虚血性腎障害を伴ったStanfordB型急性大動脈解離に対し，TEVARに末梢血管用ベアステントを併用した1例

症例は45歳，男性。他院より遠位弓部～腹部大動脈に及ぶ急性大動脈解離B型を認め，当院へ救急搬送された。腹部は偽腔が血栓化し，真腔狭窄により急性腎不全を発症していた。ステントグラフト挿入（TEVAR）を施行したが，真腔拡張は得られず，末梢血管用ベアステントを同部位に留置した。Entry閉鎖を行っても高度な真腔狭窄が残存したが，自己拡張型のベアステントを併用し，致命的な腎障害を回避することができた。...

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Published in脈管学 Vol. 60; no. 8; pp. 145 - 149
Main Authors 佐賀, 俊文, 堀, 優人, 御子柴, 晴樹, 浦田, 雅弘
Format Journal Article
LanguageJapanese
Published 日本脈管学会 10.08.2020
Subjects
malperfusion
TEVAR
type B aortic dissection
Online AccessGet full text
ISSN0387-1126
1880-8840
DOI10.7133/jca.20-00023

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Abstract 症例は45歳，男性。他院より遠位弓部～腹部大動脈に及ぶ急性大動脈解離B型を認め，当院へ救急搬送された。腹部は偽腔が血栓化し，真腔狭窄により急性腎不全を発症していた。ステントグラフト挿入（TEVAR）を施行したが，真腔拡張は得られず，末梢血管用ベアステントを同部位に留置した。Entry閉鎖を行っても高度な真腔狭窄が残存したが，自己拡張型のベアステントを併用し，致命的な腎障害を回避することができた。
AbstractList 症例は45歳，男性。他院より遠位弓部～腹部大動脈に及ぶ急性大動脈解離B型を認め，当院へ救急搬送された。腹部は偽腔が血栓化し，真腔狭窄により急性腎不全を発症していた。ステントグラフト挿入（TEVAR）を施行したが，真腔拡張は得られず，末梢血管用ベアステントを同部位に留置した。Entry閉鎖を行っても高度な真腔狭窄が残存したが，自己拡張型のベアステントを併用し，致命的な腎障害を回避することができた。
Author 浦田, 雅弘
佐賀, 俊文
堀, 優人
御子柴, 晴樹
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References 4) Kageyama S, Ohashi T, Tadakoshi M, et al: A case of esophagus rupture caused by acute type B dissection. J Vasc Surg 2015; 24: 818–821
10) Giribono AM, Ferrara D, Spalla F, et al: Endovascular treatment of spontaneous isolated abdominal aortic dissection. Acta Radiol Open 2016; 5: https://doi.org/10.1177/2058460116681042
1) Aiba M, Kawada T, Maruta K, et al: Surgical treatment for acute aortic dissection associated with end-organ malperfusion. Jpn J Vasc Surg 2003; 12: 581–586
8) Hughes GC, Andersen ND, McCann RL: Management of acute type B aortic dissection. J Thorac Cardiovasc Surg 2013; 145: S202–S207
5) Ozawa M, Uchida N, Shibamura H, et al: Strategy for acute type IIIb aortic dissection associated with abdominal-organ malperfusion. J Vasc Surg 2006; 15: 551–558
3) Yamashiro S, Arakaki R, Maeda T, et al: Management for treatment of type B aortic dissection. Jpn J Vasc Surg 2014; 23: 687–694
6) Cambria RP, Brewster DC, Gertler J, et al: Vascular complications associated with spontaneous aortic dissection. J Vasc Surg 1988; 7: 199–209
9) Ono M, Mizuno A, Komiyama N: Successful endovascular therapy for isolated abdominal aortic dissection involving bilateral common iliac arteries. Ann Vasc Dis 2019; 12: 99–102
2) Fattori R, Tsai TT, Myrmel T, et al: Complicated acute type B dissection: is surgery still the best option?: a report from the International Registry of Acute Aortic Dissection. JACC Cardiovasc Interv 2008; 1: 395–402
7) Williams DM, Lee DY, Hamilton BH, et al: The dissectied aorta: percutaneous treatment of ischemiccomplications-principles and results. J Vasc Interv Radiol 1997; 8: 605–625
References_xml – reference: 4) Kageyama S, Ohashi T, Tadakoshi M, et al: A case of esophagus rupture caused by acute type B dissection. J Vasc Surg 2015; 24: 818–821
– reference: 2) Fattori R, Tsai TT, Myrmel T, et al: Complicated acute type B dissection: is surgery still the best option?: a report from the International Registry of Acute Aortic Dissection. JACC Cardiovasc Interv 2008; 1: 395–402
– reference: 9) Ono M, Mizuno A, Komiyama N: Successful endovascular therapy for isolated abdominal aortic dissection involving bilateral common iliac arteries. Ann Vasc Dis 2019; 12: 99–102
– reference: 5) Ozawa M, Uchida N, Shibamura H, et al: Strategy for acute type IIIb aortic dissection associated with abdominal-organ malperfusion. J Vasc Surg 2006; 15: 551–558
– reference: 3) Yamashiro S, Arakaki R, Maeda T, et al: Management for treatment of type B aortic dissection. Jpn J Vasc Surg 2014; 23: 687–694
– reference: 7) Williams DM, Lee DY, Hamilton BH, et al: The dissectied aorta: percutaneous treatment of ischemiccomplications-principles and results. J Vasc Interv Radiol 1997; 8: 605–625
– reference: 1) Aiba M, Kawada T, Maruta K, et al: Surgical treatment for acute aortic dissection associated with end-organ malperfusion. Jpn J Vasc Surg 2003; 12: 581–586
– reference: 6) Cambria RP, Brewster DC, Gertler J, et al: Vascular complications associated with spontaneous aortic dissection. J Vasc Surg 1988; 7: 199–209
– reference: 8) Hughes GC, Andersen ND, McCann RL: Management of acute type B aortic dissection. J Thorac Cardiovasc Surg 2013; 145: S202–S207
– reference: 10) Giribono AM, Ferrara D, Spalla F, et al: Endovascular treatment of spontaneous isolated abdominal aortic dissection. Acta Radiol Open 2016; 5: https://doi.org/10.1177/2058460116681042
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Snippet 症例は45歳，男性。他院より遠位弓部～腹部大動脈に及ぶ急性大動脈解離B型を認め，当院へ救急搬送された。腹部は偽腔が血栓化し，真腔狭窄により急性腎不全を発...
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StartPage 145
SubjectTerms malperfusion
TEVAR
type B aortic dissection
Title 虚血性腎障害を伴ったStanfordB型急性大動脈解離に対し，TEVARに末梢血管用ベアステントを併用した1例
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