胸骨ワイヤー抜去に起因した医原性人工血管損傷に伴う非吻合部人工血管仮性動脈瘤の1例

Non-anastomotic Pseudoaneurysm due to Sternal Wire Removal After Ascending Aorta Grafting：Report of a Case

はじめに　人工血管を用いた大血管手術の合併症としての仮性動脈瘤は，ほとんどが吻合部に限局するとされている1）．かつては人工血管の破綻などの報告も散見したが2），近年は人工血管の改良により非吻合部から発生する仮性動脈瘤はまれとされる．われわれは上行大動脈置換術後に，胸骨ワイヤーを抜去した際に起こったと思われる非吻合部仮性動脈瘤を経験したので報告する（本症例報告の掲載については患者本人よりインフォームド・コンセントを得ている）．

We report a rare case of a non-anastomotic pseudoaneurysm following ascending aortic replacement. A 73-year-old woman presented with anterior chest swelling after undergoing sternal wire removal due to suspected metal allergy. A pseudoaneurysm was identified on computed tomography （CT） at the site where the removed sternal wire had been in contact with the anterior surface of the vascular graft. Surgical repair with cardiopulmonary bypass identified a bleeding pinhole at the graft surface, successfully closed with a 4-0 monofilament mattress suture. This case suggests that prevention of such complications requires protective coverage of the graft with autologous tissue prior to chest closure, careful selection and handling of sternal wires, and thorough preoperative imaging evaluation before wire removal.