部大動脈瘤に対してカラー付きグラフトを用いた二期的ハイブリッド治療を行った1例

Staged Hybrid Repair with Branched Collared Graft for Extensive Thoracic Aortic Aneurysm and Shaggy Aorta：Report of a Case

はじめに　Shaggy aortaに対する外科的治療，血管内治療は周術期の塞栓症リスクが高く，その病態に応じて合併症を回避するためさまざまな試みが行われている．われわれはshaggy aortaを伴う上行大動脈～下行大動脈の広範な胸部大動脈瘤切迫破裂症例に対して，一期目にカラー付き4分枝グラフトを使用した上行弓部置換，elephant trunk（CET）留置後，二期的に胸部ステントグラフト内挿術（TEVAR）を施行し安全に手術を施行できたため報告する．

The patient, a 64-year-old woman, presented with chest and back pain. A computed tomography （CT） scan revealed extensive dilatation of the entire thoracic aorta, along with a shaggy lesion and significant mural thrombus. A two-stage hybrid surgical approach was undertaken. In the first stage, ascending and total arch aortic replacement was performed using a four-branched collared graft （Gelweave ET）, along with the placement of a conventional elephant trunk （CET）. The second stage, thoracic endovascular aortic repair （TEVAR）, was successfully performed on postoperative day eight. No major postoperative complications were observed. This staged approach, combining total arch replacement with CET placement via median sternotomy followed by TEVAR, provided a less invasive and safer alternative, particularly in minimizing the risk of cerebral infarction.