右鎖骨下動脈起始異常にKommerell憩室を伴うStanford A型大動脈解離に対してfenestrated Frozen Elephant Trunk法による全弓部置換術を施行した1例
症例は45歳，男性．既往．左下肢痛と左下肢不全麻痺を認めたため前医を受診した．CTで右鎖骨下動脈起始異常にKommerell憩室を伴うStanford A型大動脈解離および左総腸骨動脈の真腔狭小化を認め，下肢症状を伴っていたため当院へ搬送され緊急手術となった．手術はfenestrated Frozen Elephant Trunk法による全弓部置換術と経皮的右鎖骨下動脈塞栓術による二期的手術とした．胸骨正中切開，右総大腿動脈および左腋窩動脈から送血し，右房脱血にて人工心肺を確立した．超低体温循環停止法，順行性選択的脳灌流法を用いた．Entryは遠位弓部大動脈に認めた．弓部大動脈は左総頸動脈と左...
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| Published in | 日本心臓血管外科学会雑誌 Vol. 54; no. 2; pp. 82 - 86 |
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| Main Authors | , , , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
特定非営利活動法人 日本心臓血管外科学会
15.03.2025
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0285-1474 1883-4108 |
| DOI | 10.4326/jjcvs.54.82 |
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| Abstract | 症例は45歳，男性．既往．左下肢痛と左下肢不全麻痺を認めたため前医を受診した．CTで右鎖骨下動脈起始異常にKommerell憩室を伴うStanford A型大動脈解離および左総腸骨動脈の真腔狭小化を認め，下肢症状を伴っていたため当院へ搬送され緊急手術となった．手術はfenestrated Frozen Elephant Trunk法による全弓部置換術と経皮的右鎖骨下動脈塞栓術による二期的手術とした．胸骨正中切開，右総大腿動脈および左腋窩動脈から送血し，右房脱血にて人工心肺を確立した．超低体温循環停止法，順行性選択的脳灌流法を用いた．Entryは遠位弓部大動脈に認めた．弓部大動脈は左総頸動脈と左鎖骨下動脈の間で離断した．Open Stent Graftを挿入し憩室化した右鎖骨下動脈起始部を閉鎖した．左鎖骨下動脈はfenestration法にて再建した．4分枝人工血管を使用し上行弓部大動脈と左右総頸動脈を再建した．右鎖骨下動脈は右胸腔を経路として再建した．二期目として術翌日に経皮的に右鎖骨下動脈起始部の塞栓術を施行した．術後CTではKommerell憩室への血流は消失しており，開窓部からのエンドリークも認めなかった．術後経過は良好であった．右鎖骨下動脈起始異常にKommerell憩室を伴うStanford A型大動脈解離に対してfenestrated Frozen Elephant Trunk法による全弓部置換術を施行した1例を経験したため，文献的考察を加えて報告する． |
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| AbstractList | 症例は45歳，男性．既往．左下肢痛と左下肢不全麻痺を認めたため前医を受診した．CTで右鎖骨下動脈起始異常にKommerell憩室を伴うStanford A型大動脈解離および左総腸骨動脈の真腔狭小化を認め，下肢症状を伴っていたため当院へ搬送され緊急手術となった．手術はfenestrated Frozen Elephant Trunk法による全弓部置換術と経皮的右鎖骨下動脈塞栓術による二期的手術とした．胸骨正中切開，右総大腿動脈および左腋窩動脈から送血し，右房脱血にて人工心肺を確立した．超低体温循環停止法，順行性選択的脳灌流法を用いた．Entryは遠位弓部大動脈に認めた．弓部大動脈は左総頸動脈と左鎖骨下動脈の間で離断した．Open Stent Graftを挿入し憩室化した右鎖骨下動脈起始部を閉鎖した．左鎖骨下動脈はfenestration法にて再建した．4分枝人工血管を使用し上行弓部大動脈と左右総頸動脈を再建した．右鎖骨下動脈は右胸腔を経路として再建した．二期目として術翌日に経皮的に右鎖骨下動脈起始部の塞栓術を施行した．術後CTではKommerell憩室への血流は消失しており，開窓部からのエンドリークも認めなかった．術後経過は良好であった．右鎖骨下動脈起始異常にKommerell憩室を伴うStanford A型大動脈解離に対してfenestrated Frozen Elephant Trunk法による全弓部置換術を施行した1例を経験したため，文献的考察を加えて報告する． |
| Author | 池端, 幸起 志水, 秀行 福田, 宏嗣 赤熊, 悠生 和賀, 正義 古泉, 潔 大橋, 裕恭 金山, 拓亮 |
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| References | 6) Azuma S, Morita M, Mano S et al. Efficacy of in situ fenestrated open stent technique (Fene OS) for the surgery of acute aortic dissection Type a surgery. Jpn J Cardiovasc Surg 2020; 49: 52-7. 12) Kim KM, Cambria RP, Isselbacher EM et al. Contemporary surgical approaches and outcomes in adults with Kommerell diverticulum. Ann Thorac Surg 2014; 98: 1347-54. 17) Tanaka Y, Kitamura T, Horai T et al. Two-stage operation for Stanford type A acute aortic dissection originating from Kommerell's diverticulum. Interact Cardiovasc Thorac Surg 2016; 22: 695-7. 5) Matsuzaki Y, Yamasaki T, Hohri Y et al. Surgical strategies for Type B aortic dissection by Frozen Elephant Trunk. J Jpn Coll Angiol 2018; 58: 151-7. 16) Fan W, Tan J, Shi W et al. A systematic review of total thoracic endovascular aortic repair in treatment of Kommerell Diverticulum combined with right-sided aortic arch. Med Sci Monit 2021; 27: e930031. 9) Hoffman A, Damberg ALM, Schälte G et al. Thoracic stent graft sizing for frozen elephant trunk repair in acute type A dissection. J Thorac Cardiovasc Surg 2013; 145: 964-9. 10) Czerny M, Eggebrecht H, Rousseau H et al. Distal stent graft-induced new entry after TEVAR or FET: insights into a new disease from EuREC. Ann Thorac Surg 2020; 110: 1494-500. 2) Nicholas TK, Paolo M. Aberrant subclavian artery and Kommerell aneurysm: surgical treatment with a standard approach. J Thorac Cardiovasc Surg 2007; 133: 888-92. 15) Ota T, Okada K, Takanashi, S et al. Surgical treatment for Kommerell's diverticulum. J Thorac Cardiovasc Surg 2006; 131: 574-8. 11) Tanaka A, Milner R, Ota T. Kommerell's diverticulum in the current era: a comprehensive review. Gen Thorac Cardiovasc Surg 2015; 63: 245-59. 1) Molz G, Burri B. Aberrant subclavian artery (arteria lusoria): sex differences in the prevalence of various forms of the malformation. Evaluation of 1378 observations. Virchows Arch A Pathol Anat Histol 1978; 380: 303-15. 8) Azuma S, Shimada R, Motohashi Y et al. Postoperative results of the in situ fenestrated open stent technique for acute aortic dissection type A. Gen Thorac Cardiovasc Surg 2023; 71: 331-8. 14) Cina CS, Althani H, Pasenau J et al. Kommerell's diverticulum and right-sided aortic arch: a cohort study and review of the literature. J Vasc Surg 2004; 39: 131-9. 18) Akiyoshi T, Inoue M, Tamura T et al. Efficacy of the Amplatzer vascular plug in a patient undergoing EVAR for ruptured aortoiliac aneurysm. Jpn J Cardiovasc Surg 2014; 43: 351-6. 19) Goto S, Mitsuoka H, Nakai M et al. Open stent grafting for aortic arch aneurysm with an aberrant right subclavian artery. Jpn J Cardiovasc Surg 2022; 51: 359-62. 7) Okamura H, Kitada Y, Miyagawa A et al. Clinical outcomes of a fenestrated frozen elephant trunk technique for acute type A aortic dissection. Eur J Cardiothorac Surg 2021; 59: 765-72. 3) Maekawa A, Takami Y, Yamana K et al. Two-staged surgical treatment for Kommerell diverticulum with a right aortic arch and an aberrant left subclavian artery. Gen Thorac Cardiovasc Surg 2022; 70: 83-6. 4) Kato M. Frozen elephant trunk for aortic arch repair. Jpn J Vasc Surg 2017; 26: 259-63. 13) Chai HC, Chia HL, Chi RH. Aneurysm of an aberrant right subclavian artery: treatment with thoracic aortic stent graft. Ann Thorac Surg 2010; 89: 1289-91. |
| References_xml | – reference: 6) Azuma S, Morita M, Mano S et al. Efficacy of in situ fenestrated open stent technique (Fene OS) for the surgery of acute aortic dissection Type a surgery. Jpn J Cardiovasc Surg 2020; 49: 52-7. – reference: 11) Tanaka A, Milner R, Ota T. Kommerell's diverticulum in the current era: a comprehensive review. Gen Thorac Cardiovasc Surg 2015; 63: 245-59. – reference: 15) Ota T, Okada K, Takanashi, S et al. Surgical treatment for Kommerell's diverticulum. J Thorac Cardiovasc Surg 2006; 131: 574-8. – reference: 7) Okamura H, Kitada Y, Miyagawa A et al. Clinical outcomes of a fenestrated frozen elephant trunk technique for acute type A aortic dissection. Eur J Cardiothorac Surg 2021; 59: 765-72. – reference: 1) Molz G, Burri B. Aberrant subclavian artery (arteria lusoria): sex differences in the prevalence of various forms of the malformation. Evaluation of 1378 observations. Virchows Arch A Pathol Anat Histol 1978; 380: 303-15. – reference: 13) Chai HC, Chia HL, Chi RH. Aneurysm of an aberrant right subclavian artery: treatment with thoracic aortic stent graft. Ann Thorac Surg 2010; 89: 1289-91. – reference: 14) Cina CS, Althani H, Pasenau J et al. Kommerell's diverticulum and right-sided aortic arch: a cohort study and review of the literature. J Vasc Surg 2004; 39: 131-9. – reference: 18) Akiyoshi T, Inoue M, Tamura T et al. Efficacy of the Amplatzer vascular plug in a patient undergoing EVAR for ruptured aortoiliac aneurysm. Jpn J Cardiovasc Surg 2014; 43: 351-6. – reference: 9) Hoffman A, Damberg ALM, Schälte G et al. Thoracic stent graft sizing for frozen elephant trunk repair in acute type A dissection. J Thorac Cardiovasc Surg 2013; 145: 964-9. – reference: 12) Kim KM, Cambria RP, Isselbacher EM et al. Contemporary surgical approaches and outcomes in adults with Kommerell diverticulum. Ann Thorac Surg 2014; 98: 1347-54. – reference: 2) Nicholas TK, Paolo M. Aberrant subclavian artery and Kommerell aneurysm: surgical treatment with a standard approach. J Thorac Cardiovasc Surg 2007; 133: 888-92. – reference: 17) Tanaka Y, Kitamura T, Horai T et al. Two-stage operation for Stanford type A acute aortic dissection originating from Kommerell's diverticulum. Interact Cardiovasc Thorac Surg 2016; 22: 695-7. – reference: 16) Fan W, Tan J, Shi W et al. A systematic review of total thoracic endovascular aortic repair in treatment of Kommerell Diverticulum combined with right-sided aortic arch. Med Sci Monit 2021; 27: e930031. – reference: 5) Matsuzaki Y, Yamasaki T, Hohri Y et al. Surgical strategies for Type B aortic dissection by Frozen Elephant Trunk. J Jpn Coll Angiol 2018; 58: 151-7. – reference: 4) Kato M. Frozen elephant trunk for aortic arch repair. Jpn J Vasc Surg 2017; 26: 259-63. – reference: 10) Czerny M, Eggebrecht H, Rousseau H et al. Distal stent graft-induced new entry after TEVAR or FET: insights into a new disease from EuREC. Ann Thorac Surg 2020; 110: 1494-500. – reference: 19) Goto S, Mitsuoka H, Nakai M et al. Open stent grafting for aortic arch aneurysm with an aberrant right subclavian artery. Jpn J Cardiovasc Surg 2022; 51: 359-62. – reference: 3) Maekawa A, Takami Y, Yamana K et al. Two-staged surgical treatment for Kommerell diverticulum with a right aortic arch and an aberrant left subclavian artery. Gen Thorac Cardiovasc Surg 2022; 70: 83-6. – reference: 8) Azuma S, Shimada R, Motohashi Y et al. Postoperative results of the in situ fenestrated open stent technique for acute aortic dissection type A. Gen Thorac Cardiovasc Surg 2023; 71: 331-8. |
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| Snippet | 症例は45歳，男性．既往．左下肢痛と左下肢不全麻痺を認めたため前医を受診した．CTで右鎖骨下動脈起始異常にKommerell憩室を伴うStanford A型大動脈解離および左総腸骨動... |
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| SubjectTerms | fenestrated Frozen Elephant Trunk法 Kommerell憩室 右鎖骨下動脈起始異常 急性大動脈解離 |
| Title | 右鎖骨下動脈起始異常にKommerell憩室を伴うStanford A型大動脈解離に対してfenestrated Frozen Elephant Trunk法による全弓部置換術を施行した1例 |
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