腕頭動脈・総頸動脈共通幹を伴う胸部大動脈瘤に対する自作開窓型オープンステント法の1例

In Situ Fenestrated Open Stent Technique for Thoracic Aortic Aneurysm With Bovine Arch：Report of a Case

はじめに　大動脈疾患において，胸部ステントグラフト内挿術（TEVAR）をはじめとする血管内治療の普及により，以前は治療困難とされた高齢者や耐術能の乏しい重症例に対しても治療が可能となった．一方で，大動脈瘤の解剖学的条件によっては血管内治療が困難な症例もあり，このような場合には開胸手術を選択せざるをえない．

In situ fenestrated open stent technique （FeneOS） is a less invasive adjunct to total arch replacement （TAR）. It spares complex left subclavian artery reconstruction by directly creating a fenestration in an open stent graft. We report a successful TAR using FeneOS for a 5-cm saccular thoracic aortic aneurysm in an 81-year-old man with a bovine arch configuration. Because of the patient’s advanced age and severe atherosclerosis, we selected FeneOS to minimize surgical invasiveness and embolic risk. The key structural advantage was preserving blood flow both in the brachiocephalic and the left common carotid arteries through a single large fenestration for bovine arch’s common orifice. This method simplified the procedure, reduced circulatory arrest time, and enabled a safe distal anastomosis at zone 0. The patient recovered without neurological complications and was discharged on postoperative day 15. FeneOS may represent a useful and flexible option during surgery for complex aortic arch pathologies.