Frozen elephant trunk施行後脊髄障害を合併したStanford A型急性大動脈解離

Complicated with Spinal Cord Injury After Frozen Elephant Trunk Procedure for Stanford Type A Acute Aortic Dissection

Stanford A型急性大動脈解離（ATAAD）に対するfrozen elephant trunk（FET）併用全弓部置換術（TAR）は，偽腔血栓化およびremodelingを促進し長期成績向上に寄与するとの報告1）や，FET施行にあたりいまだ解決されていない脊髄障害（SCI）合併に関しても真性瘤に比しATAADでは少ないとの報告2）もなされている．一方，解離形態によってはSCI合併のリスクがあるとの報告3）もある．われわれはATAADに対しFET併用TAR術後にSCIを合併した2例を経験したので，若干の文献的考察も加え報告する．

We report two cases complicated with spinal cord injury after the frozen elephant trunk procedure for Stanford type A acute aortic dissection. The two patients experienced dissection from the ascending aorta to the iliac arteries, and posterior false lumens were seen from Th8 to L2 in both cases. After an emergent surgery, both patients showed paraplegia and underwent immediate spinal fluid drainage. Symptoms improved to paraparesis in both patients, who were subsequently transferred to rehabilitation hospital. If a posterior false lumen is present from Th8 to L2, an increased risk of complications by spinal cord injury following the frozen elephant trunk procedure should be considered.