| Japanese |
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| Title | Debranching TEVAR(Zone 1留置)時の腕頭動脈閉塞の判定にINVOS(R)が有効であった1例 |
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| Subtitle | 症例 |
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| Authors | 近藤俊一*1, 廣田潤*2, 山部剛史*3, 近藤太一*4, 高野智弘*2, 中村健*2, 六角丘*5, 入江嘉仁*5, 横山斉*6, 片田芳明*7 |
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| Authors(kana) | |
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| Organization | *1いわき市立総合磐城共立病院心臓血管外科小切開心臓手術-大動脈ステントグラフトセンター, *2いわき市立総合磐城共立病院心臓血管外科, *3心臓血管研究所付属病院心臓血管外科, *4葉山ハートセンター心臓血管外科, *5獨協医科大学越谷病院心臓血管外科呼吸器外科, *6福島県立医科大学心臓血管外科, *7獨協医科大学越谷病院放射線科 |
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| Journal | 循環制御 |
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| Volume | 33 |
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| Number | 3 |
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| Page | 204-208 |
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| Year/Month | 2012/12 |
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| Article | 報告 |
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| Publisher | 日本循環制御医学会 |
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| Abstract | 「はじめに」2001年よりZ-STENT+UBE graftによる胸部ステントグラフト内挿術(TEVAR)を開始し, 企業性ステントグラフトを含め現在まで138例を経験した. 本邦では, 2008年から, 企業性ステントグラフトがTEVARに使用可能となり, 大動脈治療戦略の1つとなっている. 下行大動脈(Z3 & Z4)へのTEVARの成績は良好であり1, 2), 満足できる. しかし, 弓部大動脈に対するTEVARでは, 屈曲への対応, 分岐する頭頸部分枝への対応を迫られ, 通常のTEVARでは対応困難な場合が多い. 弓部大動脈へのTEVARでは, より安定したランディングゾーンを確保するために, 外科手術によるdebranchingを行うことで, より中枢までそのランディングゾーンを延ばす事が可能となる3). Z1へのランディングの場合, 腕頭動脈の血流で頭頸部分枝すべての血流を担うこととなり, その血流の維持が絶対条件となる. |
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| Practice | 基礎医学・関連科学 |
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| Keywords | TEVAR, INVOS, aortic arch aneurysm, debranching |
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| English |
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| Title | A Case That INVOS was Effective for a Judgment of Brachiocephalic Trunk Coverage in Debranching TEVAR (Zone 1 Placement) |
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| Authors | Shunichi Kondo*1, Jun Hirota*2, Tsuyoshi Yamabe*3, Taichi Kondo*4, Tomohiro Takano*2, Ken Nakamura*2, Kyu Rokkaku*5, Yoshihito Irie*5, Hitoshi Yokoyama*6, Yoshiaki Katada*7 |
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| Authors(kana) | |
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| Organization | *1MICS & Stent Graft Center, Department of Cardiovascular Surgery, Iwaki City General Iwaki Kyoritsu Hospital, *2Department of Cardiovascular Surgery, Iwaki City General Iwaki Kyoritsu Hospital, *3Department of Cardiovascular Surgery, The Cardiovascular Institute, *4Department of Cardiovascular Surgery, Hayama Heart Center, *5Department of Thoracic and Cardiovascular Surgery, Dokkyo Medical University Koshigaya Hospital, *6Department of Cardiovascular Surgery, Fukushima Medical University, School of Medicine, *7Department of Radiology, Dokkyo Medical University Koshigaya Hospital |
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| Journal | Circulation Control |
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| Volume | 33 |
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| Number | 3 |
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| Page | 204-208 |
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| Year/Month | 2012/12 |
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| Article | Report |
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| Publisher | Japan Society of Circulation Control in Medicine |
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| Abstract | [Case Study:] Male, 82 years old. [Present Illness:] Enhanced CT scan revealed an infrarenal abdominal aortic aneurysm (60mm) and an aortic arch aneurysm (45mm). We placed a stent graft on the abdominal aortic aneurysm using a Gore Excluder(R). The post-operative period passed without incident and led to outpatient observation. A follow-up CT scan revealed expansion (50mm) of the aortic arch aneurysm and the decision was made to operate. [Operation:] First we performed a right axillary-left common carotid artery-left subclavian artery bypass operation using Ringed Gelsoft 8mm. We placed a Talent(R) thoracic stent graft just distal of the brachiocephalic trunk. Just subsequent to balloon fixation, INVOS(R) values fell. It was determined that the stent graft had covered the inlet of the brachiocephalic trunk, resulting in stenosis. We immediately inserted a balloon catheter through the right radial artery, avoiding the stent graft at the inlet of the brachiocephalic trunk, and placed a stent at the inlet of the brachiocephalic trunk. INVOS values improved. [Results:] Whole brain ischemia occurred for about 5 minutes. Postoperative recovery from anesthesia was delayed and there was right hemiplegia. This gradually improved and the patient was able to walk unassisted at time of discharge. [Summary:] INVOS(R) was an effective cerebral blood flow monitor during TEVAR in the aortic arch. |
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| Practice | Basic medicine |
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| Keywords | TEVAR, INVOS, aortic arch aneurysm, debranching |
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