血栓閉塞型急性B型大動脈解離に併発した腹部大動脈瘤破裂に対して血管内治療を行った1例
症例は70歳の通院歴のない男性．20XX年X月X日の夜に嘔吐され，翌日，四肢の脱力感と腹痛を主訴に前医を受診された．腹部単純CT検査で腹部大動脈瘤破裂が疑われ当院へ救急搬送された．当院での造影CT検査で，血栓閉塞型のB型大動脈解離と腹部大動脈瘤破裂（ruptured abdominal aortic aneurysm; rAAA）と診断され同日緊急手術を行った．腹部大動脈瘤は最大短径で70 mm以上あり，腎動脈から腹部大動脈瘤までは40 mm以上あった．一方で，大動脈解離は腹部大動脈瘤まで進展していたが，血栓閉塞型であったので腹部大動脈内ステントグラフト内挿術（EVAR）を行った．ICU入室後...
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| Published in | 日本心臓血管外科学会雑誌 Vol. 53; no. 2; pp. 87 - 90 |
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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
15.03.2024
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0285-1474 1883-4108 |
| DOI | 10.4326/jjcvs.53.87 |
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| Abstract | 症例は70歳の通院歴のない男性．20XX年X月X日の夜に嘔吐され，翌日，四肢の脱力感と腹痛を主訴に前医を受診された．腹部単純CT検査で腹部大動脈瘤破裂が疑われ当院へ救急搬送された．当院での造影CT検査で，血栓閉塞型のB型大動脈解離と腹部大動脈瘤破裂（ruptured abdominal aortic aneurysm; rAAA）と診断され同日緊急手術を行った．腹部大動脈瘤は最大短径で70 mm以上あり，腎動脈から腹部大動脈瘤までは40 mm以上あった．一方で，大動脈解離は腹部大動脈瘤まで進展していたが，血栓閉塞型であったので腹部大動脈内ステントグラフト内挿術（EVAR）を行った．ICU入室後に膀胱内圧が23 mmHgと高値を示し，尿量も減少したため，abdominal compartment syndrome（ACS）と判断し緊急で開腹減圧術を施行した．第2病日には閉腹でき，第3病日に抜管できた．第8病日にICUを退室し，第38病日にリハビリ転院した．今回われわれは，血栓閉塞型急性B型大動脈解離に併発したrAAAの症例に対して救命できた症例を経験したので，文献的考察を加えて報告する． |
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| AbstractList | 症例は70歳の通院歴のない男性．20XX年X月X日の夜に嘔吐され，翌日，四肢の脱力感と腹痛を主訴に前医を受診された．腹部単純CT検査で腹部大動脈瘤破裂が疑われ当院へ救急搬送された．当院での造影CT検査で，血栓閉塞型のB型大動脈解離と腹部大動脈瘤破裂（ruptured abdominal aortic aneurysm; rAAA）と診断され同日緊急手術を行った．腹部大動脈瘤は最大短径で70 mm以上あり，腎動脈から腹部大動脈瘤までは40 mm以上あった．一方で，大動脈解離は腹部大動脈瘤まで進展していたが，血栓閉塞型であったので腹部大動脈内ステントグラフト内挿術（EVAR）を行った．ICU入室後に膀胱内圧が23 mmHgと高値を示し，尿量も減少したため，abdominal compartment syndrome（ACS）と判断し緊急で開腹減圧術を施行した．第2病日には閉腹でき，第3病日に抜管できた．第8病日にICUを退室し，第38病日にリハビリ転院した．今回われわれは，血栓閉塞型急性B型大動脈解離に併発したrAAAの症例に対して救命できた症例を経験したので，文献的考察を加えて報告する． |
| Author | 馬場, 啓徳 中村, 栄作 岩﨑, あや香 森, 晃佑 |
| Author_xml | – sequence: 1 fullname: 森, 晃佑 organization: 県立宮崎病院心臓血管外科 – sequence: 1 fullname: 岩﨑, あや香 organization: 県立宮崎病院心臓血管外科 – sequence: 1 fullname: 中村, 栄作 organization: 県立宮崎病院心臓血管外科 – sequence: 1 fullname: 馬場, 啓徳 organization: 県立宮崎病院心臓血管外科 |
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| References | 5) Nagata E, Sato Y, Takahashi K. A case of acute type B aortic dissection with visceral Malperfusion and impending rupture of abdominal aortic aneurysm. Jpn J Vasc Surg 2022; 31: 337-41. 9) Mizushima Y, Masunaga N, Yosikawa Y et al. A retrospective, multicenter study of clinical outcome after management of the open abdomen. JJAAM 2015; 26: 116-24. 2) Kuroda H, Honda T, Ashida Y et al. Aortic dissection associated with atherosclerotic aortic aneurysm. Jpn J Cardiovasc Surg 1995; 24: 1-5. 6) Tsukamoto S, Shindo S, Obana M et al. Aortic dissection complicated by atherosclerotic aneurysm. Jpn J Cardiovasc Surg 2003; 32: 201-5. 8) Kirkpatrick AW, Roberts DJ, De Waele J et al. Pediatric guidelines Sub-Committee for the World Society of the Abdominal Compartment Syndrome. Intra-abdominal hypertension and the abdominal compartment syndrome: updated consensus definitions and clinical practice guidelines from the World Society of the Abdominal Compartment Syndrome. Intens Care Med 2013; 39: 1190-206. 1) Cambria RP, Brewster DC, Moncure AC et al. Spontaneous aortic dissection in the presence of coexistent or previously repaired atherosclerotic aortic aneurysm. Ann Surg 1988; 208: 619-24. 4) Aratame A, Bito Y, Inno G et al. A case of intraoperative Malperfusion following abdominal aortic replacement for abdominal aortic rupture with acute Type B aortic dissection. Jpn J Vasc Surg 2019; 28: 307-10. 7) Karkos CD, Menexes GC, Patelis N et al. A systematic review and meta-analysis of abdominal compartment syndrome after endovascular repair of ruptured abdominal aortic aneurysm. J Vasc Surg 2014; 59: 829-42. 3) Tsukamoto S, Orime Y, Shinno S et al. Abdominal aortic aneurysm accompanied by aortic dissection. Jpn J Cardiovasc Surg 2004; 33: 162-5. |
| References_xml | – reference: 1) Cambria RP, Brewster DC, Moncure AC et al. Spontaneous aortic dissection in the presence of coexistent or previously repaired atherosclerotic aortic aneurysm. Ann Surg 1988; 208: 619-24. – reference: 2) Kuroda H, Honda T, Ashida Y et al. Aortic dissection associated with atherosclerotic aortic aneurysm. Jpn J Cardiovasc Surg 1995; 24: 1-5. – reference: 6) Tsukamoto S, Shindo S, Obana M et al. Aortic dissection complicated by atherosclerotic aneurysm. Jpn J Cardiovasc Surg 2003; 32: 201-5. – reference: 8) Kirkpatrick AW, Roberts DJ, De Waele J et al. Pediatric guidelines Sub-Committee for the World Society of the Abdominal Compartment Syndrome. Intra-abdominal hypertension and the abdominal compartment syndrome: updated consensus definitions and clinical practice guidelines from the World Society of the Abdominal Compartment Syndrome. Intens Care Med 2013; 39: 1190-206. – reference: 3) Tsukamoto S, Orime Y, Shinno S et al. Abdominal aortic aneurysm accompanied by aortic dissection. Jpn J Cardiovasc Surg 2004; 33: 162-5. – reference: 4) Aratame A, Bito Y, Inno G et al. A case of intraoperative Malperfusion following abdominal aortic replacement for abdominal aortic rupture with acute Type B aortic dissection. Jpn J Vasc Surg 2019; 28: 307-10. – reference: 5) Nagata E, Sato Y, Takahashi K. A case of acute type B aortic dissection with visceral Malperfusion and impending rupture of abdominal aortic aneurysm. Jpn J Vasc Surg 2022; 31: 337-41. – reference: 7) Karkos CD, Menexes GC, Patelis N et al. A systematic review and meta-analysis of abdominal compartment syndrome after endovascular repair of ruptured abdominal aortic aneurysm. J Vasc Surg 2014; 59: 829-42. – reference: 9) Mizushima Y, Masunaga N, Yosikawa Y et al. A retrospective, multicenter study of clinical outcome after management of the open abdomen. JJAAM 2015; 26: 116-24. |
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| SubjectTerms | Stanford B型急性大動脈解離（血栓閉塞型） ステントグラフト内挿術 腹部コンパートメント症候群 腹部大動脈瘤破裂 |
| Title | 血栓閉塞型急性B型大動脈解離に併発した腹部大動脈瘤破裂に対して血管内治療を行った1例 |
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