胸腹部大動脈瘤および弓部大動脈瘤に対して二期的に行ったステントグラフト治療

Staged Endovascular Aortic Repair for Thoracoabdominal and Aortic Arch Aneurysms

近年，大動脈瘤に対するステントグラフト内挿術は標準治療の一つとなっている．しかし腹部大動脈分枝や弓部大動脈分枝にまたがる大動脈瘤のステントグラフト治療は複雑になり，外科的分枝再建を必要とすることも多い．これらの問題を解決すべく，最近では既成のステントグラフトデバイスに対して術者が独自に開窓を施したステントグラフト（physician modified endografts：PMEGs）を用いて小口径ステントグラフトを開窓部から留置するステントグラフト治療（fenestrated and branched endovascular aortic repair：FB-EVAR）の有用性が報告されている．われわれは胸腹部大動脈瘤および弓部大動脈瘤を有する患者に対してPMEGsを用いたFB-EVARを施行し，良好な結果を得たので報告する．

In recent years, endovascular aortic repair has become one of the standard treatments for aortic aneurysms. However, when the aneurysm involves the branches of the abdominal aorta or the aortic arch, the procedure becomes more complex and often necessitates surgical reconstruction of the involved branches. To address these challenges, the use of physician-modified endografts in which fenestrations are manually created by physicians has been reported. This approach, known as fenestrated and branched endovascular aortic repair, involves the placement of small-diameter bridging stent grafts through the fenestrations, and its utility has recently been highlighted. Herein, we report a case of successful fenestrated and branched endovascular aortic repair using physician-modified endografts in a patient with both thoracoabdominal and aortic arch aneurysms.