弓部大動脈半周切開下オープンステントグラフト内挿術で治療した遠位弓部大動脈瘤破裂の1例

Frozen Elephant Trunk Technique with Semi-circumferential Aortic Arch Incision for Distal Arch Aortic Aneurism Rupture：Report of a Case

はじめに　オープンステントグラフト法の出現により，遠位弓部大動脈瘤に対して瘤の末梢深くでの人工血管吻合を避けることができるようになり，同部位の手術の安全性が増している．その際，中枢側の上行・弓部大動脈に病変がなくともオープンステントグラフトの中枢側を4分枝人工血管に置換する方法が一般的である．われわれは遠位弓部大動脈瘤の破裂に対して弓部大動脈を半周切開し，同部位よりオープンステントグラフトを挿入・縫合固定した後に大動脈を閉鎖することで良好な結果を得た症例を経験したので報告する．

An 82-year-old man was admitted to our hospital with chest pain as a chief complaint and diagnosed with a ruptured aortic aneurysm in the distal arch by contrast-enhanced computed tomography （CT）. The patient underwent surgery using artificial heart-lung and selective cerebral extracorporeal circulation, and a semi-circumferential aortic arch incision was made around the anterior surface of the aortic arch. An open stent graft was inserted through the incision, trimmed to fit the size, and the aortic wall and the stent graft were fixed with 3-0 proline continuous sutures, and finally the incision was closed with 3-0 proline. This method was useful because it may shorten the operation time and decrease the amount of blood loss compared to the common aortic arch replacement with frozen elephant trunk.