Stanford A型急性大動脈解離に腹部大動脈瘤破裂を合併し同時手術を施行した1例

Concurrent Operations for Stanford Type A Acute Aortic Dissection and Ruptured Abdominal Aortic Aneurysm：Report of a Case

はじめに　急性大動脈解離と真性大動脈瘤破裂の合併はきわめてまれである1～3）．Stanford A型急性大動脈解離に腹部大動脈瘤破裂を合併した症例に同時手術を施行したので，文献的考察を加えて報告する．

A 70-year-old man presented to the previous hospital with lower abdominal pain that began three days earlier, subsequently showed cold sweats the day after, and back pain on the day of admission. He was diagnosed with acute aortic dissection （Stanford type A） and ruptured abdominal aortic aneurysm and urgently transferred to our hospital. Contrast-enhanced computed tomography （CT） revealed a dissection extending from the ascending aorta to the abdominal aortic aneurysm. A large retroperitoneal hematoma was present around the abdominal aorta and left external iliac artery （Fitzgerald typeⅢ）. No findings suggestive of organ ischemia were observed. Emergency abdominal aortic graft replacement was performed for ruptured aneurysm first, followed by ascending aortic graft replacement. Concomitant acute Stanford type A aortic dissection and ruptured abdominal aortic aneurysm is extremely rare. We report this case along with a review of the relevant literature.