胸膜を使用した断端形成法により救命しえた破裂性急性大動脈解離

Distal Anastomosis with Pleural Flap Wrap for Ruptured Acute Aortic Dissection

破裂性急性大動脈解離（RAAD）は致死的な病態であり，緊急手術を要する．大動脈の断端形成法としてさまざまな術式による良好な成績が報告されているが，われわれは，RAADの破裂した偽腔外膜に対する末梢側断端形成法として胸膜を使用した断端形成法を施行し，救命した症例を経験した．

A 69-year-old woman developed back pain was brought to our hospital. She was diagnosed with acute Stanford type B aortic dissection, and had a history of ascending aortic replacement for acute Stanford type A aortic dissection at another hospital 10 years before. In three days after admission, enhanced computer tomography （CT） revealed ruptured aortic dissection at the distal arch. Total aortic arch replacement was performed using the frozen elephant trunk technique. The Dacron polyester fabric prosthesis and aorta were anastomosed using the modified turn-up method at the distal anastomosis. Due to the fragility of the oesophageal side, the pleural flap was detached with the surrounding fatty tissue and transection was performed from the elephant trunk to the intima, adventitia, pleural flap, and felt strip. The use of an autologous pleural flap is a simple and effective method for controlling bleeding in a ruptured aortic dissection and for the distal anastomosis of fragile adventitia.