ダブルバレル吻合による下行置換後の胸腹部大動脈瘤破裂に対する手術の工夫

Surgical Treatment for Ruptured Thoracoabdominal Aneurysm Following Descending Aortic Replacement with Double Barrel Anastomosis

胸腹部大動脈瘤破裂に対する血行再建術は侵襲が大きく，周術期死亡率も高い．われわれは，ダブルバレル吻合による下行置換後の解離性胸腹部大動脈瘤破裂に対して，胸部ステントグラフト内挿術（TEVAR）で偽腔血流を制御してから胸腹部大動脈人工血管置換を施行した1例を経験したので報告する．

A 75-year-old woman was diagnosed with type B acute aortic dissection 14 years ago and 3-channeled aortic dissection 7 years ago. She received total arch replacement 6 years ago and descending aortic replacement with double barrel anastomosis technique for distal anastomosis 5 years ago. Computed tomography （CT） revealed giant thyroid tumor and thoracoabdominal aortic aneurysm （58 mm in diameter）. She suffered from back pain during her follow-up period. CT revealed ruptured thoracoabdominal aortic aneurysm. First, the false lumen of descending aorta was closed by thoracic endovascular aortic repair, and then thoracoabdominal aortic replacement was performed uneventfully.