Two stage surgical treatments for a chronic type B dissecting aortic aneurysm with aberrant right subclavian artery and Kommerell Diverticulum ; a case report
| Autor: | Takeuchi, Katsunori, Yamashita, Akio, Seki, Koji, Sakata, Kimimasa, Yoshimura, Naoki |
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| Jazyk: | angličtina |
| Rok vydání: | 2019 |
| Předmět: | |
| Zdroj: | Toyama medical journal. 29(1):40-43 |
| ISSN: | 2189-2466 |
| Popis: | We report a case of two stage operations for a chronic type B dissecting aortic aneurysm with aberrant right subclavian artery(ARSA) and Kommerell’s diverticulum (KD). A 62-year-old man with a type B aortic dissection from 9 years before underwent follow-up Computed Tomography (CT) revealing aortic arch with KD expanded to 53mm and aberrant right subclavian artery expanded to 23mm in diameter. We performed two stage operations. In the first, we performed ARSA division at the proximal part of vertebral artery and transposed the distal end to right common carotid artery transposition. Subsequently, we performed replacement of descending aortia and over sewing of the aneurysmal of the origin ARSA under circulatory arrest. KD with ARSA is a rare anomaly of the aortic arch, and it may develop complications such as distal embolization, subclavian-esophageal fistula, dissection and rupture. We performing in two stages, subclavian reconstruction before the intrathoracic repair would be expected to reduce the subsequent risk of distal ischemia or subclavian steal. 我々は，異所性右鎖骨下動脈（ARSA）とKommerell憩室（KD）を伴った慢性B型解離性大動脈瘤に二期的手術を行った1 例を報告する。症例は， 9 年前にB型大動脈解離を来した62歳の男性でCTによる定期検査を受け，KDを伴う53mmに拡大した大動脈弓と直径23mmに拡大した異所性右鎖骨下動脈を認めた。治療は， 2 期的手術の方針とし，初回は椎骨動脈の近位部でARSAを離断し，末端部を右総頸動脈に転位吻合した。二期目は，循環停止下で下行大動脈置換と瘤化したARSAの起始部を縫合した。ARSAを伴ったKDは稀な大動脈弓異常であり，末梢部の塞栓形成，鎖骨下動脈食道瘻，解離や破裂などの合併症を呈する可能性がある。我々が二期的に行った，大動脈置換前の鎖骨下動脈の再建は，末梢の虚血または鎖骨下動脈盗血のリスクを低下させると思われた。 |
| Databáze: | OpenAIRE |
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