弓部大動脈ステントグラフト内挿術後のガターエンドリークに対する左総頸動脈断端からの塞栓術

Embolization Using a Debranched Left Common Carotid Artery Stump for Gutter Endoleak After Thoracic Endovascular Aortic Repair with the Double-debranching and Chimney Technique

胸部ステントグラフト内挿術（TEVAR）の増加に伴い，頸部分枝のデブランチやチムニー法の併用が必要となる複雑な症例が出てくるが，チムニー法の場合はエンドリーク，とりわけガターエンドリークが問題であり，治療に難渋することもある1）．当院でもチムニー併用TEVAR後のガターエンドリークを経験したが，デブランチした左総頸動脈の断端を利用し，比較的簡易なアプローチでのコイル塞栓に成功したので報告する．

An 88-year-old male underwent thoracic endovascular aortic repair （TEVAR） with the double-debranching and chimney technique for arch aortic aneurysm. When the aforementioned procedure was performed, the left common carotid artery was closed and transected, and the left subclavian artery was embolized and bypassed, respectively. However, postoperatively, the gutter endoleak persisted, and the aneurysm enlarged；therefore, requiring additional surgery. A skin incision was made on the left side of the neck, and the closed and dissected left common carotid artery stump was detected. A sheath was placed at the stump and an angiographic catheter and guidewire were used to retrograde cannulate the gutter beside the chimney graft, and coil embolization was performed. No endoleak was observed at postoperatively and 6-month follow up computed tomography （CT）. We believe that embolization from a deblanched left common carotid artery stump is useful for endoleaks after TEVAR employing the chimney and debranching technique.