Shaggy aortaを伴う遠位弓部大動脈瘤に対し2期的ハイブリッド手術を施行した1例
症例は67歳男性．前医で肺癌経過観察中のCTで胸部大動脈瘤を指摘され，精査加療目的で当院紹介となった．広範囲にSevere shaggy aortaを伴う最大径68 mmの遠位弓部大動脈瘤であり，手術による脳梗塞，脊髄虚血のリスクが高いと考え，二期的ハイブリッド手術の方針とした．初回手術はbrain isolation法を用いたelephant trunkを伴う全弓部置換術を施行，術後経過は良好であり，初回手術から26日後に二期的手術として胸部大動脈ステントグラフト内挿術（TEVAR）を施行し，38日目に合併症なく独歩退院した．Shaggy aortaを伴う遠位弓部大動脈瘤に対して二期的ハイブ...
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| Published in | 日本心臓血管外科学会雑誌 Vol. 52; no. 5; pp. 330 - 334 |
|---|---|
| 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
15.09.2023
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0285-1474 1883-4108 |
| DOI | 10.4326/jjcvs.52.330 |
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| Abstract | 症例は67歳男性．前医で肺癌経過観察中のCTで胸部大動脈瘤を指摘され，精査加療目的で当院紹介となった．広範囲にSevere shaggy aortaを伴う最大径68 mmの遠位弓部大動脈瘤であり，手術による脳梗塞，脊髄虚血のリスクが高いと考え，二期的ハイブリッド手術の方針とした．初回手術はbrain isolation法を用いたelephant trunkを伴う全弓部置換術を施行，術後経過は良好であり，初回手術から26日後に二期的手術として胸部大動脈ステントグラフト内挿術（TEVAR）を施行し，38日目に合併症なく独歩退院した．Shaggy aortaを伴う遠位弓部大動脈瘤に対して二期的ハイブリッド手術を施行し合併症なく治療しえた1例を報告する． |
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| AbstractList | 症例は67歳男性．前医で肺癌経過観察中のCTで胸部大動脈瘤を指摘され，精査加療目的で当院紹介となった．広範囲にSevere shaggy aortaを伴う最大径68 mmの遠位弓部大動脈瘤であり，手術による脳梗塞，脊髄虚血のリスクが高いと考え，二期的ハイブリッド手術の方針とした．初回手術はbrain isolation法を用いたelephant trunkを伴う全弓部置換術を施行，術後経過は良好であり，初回手術から26日後に二期的手術として胸部大動脈ステントグラフト内挿術（TEVAR）を施行し，38日目に合併症なく独歩退院した．Shaggy aortaを伴う遠位弓部大動脈瘤に対して二期的ハイブリッド手術を施行し合併症なく治療しえた1例を報告する． |
| Author | 緑川, 博文 湯田, 健太郎 植野, 恭平 滝浪, 学 菅野, 惠 太田, 和寛 |
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| References | 5) Okada K, Omura A, Kano H et al. Effect of atherothrombotic aorta on outcomes of total aortic arch replacement. J Thorac Cardiovasc Surg 2013; 145: 984-91. 8) Moritz A, Bischoff MD, Johannes S et al. Staged approach prevents spinal cord injury in hybrid surgical-endovascular thoracoabdominal aort aneurysm repair: an experimental model. Ann Thorac Surg 2011; 92: 138-46. 11) Watanabe T, Yoshitani N, Tohma R et al. A case of staged hybrid repair for subacute type B aortic dissection in a patient with shaggy aorta. Jpn J Cardiovasc Surg 50: 44-8. 12) Akuzawa S, Mitsuoka H, Ishigami N et al. An experience of distal embolic protection with a filtered temporary AV shunt during TEVAR for shaggy aorta. Jpn J Vasc Surg 2013; 22: 1009-12. 2) Charles W, Hogue MD, Rebecca F et al. Mechanisms of cerebral injury from cardiac surgery. Crit Care Clin 2008 ; 24: 83-98. 3) Morokuma H, Kamohara K, Uchino M et al. A case of one-staged hybrid treatment for extended thoracic aortic aneurysm. Jpn J Vasc Surg 2015; 24: 975-9. 6) Kouchoukos NT, Mauney MC, Masetti P et al. Optimization of aortic arch replacement with a one-stage approach. Ann Thorac Surg 2007; 83: S811-4. 9) Shiiya N, Kunihara T, Kamikubo Y et al. Isolation technique for stroke prevention in patients with a mobile atheroma. Ann Thorac Surg 2001; 72: 1401-2. 1) Hage A, Hage F, Dagenais F et al. Frozen elephant trunk for aortic arch reconstruction is associated with reduced mortality as compared to conventional techniques. Semin Thorac Surg 34: 386-92. 7) Preventza O, Liao JL, Olive JK et al. Neurologic complications after the frozen elephant trunk procedure: a meta-analysis of more than 3000 patients. J Thorac Cardiovasc Surg 2019. doi: 10.1016/j.jtcvs.2019.10.031 10) Coselli JS, Frankel WC, Green SY et al. Staged repair of extensive aneurysms of the thoracic aorta by using the elephant trunk technique. Ann Thorac Surg 2022; 114: 1578-85. 4) Yokokawa K, Ikeno Y, Henmi S et al. Impact of shaggy aorta on outcomes of open thoracoabdominal aortic aneurysm repair. J Thorac Cardiovasc Surg 2020; 160: 889-97. |
| References_xml | – reference: 3) Morokuma H, Kamohara K, Uchino M et al. A case of one-staged hybrid treatment for extended thoracic aortic aneurysm. Jpn J Vasc Surg 2015; 24: 975-9. – reference: 6) Kouchoukos NT, Mauney MC, Masetti P et al. Optimization of aortic arch replacement with a one-stage approach. Ann Thorac Surg 2007; 83: S811-4. – reference: 8) Moritz A, Bischoff MD, Johannes S et al. Staged approach prevents spinal cord injury in hybrid surgical-endovascular thoracoabdominal aort aneurysm repair: an experimental model. Ann Thorac Surg 2011; 92: 138-46. – reference: 4) Yokokawa K, Ikeno Y, Henmi S et al. Impact of shaggy aorta on outcomes of open thoracoabdominal aortic aneurysm repair. J Thorac Cardiovasc Surg 2020; 160: 889-97. – reference: 5) Okada K, Omura A, Kano H et al. Effect of atherothrombotic aorta on outcomes of total aortic arch replacement. J Thorac Cardiovasc Surg 2013; 145: 984-91. – reference: 12) Akuzawa S, Mitsuoka H, Ishigami N et al. An experience of distal embolic protection with a filtered temporary AV shunt during TEVAR for shaggy aorta. Jpn J Vasc Surg 2013; 22: 1009-12. – reference: 1) Hage A, Hage F, Dagenais F et al. Frozen elephant trunk for aortic arch reconstruction is associated with reduced mortality as compared to conventional techniques. Semin Thorac Surg 34: 386-92. – reference: 7) Preventza O, Liao JL, Olive JK et al. Neurologic complications after the frozen elephant trunk procedure: a meta-analysis of more than 3000 patients. J Thorac Cardiovasc Surg 2019. doi: 10.1016/j.jtcvs.2019.10.031 – reference: 10) Coselli JS, Frankel WC, Green SY et al. Staged repair of extensive aneurysms of the thoracic aorta by using the elephant trunk technique. Ann Thorac Surg 2022; 114: 1578-85. – reference: 11) Watanabe T, Yoshitani N, Tohma R et al. A case of staged hybrid repair for subacute type B aortic dissection in a patient with shaggy aorta. Jpn J Cardiovasc Surg 50: 44-8. – reference: 9) Shiiya N, Kunihara T, Kamikubo Y et al. Isolation technique for stroke prevention in patients with a mobile atheroma. Ann Thorac Surg 2001; 72: 1401-2. – reference: 2) Charles W, Hogue MD, Rebecca F et al. Mechanisms of cerebral injury from cardiac surgery. Crit Care Clin 2008 ; 24: 83-98. |
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| Snippet | 症例は67歳男性．前医で肺癌経過観察中のCTで胸部大動脈瘤を指摘され，精査加療目的で当院紹介となった．広範囲にSevere shaggy aortaを伴う最大径68 mmの遠位弓部大動脈... |
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| SubjectTerms | brain isolation法 shaggy aorta 弓部置換術 胸部ステントグラフト内挿術 胸部大動脈瘤 |
| Title | Shaggy aortaを伴う遠位弓部大動脈瘤に対し2期的ハイブリッド手術を施行した1例 |
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