切除不能局所進行食道癌の動脈浸潤に伴う仮性動脈瘤に対し胸部ステントグラフト内挿術を施行した2例

Thoracic Aortic Stent-graft Treatment for Pseudoaneurysm in Advanced Esophageal Cancer：Report of Two Cases

はじめに　切除不能局所進行食道癌に対して化学放射線療法が推奨されている1，2）が，穿孔・穿通，腫瘍の浸潤・自壊に伴う仮性動脈瘤など腫瘍の進展・治療経過に伴う致死的合併症をきたすことがある．われわれは食道癌の動脈浸潤に伴う仮性動脈瘤に対し胸部ステントグラフト内挿術（TEVAR）を施行した2例を経験したので，文献的考察を加えて報告する．

Aortic pseudoaneurysm is a rare complication of advanced esophageal cancer. While emergency open aortic surgery is associated with high operative mortality, massive bleeding without treatment is fatal. On the other hand, thoracic endovascular aortic repair （TEVAR） for pseudoaneurysm is far less invasive. We experienced two cases of aortic pseudoaneurysm successfully treated by TEVAR. Case 1：68-year-old male. During preoperative adjuvant chemotherapy for advanced esophageal cancer, he was diagnosed with esophageal non-aortic fistula by computed tomography （CT）. Case 2：80-year-old woman. She complained dysphagia, and CT revealed an aortic pseudoaneurysm associated with mediastinal perforation of advanced esophageal cancer and direct invasion to the descending aorta. Considering their general condition, they underwent minimally invasive TEVAR. Clinical condition dramatically improved and they become able to eat well, and they were transferred to the hospice until they died of cachexia due to progression of esophageal cancer.