Stanford A型急性大動脈解離術後の血胸に対する気管支動脈コイル塞栓術と胸腔鏡補助下止血術

Treatment of Hemothorax with Bronchial Artery Embolization Combined with Video-assisted Thoracic Surgery Following Hemi-arch Replacement for Stanford Type A Acute Aortic Dissection

心臓手術後に血胸となる症例は非常にまれで，また，心臓手術後に気管支動脈から出血して血胸となった報告例はない．われわれは， Stanford A型急性大動脈解離術後に気管支動脈からの肺出血を合併し，コイル塞栓術と胸腔鏡補助下止血術の併用が有効であった1例を経験したので，文献的考察を加えて報告する．

A 51-year-old male arrived at our hospital by ambulance, presenting with a sudden onset of chest pain. Computed tomography （CT） revealed Stanford type A acute aortic dissection. Although emergency hemi-arch replacement was successfully performed, the blood pressure decreased and anemia acutely progressed. As chest X-ray revealed right lung opacity, a chest drain was inserted and 3,000 ml of bloody effusion was drawn over a period of 2 hours. Enhanced CT revealed hemothorax and extravasation of the right lung. Since the preoperative CT showed an abnormally dilated right bronchial artery, the branch vessels of the bronchial artery were considered to be the source of hemorrhage. Bronchial artery coil embolization was first performed, which decreased the bronchial artery flow, stabilizing the hemodynamics. Video-assisted thoracic surgery （VATS） was then performed, and the bleeding site at the surface of the lung was electrocauterized. Finally, the hemorrhage was controlled. This case suggests that the combination of coil embolization and VATS is an effective procedure.