左椎骨動脈大動脈起始を伴うStanford A型急性大動脈解離に対するfenestrated frozen elephant trunkを用いた弓部置換

Aortic Arch Replacement Using Fenestrated Frozen Elephant Trunk Technique for Acute Type A Aortic Dissection with Isolated Left Vertebral Artery

左椎骨動脈大動脈起始（isolated left vertebral artery：ILVA）は人口の数％に認める破格で，Stanford A型急性大動脈解離（acute type A aortic dissection：ATAAD）との合併もまれに経験する．その際，弓部置換が必要な場合の左椎骨動脈（left vertebral artery：LVA）の処理方法に関して決まった見解はない．われわれはILVAを伴うATAADに対してfenestrated frozen elephant trunk（fenestrated FET）を用いた弓部置換を行い，良好な結果を得た症例を経験したので報告する．

We report a case of acute type A aortic dissection （ATAAD） with an isolated left vertebral artery （ILVA）, and our successful surgical treatment with a fenestrated frozen elephant trunk （FET）. A 56-year-old man was referred to our department for chest and back pain. Contrast enhanced computed tomography （CT） revealed ATAAD. The left vertebral artery branched directly from the aorta. We performed total arch replacement with fenestrated FET to preserve the ILVA and left subclavian artery （LSCA） blood flow. During surgery, the aorta was transected at zone 2, and FET was deployed into the distal aorta, then we manually created a hole on the ILVA and LSCA side in the stented portion. After surgery, angiography confirmed antegrade flow in the ILVA and LSCA. Although care must be taken with the location of the intimal tear, we advocate this technique for treating ATAAD with ILVA in suitable cases.