胸部大動脈瘤破裂に対する緊急オープンステントグラフトの1例

Successful Emergent Open Stent Grafting for a Ruptured Aortic Arch Aneurysm：Report of a Case

はじめに　大動脈破裂による致死率はきわめて高く，胸部大動脈瘤破裂の救命率は低い．胸部大動脈瘤破裂例は突然死の原因となり，手術に到達する患者はまれで，術前状態自体がきわめて不良である．したがって耐術例も少なく，また術後の重篤な合併症により在院死亡する症例が多くなると考えられる．われわれは意識消失した胸部大動脈瘤破裂例に対してホプンステントグラフト（OSG）を施行し，良好な結果を得たので報告する．

The classical surgical procedure ruptured thoracic aortic aneurysm is associated with mortality rates of up to 50％ and prolonged intensive care hospitalization. We present an emergent case of procedure of open stent grafting. A 80-year-old man was brought to the emergency department in our hospital with loss of consciousness. Chest computed tomography （CT） revealed a saccular-shaped aortic aneurysm in the aortic arch with diameter of 56 mm. The chest was opened via midsternotomy. After a circulatory arrest was induced at 30 ℃ with cerebral perfusion, the anterior surface of the arch was incised in a hemi-circumferencial mannar at the level of left subclavian artery. The stent graft was inserted into the aortic arch and was deployed. The proximal side of the graft was then trimmed, and the posterior aortic wall and the graft were continuously anastomosis, the aortic incision and anterior side of the graft were continuously closed. The patient’s postoperative course was uneventful and he was discharged on postoperative day 14. An open stent grafting via an aortotomy was useful in the surgery for a ruptured aortic arch aneurysm.