腹腔動脈分枝バイパスを追加し救命しえた腹部臓器灌流障害を合併したStanford A型急性大動脈解離の1例

Celiac Artery Bypass Grafting from the Ascending Aorta Following Aortic Repair for Treatment of Stanford Type A Acute Aortic Dissection Complicated by Abdominal Malperfusion：Report of a Case

はじめに　臓器灌流障害（malperfusion）を合併したStanford A型急性大動脈解離の治療成績はいまだに不良であり，central repairとともに臓器灌流障害に対する治療戦略が重要である．われわれは，腹部臓器灌流障害を合併したStanford A型急性大動脈解離に対し，central repairに引き続き腹腔動脈（CA）分枝バイパス術を一期的に行い，救命しえた1例を経験したので報告する．

A 73-year-old woman presented with sudden chest and back pain. Computed tomography （CT） revealed Stanford type A acute aortic dissection complicated by occlusion of the celiac artery and stenosis of the superior mesenteric artery. Because there was no clear sign of critical abdominal organ ischemia before surgery, central repair was performed first. Then, after cardiopulmonary bypass, laparotomy was performed to check the blood flow in the abdominal organs. Malperfusion of the celiac artery remained. We therefore made an ascending aorta-common hepatic artery bypass using a great saphenous vein graft. Postoperatively, the patient was saved from irreversible abdominal malperfusion, however, her condition was complicated by paraparesis due to spinal cord ischemia. After a long period of rehabilitation, she was transferred to another hospital for rehabilitation. She is currently doing well at 15 months after treatment.