EVAR 術後Type 1a エンドリークからDIC を呈した1 症例
要旨：症例は82 歳女性．最大短径50 mm の腹部大動脈瘤に対し，ステントグラフト内挿術を施行した．最終造影でエンドリーク（endoleak; EL）を認めたがType 4 と判断した．退院3 カ月後に倦怠感が出現し，高度貧血，播種性血管内凝固症候群（disseminated intravascular coagulation; DIC），右大腿筋肉内血腫の診断で再入院となった．造影CT では瘤径の拡大はないもののEL は残存していた．DIC に対する薬物治療を行ったが血小板減少が進行する状態であり，瘤内における消費性凝固障害を疑いEL の完全消失を目的に再治療を行う方針となった．血管造影で...
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| Published in | Japanese Journal of Vascular Surgery Vol. 24; no. 4; pp. 794 - 798 |
|---|---|
| Main Authors | , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
特定非営利活動法人 日本血管外科学会
2015
日本血管外科学会 JAPANESE SOCIETY FOR VASCULAR SURGERY |
| Subjects | |
| Online Access | Get full text |
| ISSN | 0918-6778 1881-767X |
| DOI | 10.11401/jsvs.14-00112 |
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| Abstract | 要旨：症例は82 歳女性．最大短径50 mm の腹部大動脈瘤に対し，ステントグラフト内挿術を施行した．最終造影でエンドリーク（endoleak; EL）を認めたがType 4 と判断した．退院3 カ月後に倦怠感が出現し，高度貧血，播種性血管内凝固症候群（disseminated intravascular coagulation; DIC），右大腿筋肉内血腫の診断で再入院となった．造影CT では瘤径の拡大はないもののEL は残存していた．DIC に対する薬物治療を行ったが血小板減少が進行する状態であり，瘤内における消費性凝固障害を疑いEL の完全消失を目的に再治療を行う方針となった．血管造影でType 1a EL と判明し，バルーンやステント追加で中枢圧着を試みたが完全な消失は得られず，そのまま開腹手術に移行した．バルーン遮断下に瘤を切開しY 型人工血管置換術を施行した．術後DIC は改善し現在まで再燃なく経過している． |
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| AbstractList | We report a patient who developed disseminated intravascular coagulation (DIC) following a type 1a endoleak after an endovascular aneurysm repair (EVAR) for an abdominal aortic aneurysm (AAA), and who improved after open surgery. An 82-year-old woman underwent EVAR for a 50-mm infrarenal AAA in July 2012. Argatroban was used as anticoagulant because she had a history of heparin-induced thrombocytopenia. Postoperatively, a type 4 endoleak was present. Three months after the EVAR, she was admitted due to severe anemia and DIC. Computed tomography showed an endoleak with no evidence of an increase in size of AAA and huge intramuscular hematoma in her right thigh. The DIC was treated medically, but when the thrombomodulin was stopped, the thrombopenia progressed. Since no other cause of the DIC was found, we diagnosed that a consumption coagulopathy in the aneurysm sac was occured. She was re-treated to stop the leak completely. Angiography showed a type 1a endoleak. The volume of the endoleak was minimized but not disappeared following placement of a cuff and extra-large stent in the proximal neck, and then we proceeded with open psurgery to eliminate the leak completely. Postoperatively, the DIC improved and has not returned.
要旨：症例は82 歳女性．最大短径50 mm の腹部大動脈瘤に対し，ステントグラフト内挿術を施行した．最終造影でエンドリーク（endoleak; EL）を認めたがType 4 と判断した．退院3 カ月後に倦怠感が出現し，高度貧血，播種性血管内凝固症候群（disseminated intravascular coagulation; DIC），右大腿筋肉内血腫の診断で再入院となった．造影CT では瘤径の拡大はないもののEL は残存していた．DIC に対する薬物治療を行ったが血小板減少が進行する状態であり，瘤内における消費性凝固障害を疑いEL の完全消失を目的に再治療を行う方針となった．血管造影でType 1a EL と判明し，バルーンやステント追加で中枢圧着を試みたが完全な消失は得られず，そのまま開腹手術に移行した．バルーン遮断下に瘤を切開しY 型人工血管置換術を施行した．術後DIC は改善し現在まで再燃なく経過している． 要旨：症例は82 歳女性．最大短径50 mm の腹部大動脈瘤に対し，ステントグラフト内挿術を施行した．最終造影でエンドリーク（endoleak; EL）を認めたがType 4 と判断した．退院3 カ月後に倦怠感が出現し，高度貧血，播種性血管内凝固症候群（disseminated intravascular coagulation; DIC），右大腿筋肉内血腫の診断で再入院となった．造影CT では瘤径の拡大はないもののEL は残存していた．DIC に対する薬物治療を行ったが血小板減少が進行する状態であり，瘤内における消費性凝固障害を疑いEL の完全消失を目的に再治療を行う方針となった．血管造影でType 1a EL と判明し，バルーンやステント追加で中枢圧着を試みたが完全な消失は得られず，そのまま開腹手術に移行した．バルーン遮断下に瘤を切開しY 型人工血管置換術を施行した．術後DIC は改善し現在まで再燃なく経過している． 「要旨」 : 症例は82歳女性. 最大短径50mmの腹部大動脈瘤に対し, ステントグラフト内挿術を施行した. 最終造影でエンドリーク (endoleak ; EL) を認めたがType 4と判断した. 退院3カ月後に倦怠感が出現し, 高度貧血, 播種性血管内凝固症候群 (disseminated intravascular coagulation ; DIC) , 右大腿筋肉内血腫の診断で再入院となった. 造影CTでは瘤径の拡大はないもののELは残存していた. DICに対する薬物治療を行ったが血小板減少が進行する状態であり, 瘤内における消費性凝固障害を疑いELの完全消失を目的に再治療を行う方針となった. 血管造影でType 1a ELと判明し, バルーンやステント追加で中枢圧着を試みたが完全な消失は得られず, そのまま開腹手術に移行した. バルーン遮断下に瘤を切開しY型人工血管置換術を施行した. 術後DICは改善し現在まで再燃なく経過している. |
| Author | 高梨, 秀一郎 柳原, 孝章 乗松, 東吾 新本, 春夫 在國寺, 健太 加藤, 泰之 |
| Author_FL | 乗松 東吾 Aramoto Haruo Yanagihara Takayuki Takanashi Shuichiro Kato Yasuyuki 在國寺 健太 |
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| References | 3) ten Cate JW, Timmers H, Becker AE. Coagulopathy in ruptured or dissecting aortic aneurysms. Am J Med 1975;59: 171–176. 4) Mishima Y. Daidoumyakuryu to DIC. Naika MOOK 1986;30: 123–128. 8) Higashiura W, Kichikawa K, Sakaguchi S, et al. Deteriorating consumptive coagulopathy with type III endoleak following endovascular repair for abdominal aortic aneurysm associated with liver cirrhosis. J Endovasc Ther 2007;14:421–425. 7) Shimazaki T, Ishimaru S, Kawaguchi S, et al. Blood coagulation and fibrinolytic response after endovascular stent grafting of thoracic aorta. J Vasc Surg 2003;37:1213–1218. 9) Keo HH, Diehm N, Baumgartner I, et al. Disseminated intravascular coagulopathy caused by endoleak type I: successful treatment by endovascular stent-graft extension. Eur J Vasc Endovasc Surg 2006;12:98–70. 11) Fulton JJ, Farber MA, Sanchez LA, et al. Effect of challenging neck anatomy on mid-term migration rates in AneuRx endografts. J Vasc Surg 2006;44:932–937; discussion 937. 16) Lipsitz EC, Ohki T, Veith FJ, et al. Delayed open conversion following endovascular aortoiliac aneurysm repair: partial (or complete) endograft preservation as a useful adjunct. J Vasc Surg 2003;38:1191–1198. 5) Yao Y, Ishimaru S. Doumyaku nai Kessen. Thromb Circ 1999; 17:16–19. 1) Fisher DF, Yawn DH, Crawford ES. Preoperative disseminated intravascular coagulation associated with aortic aneurysms. A prospective study of 76 cases. Arch Surg 1983;118:1252–1255. 12) Schanzer A, Greenberg RK, Hevelone N, et al. Predictors of abdominal aortic aneurysm sac enlargement after endovascular repair. Circulation 2011;123:2848–2855. 2) Sasaki S, Fukada Y, Kunihara T, et al. Preoperative disseminated intravascular coagulation associated with aortic aneurysms. J Cardiovasc Surg (Torino) 2001;42:595–599. 10) Abbruzzese TA, Kwolek CJ, Brewster DC, et al. Outcomes following endovascular abdominal aortic aneurysm repair (EVAR): an anatomic and device-specific analysis. J Vasc Surg 2008;48:19–28. 13) Kelso RL, Lyden SP, Butler B, et al. Late conversion of aortic stent grafts. J Vasc Surg 2009;49:589–595. 14) Patel AS, Bell R, Hunt BJ, et al. Disseminated intravascular coagulation after endovascular aneurysm repair: resolution after aortic banding. J Vasc Surg 2009;49:1046–1049. 15) Ohara N, Miyata T, Oshiro H, et al. Adverse outcome following transfemoral endovascular stent-graft repair of an abdominal aortic aneurysm in a patient with severe liver dysfunction: report of a case. Surg Today 2000;30:764–767. 17) Jimenez JC, Moore WS, Quinones-Baldrich WJ. Acute and chronic open conversion after endovascular aortic aneurysm repair: a 14-year review. J Vasc Surg 2007;46:642–647. 6) Monaco M, Di Tommaso L, Stassano P, et al. Impact of blood coagulation and fibrinolytic system changes on early and mid term clinical outcome in patients undergoing stent endografting surgery. Interact Cardiovasc Thorac Surg 2006;5:724–728. |
| References_xml | – reference: 8) Higashiura W, Kichikawa K, Sakaguchi S, et al. Deteriorating consumptive coagulopathy with type III endoleak following endovascular repair for abdominal aortic aneurysm associated with liver cirrhosis. J Endovasc Ther 2007;14:421–425. – reference: 9) Keo HH, Diehm N, Baumgartner I, et al. Disseminated intravascular coagulopathy caused by endoleak type I: successful treatment by endovascular stent-graft extension. Eur J Vasc Endovasc Surg 2006;12:98–70. – reference: 2) Sasaki S, Fukada Y, Kunihara T, et al. Preoperative disseminated intravascular coagulation associated with aortic aneurysms. J Cardiovasc Surg (Torino) 2001;42:595–599. – reference: 16) Lipsitz EC, Ohki T, Veith FJ, et al. Delayed open conversion following endovascular aortoiliac aneurysm repair: partial (or complete) endograft preservation as a useful adjunct. J Vasc Surg 2003;38:1191–1198. – reference: 3) ten Cate JW, Timmers H, Becker AE. Coagulopathy in ruptured or dissecting aortic aneurysms. Am J Med 1975;59: 171–176. – reference: 5) Yao Y, Ishimaru S. Doumyaku nai Kessen. Thromb Circ 1999; 17:16–19. – reference: 10) Abbruzzese TA, Kwolek CJ, Brewster DC, et al. Outcomes following endovascular abdominal aortic aneurysm repair (EVAR): an anatomic and device-specific analysis. J Vasc Surg 2008;48:19–28. – reference: 15) Ohara N, Miyata T, Oshiro H, et al. Adverse outcome following transfemoral endovascular stent-graft repair of an abdominal aortic aneurysm in a patient with severe liver dysfunction: report of a case. Surg Today 2000;30:764–767. – reference: 4) Mishima Y. Daidoumyakuryu to DIC. Naika MOOK 1986;30: 123–128. – reference: 11) Fulton JJ, Farber MA, Sanchez LA, et al. Effect of challenging neck anatomy on mid-term migration rates in AneuRx endografts. J Vasc Surg 2006;44:932–937; discussion 937. – reference: 17) Jimenez JC, Moore WS, Quinones-Baldrich WJ. Acute and chronic open conversion after endovascular aortic aneurysm repair: a 14-year review. J Vasc Surg 2007;46:642–647. – reference: 14) Patel AS, Bell R, Hunt BJ, et al. Disseminated intravascular coagulation after endovascular aneurysm repair: resolution after aortic banding. J Vasc Surg 2009;49:1046–1049. – reference: 7) Shimazaki T, Ishimaru S, Kawaguchi S, et al. Blood coagulation and fibrinolytic response after endovascular stent grafting of thoracic aorta. J Vasc Surg 2003;37:1213–1218. – reference: 1) Fisher DF, Yawn DH, Crawford ES. Preoperative disseminated intravascular coagulation associated with aortic aneurysms. A prospective study of 76 cases. Arch Surg 1983;118:1252–1255. – reference: 13) Kelso RL, Lyden SP, Butler B, et al. Late conversion of aortic stent grafts. J Vasc Surg 2009;49:589–595. – reference: 6) Monaco M, Di Tommaso L, Stassano P, et al. Impact of blood coagulation and fibrinolytic system changes on early and mid term clinical outcome in patients undergoing stent endografting surgery. Interact Cardiovasc Thorac Surg 2006;5:724–728. – reference: 12) Schanzer A, Greenberg RK, Hevelone N, et al. Predictors of abdominal aortic aneurysm sac enlargement after endovascular repair. Circulation 2011;123:2848–2855. |
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| Snippet | 要旨：症例は82 歳女性．最大短径50 mm の腹部大動脈瘤に対し，ステントグラフト内挿術を施行した．最終造影でエンドリーク（endoleak; EL）を認めたがType 4 と判断した．退院3 カ月後に倦怠感が出現し，高度貧血，播種性血管内凝固症候群（disseminated intravascular... 「要旨」 : 症例は82歳女性. 最大短径50mmの腹部大動脈瘤に対し, ステントグラフト内挿術を施行した. 最終造影でエンドリーク (endoleak ; EL) を認めたがType 4と判断した. 退院3カ月後に倦怠感が出現し, 高度貧血, 播種性血管内凝固症候群 (disseminated... We report a patient who developed disseminated intravascular coagulation (DIC) following a type 1a endoleak after an endovascular aneurysm repair (EVAR) for an... |
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| SubjectTerms | abdominal aortic aneurysm disseminated intravascular coagulation endoleak stent graft エンドリーク ステントグラフト 播種性血管内凝固症候群 腹部大動脈瘤 |
| Title | EVAR 術後Type 1a エンドリークからDIC を呈した1 症例 |
| URI | https://www.jstage.jst.go.jp/article/jsvs/24/4/24_14-00112/_article/-char/ja http://mol.medicalonline.jp/en/journal/download?GoodsID=fj4kekka/2015/002404/011&name=0794-0798j https://cir.nii.ac.jp/crid/1390001204415054080 |
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