大動脈解離術後早期に上腸間膜動脈解離および腸管虚血をきたした1例

Superior Mesenteric Artery Dissection and Mesenteric Ischemia Early After Surgery for Acute Stanford Type A Aortic Dissection：Report of a Case

はじめに　Stanford A型急性大動脈解離（AAD）に対する外科治療の第一の目的は救命である．したがって術式選択は，術前状態や内膜の亀裂（エントリー）の位置，解離の進展度などから適切に判断する必要がある．われわれは上行大動脈および弓部大動脈にエントリーを有するAAD患者に対して，術前ショック状態であったことから上行置換術を施行し，手術から1週間後に上腸間膜動脈（SMA）解離および腸管虚血をきたした症例を経験したので報告する．

A 78-year-old man was admitted to the emergency department with an acute neurological complication and shock. Echography revealed massive pericardial effusion and a flap in the ascending aorta which suggested acute Stanford type A aortic dissection （AAD）, requiring an emergency surgery. Intraoperatively, we found the entry in his ascending aorta and arch. Considering his poor preoperative condition, an ascending aorta replacement was performed. His postoperative course was uneventful. Computed tomography （CT） performed on the seventh day after surgery revealed that there was an entry left in the arch and false lumen from the descending to terminal aorta was patent without any malperfusion. However, several hours later, he complained of sudden abdominal pain. CT demonstrated superior mesenteric artery （SMA） dissection and mesenteric necrosis. Therefore, he underwent iliac artery-SMA bypass and bowel resection. For AAD, an appropriate surgical procedure must be selected on a patient basis, and meticulous postoperative management is required.