遠位弓部大動脈小彎側に認めたdistal stent graft-induced new entryの1例

Distal Stent Graft-induced New Entry on the Lesser Curvature of Distal Aortic Arch：Report of a Case

はじめに　胸部大動脈疾患に対するfrozen elephant trunk（FET）法を用いた全弓部置換術術後のdistal stent graft-induced new entry（dSINE）は術後中期までに12.7〜28.5％1～4）にみられるとされ，重篤な合併症の一つである．FROZENIX（JGOSG，日本ライフライン社）はその構造の特性上，弓部下行大動脈の大彎側にdSINEを認めることが多く，小彎側に発症することは比較的まれである．われわれは術後2年7ヵ月に小彎側にdSINEを認めた症例を経験したため，発症機序に関して文献的考察を加え報告する．

A 62-year-old male was admitted for cerebral hemorrhage, enhanced computed tomography （CT） revealed a dissecting thoracic aortic aneurysm in the distal arch. Following cerebral hemorrhage treatment, the patient was referred to our department and underwent a total arch replacement using the frozen elephant trunk （FET） technique. The patient was followed up regularly post operatively at our hospital. Enhanced CT at 31 months post surgery revealed a distal stent graft-induced new entry （dSINE） on the lesser curvature of the distal arch. Additional thoracic endovascular aortic repair （TEVAR） was performed. Although dSINE can be caused by various factors, it is usually seen on the greater curvature of the aorta and is relatively rare on the lesser curvature, as in this case in Japan. We will discuss the mechanisms underlying the development of dSINE on the lesser curvature with reference to the literature.