前外側部分胸骨切開が有用であった弓部大動脈瘤再手術

Anterolateral Partial Sternotomy as an Effective Approach for Open Repair After Debranching Thoracic Endovascular Aortic Repair in Aortic Arch Aneurysm

胸部大動脈ステントグラフト内挿術（thoracic endovascular aortic repair：TEVAR）は低侵襲治療として大動脈手術の一般的な選択肢の一つとなり1），それに伴い弓部分枝のデブランチを併施する症例も増加している．しかしながら，それらに特有の合併症を生じ，観血的手術修復が必要となる症例も散見される2，3）．それゆえ，疾患背景を含め，複雑な大動脈弓部病変に対する再手術では特にアプローチが重要となる．

Thoracic endovascular aortic repair （TEVAR） has become a common minimally invasive option for aortic surgery, often accompanied by debranching of the aortic arch branches. However, TEVAR-specific complications occasionally necessitate open repair. In such cases, especially in patients with complex aortic arch pathology, the choice of surgical approach is critical. In this case, considering the unique background of cold agglutinin disease, we opted for an anterolateral partial sternotomy approach. This approach provided excellent exposure for aortic manipulation and allowed preservation of the existing bypass grafts, contributing to a successful outcome. We believe that this technique can be effectively applied in similar complex cases requiring open repair after debranching TEVAR.