全弓部置換術後に生じた中枢側吻合部仮性動脈瘤による腕頭動脈グラフト閉塞

Brachiocephalic Artery Graft Occlusion Caused by Compression from a Pseudoaneurysm at the Proximal Anastomosis After Total Arch Replacement

上行大動脈に発生する仮性動脈瘤は致死的な病態であるが，無症状なことが多く，有症状でも胸痛や拍動性腫瘤の触知，嚥下障害など非特異的な症状を呈する1）．われわれは全弓部置換術後に，脳梗塞症状を契機に診断された上行大動脈仮性瘤の症例を経験したので報告する．

A 75-year-old man, who had undergone total arch replacement for a thoracic aortic aneurysm 4 years earlier, presented with transient left hemiplegia and right upper extremity weakness. Contrast-enhanced computed tomography （CT） revealed a large pseudoaneurysm at the proximal anastomosis of the ascending aortic graft, compressing and occluding the brachiocephalic graft. Surgical resection of the pseudoaneurysm and ascending aortic graft replacement with a 1-branched graft were performed. Cardiopulmonary bypass was established via peripheral vessels prior to re-median sternotomy. Thrombi were removed from the brachiocephalic graft, followed by replacement of the ascending aorta with a branched artificial graft for the brachiocephalic artery. The patient was discharged without complications. We report a rare case of transient hemiplegia due to brachiocephalic graft compression by a pseudoaneurysm.