腹部大動脈瘤・大腿深動脈瘤に対してステントグラフト内挿術と大腿深動脈血行再建術を同時施行した1例
72歳男性．胸部大動脈瘤にて紹介となり，当院施行のCTで腹部大動脈瘤・左総腸骨動脈瘤・両側内腸骨動脈瘤・右大腿深動脈瘤を指摘された．上行弓部大動脈置換術を先行し，1年後に腹部大動脈ステントグラフト内挿術と同時に大腿深動脈瘤切除・人工血管置換を行った．術後CTやその後の経過観察にても良好な開存が得られている．無症状で発見される大腿深動脈瘤は，本症例のように他部位の動脈瘤を合併する場合が多い．動脈拡張に加え動脈瘤の多発する病態はarteriomegalyと呼ばれる．大腿深動脈瘤は破裂症例では視野不良のため血行再建が困難であり，胸部・腹部大動脈瘤や腸骨動脈瘤の症例ではarteriomegalyも考慮...
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| Published in | Japanese Journal of Vascular Surgery Vol. 27; no. 6; pp. 491 - 494 |
|---|---|
| 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
27.12.2018
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.18-00100 |
Cover
| Abstract | 72歳男性．胸部大動脈瘤にて紹介となり，当院施行のCTで腹部大動脈瘤・左総腸骨動脈瘤・両側内腸骨動脈瘤・右大腿深動脈瘤を指摘された．上行弓部大動脈置換術を先行し，1年後に腹部大動脈ステントグラフト内挿術と同時に大腿深動脈瘤切除・人工血管置換を行った．術後CTやその後の経過観察にても良好な開存が得られている．無症状で発見される大腿深動脈瘤は，本症例のように他部位の動脈瘤を合併する場合が多い．動脈拡張に加え動脈瘤の多発する病態はarteriomegalyと呼ばれる．大腿深動脈瘤は破裂症例では視野不良のため血行再建が困難であり，胸部・腹部大動脈瘤や腸骨動脈瘤の症例ではarteriomegalyも考慮し，末梢まで検索することが肝要と考える． |
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| AbstractList | 72歳男性．胸部大動脈瘤にて紹介となり，当院施行のCTで腹部大動脈瘤・左総腸骨動脈瘤・両側内腸骨動脈瘤・右大腿深動脈瘤を指摘された．上行弓部大動脈置換術を先行し，1年後に腹部大動脈ステントグラフト内挿術と同時に大腿深動脈瘤切除・人工血管置換を行った．術後CTやその後の経過観察にても良好な開存が得られている．無症状で発見される大腿深動脈瘤は，本症例のように他部位の動脈瘤を合併する場合が多い．動脈拡張に加え動脈瘤の多発する病態はarteriomegalyと呼ばれる．大腿深動脈瘤は破裂症例では視野不良のため血行再建が困難であり，胸部・腹部大動脈瘤や腸骨動脈瘤の症例ではarteriomegalyも考慮し，末梢まで検索することが肝要と考える． A 72-year-old man was admitted for the purpose of surgical and endovascular treatment for profunda femoris artery aneurysm (PFAA) associated with abdominal aortic aneurysm (AAA) and common iliac artery aneurysm. The patient had undergone surgical treatment for thoracic aortic aneurysm 1 year ago. This patient had arteriomegaly which is defined as the diffuse ectasia of arteries with or without aneurysmal disease. We simultaneously performed endovascular abdominal aortic repair (EVAR) and profunda femoris artery interposition with expanded polytetrafluoroethylene (ePTFE) ringed graft and could preserve distal blood flow of profunda femoris artery. In the outpatient follow-up, the bypass graft of profunda femoris artery was patent for 4 years after surgery. Although some cases of PFAAs are reported recently, PFAAs are still rare entity in the peripheral artery aneurysms. There is no report of concomitant treatment of endovascular repair for AAA and open surgery for PFAA, we report this case and review some literature of PFAA. 72歳男性．胸部大動脈瘤にて紹介となり，当院施行のCTで腹部大動脈瘤・左総腸骨動脈瘤・両側内腸骨動脈瘤・右大腿深動脈瘤を指摘された．上行弓部大動脈置換術を先行し，1年後に腹部大動脈ステントグラフト内挿術と同時に大腿深動脈瘤切除・人工血管置換を行った．術後CTやその後の経過観察にても良好な開存が得られている．無症状で発見される大腿深動脈瘤は，本症例のように他部位の動脈瘤を合併する場合が多い．動脈拡張に加え動脈瘤の多発する病態はarteriomegalyと呼ばれる．大腿深動脈瘤は破裂症例では視野不良のため血行再建が困難であり，胸部・腹部大動脈瘤や腸骨動脈瘤の症例ではarteriomegalyも考慮し，末梢まで検索することが肝要と考える． 要旨 : 72歳男性. 胸部大動脈瘤にて紹介となり, 当院施行のCTで腹部大動脈瘤・左総腸骨動脈瘤・両側内腸骨動脈瘤・右大腿深動脈瘤を指摘された. 上行弓部大動脈置換術を先行し, 1年後に腹部大動脈ステントグラフト内挿術と同時に大腿深動脈瘤切除・人工血管置換を行った. 術後CTやその後の経過観察にても良好な開存が得られている. 無症状で発見される大腿深動脈瘤は, 本症例のように他部位の動脈瘤を合併する場合が多い. 動脈拡張に加え動脈瘤の多発する病態はarteriomegalyと呼ばれる. 大腿深動脈瘤は破裂症例では視野不良のため血行再建が困難であり, 胸部・腹部大動脈瘤や腸骨動脈瘤の症例ではarteriomegalyも考慮し, 末梢まで検索することが肝要と考える. |
| Author | 吉尾, 敬秀 井村, 肇 高橋, 賢一朗 丸山, 雄二 太田, 恵介 新田, 隆 |
| Author_FL | Nitta Takashi Imura Hajime Takahashi Ken-ichiro Maruyama Yuji Yoshio Takahide Ota Keisuke |
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| References | 4) Sapienza P, Mingoli A, Feldhaus R, et al. Femoral artery aneurysms: long-term followup and results of surgical treatment. Cardiovasc Surg 1996; 4: 181–184. 9) Hollier LH, Stanson AW, Gloviczki P, et al. Arteriomegaly: classification and morbid implications of diffuse aneurysmal disease. Surgery 1983; 93: 700–708. 12) Xu J, Eslami M. Open Surgical Revascularization of Profunda Femoris Artery Aneurysm. Ann Vasc Surg 2017; 42: 299.e7–299.e9. 6) Lawrence PF, Harlander-Locke MP, Oderich GS, et al.; Vascular Low-Frequency Disease Consortium. The current management of isolated degenerative femoral artery aneurysms is too aggressive for their natural history. J Vasc Surg 2014; 59: 343–349. 8) Thomas ML. Arteriomegaly. Br J Surg 1971; 58: 690–694. 2) Posner SR, Wilensky J, Dimick J, et al. A true aneurysm of the profunda femoris artery: a case report and review of the English language literature. Ann Vasc Surg 2004; 18: 740–746. 1) Tait WF, Vohra RK, Carr HM, et al. True profunda femoris aneurysms: are they more dangerous than other atherosclerotic aneurysms of the femoropopliteal segment? Ann Vasc Surg 1991; 5: 92–95. 7) Leriche R. Dolicho et méga-artère. Dolicho et méga-veine. Presse Med 1943; 51: 554–555. 16) Brancaccio G, Celoria GM, Stefanini T, et al. Endovascular repair of a profunda femoris artery aneurysm. Ann Vasc Surg 2011; 25: 980.e11–e13. 5) Harbuzariu C, Duncan AA, Bower TC, et al. Profunda femoris artery aneurysms: association with aneurysmal disease and limb ischemia. J Vasc Surg 2008; 47: 31–34; discussion, 34–35. 10) Piffaretti G, Mariscalco G, Tozzi M, et al. Twenty-year experience of femoral artery aneurysms. J Vasc Surg 2011; 53: 1230–1236. 14) Idetsu A, Sugimoto M, Matsushita M, et al. Solitary profunda femoris artery aneurysm. Ann Vasc Surg 2011; 25: 558.e13–e15. 17) Bath J, Avgerinos E. A pooled analysis of common femoral and profunda femoris endovascular interventions. Vascular 2016; 24: 404–413. 13) Levi N, Schroeder TV. Rupture of true profunda femoris artery aneurysms. Two new cases. J Cardiovasc Surg (Torino) 1996; 37: 117–118. 11) Mohan IV, Stephen MS. Peripheral arterial aneurysms: open or endovascular surgery? Prog Cardiovasc Dis 2013; 56: 36–56. 3) Pappas G, Janes JM, Bernatz PE, et al. Femoral aneurysms. JAMA 1964; 190: 489–493. 15) Saha S, Trompetas V, Al-Robaie B, et al. Endovascular stent graft management of a ruptured profunda femoris artery aneurysm. Eur J Vasc Endovasc Surg 2010; 19: 38–40. |
| References_xml | – reference: 10) Piffaretti G, Mariscalco G, Tozzi M, et al. Twenty-year experience of femoral artery aneurysms. J Vasc Surg 2011; 53: 1230–1236. – reference: 12) Xu J, Eslami M. Open Surgical Revascularization of Profunda Femoris Artery Aneurysm. Ann Vasc Surg 2017; 42: 299.e7–299.e9. – reference: 6) Lawrence PF, Harlander-Locke MP, Oderich GS, et al.; Vascular Low-Frequency Disease Consortium. The current management of isolated degenerative femoral artery aneurysms is too aggressive for their natural history. J Vasc Surg 2014; 59: 343–349. – reference: 15) Saha S, Trompetas V, Al-Robaie B, et al. Endovascular stent graft management of a ruptured profunda femoris artery aneurysm. Eur J Vasc Endovasc Surg 2010; 19: 38–40. – reference: 9) Hollier LH, Stanson AW, Gloviczki P, et al. Arteriomegaly: classification and morbid implications of diffuse aneurysmal disease. Surgery 1983; 93: 700–708. – reference: 13) Levi N, Schroeder TV. Rupture of true profunda femoris artery aneurysms. Two new cases. J Cardiovasc Surg (Torino) 1996; 37: 117–118. – reference: 8) Thomas ML. Arteriomegaly. Br J Surg 1971; 58: 690–694. – reference: 2) Posner SR, Wilensky J, Dimick J, et al. A true aneurysm of the profunda femoris artery: a case report and review of the English language literature. Ann Vasc Surg 2004; 18: 740–746. – reference: 17) Bath J, Avgerinos E. A pooled analysis of common femoral and profunda femoris endovascular interventions. Vascular 2016; 24: 404–413. – reference: 1) Tait WF, Vohra RK, Carr HM, et al. True profunda femoris aneurysms: are they more dangerous than other atherosclerotic aneurysms of the femoropopliteal segment? Ann Vasc Surg 1991; 5: 92–95. – reference: 14) Idetsu A, Sugimoto M, Matsushita M, et al. Solitary profunda femoris artery aneurysm. Ann Vasc Surg 2011; 25: 558.e13–e15. – reference: 11) Mohan IV, Stephen MS. Peripheral arterial aneurysms: open or endovascular surgery? Prog Cardiovasc Dis 2013; 56: 36–56. – reference: 16) Brancaccio G, Celoria GM, Stefanini T, et al. Endovascular repair of a profunda femoris artery aneurysm. Ann Vasc Surg 2011; 25: 980.e11–e13. – reference: 7) Leriche R. Dolicho et méga-artère. Dolicho et méga-veine. Presse Med 1943; 51: 554–555. – reference: 5) Harbuzariu C, Duncan AA, Bower TC, et al. Profunda femoris artery aneurysms: association with aneurysmal disease and limb ischemia. J Vasc Surg 2008; 47: 31–34; discussion, 34–35. – reference: 4) Sapienza P, Mingoli A, Feldhaus R, et al. Femoral artery aneurysms: long-term followup and results of surgical treatment. Cardiovasc Surg 1996; 4: 181–184. – reference: 3) Pappas G, Janes JM, Bernatz PE, et al. Femoral aneurysms. JAMA 1964; 190: 489–493. |
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| Snippet | ... 要旨 : 72歳男性. 胸部大動脈瘤にて紹介となり, 当院施行のCTで腹部大動脈瘤・左総腸骨動脈瘤・両側内腸骨動脈瘤・右大腿深動脈瘤を指摘された. 上行弓部大動脈置換術を先行し, 1年後に腹部大動脈ステントグラフト内挿術と同時に大腿深動脈瘤切除・人工血管置換を行った.... A 72-year-old man was admitted for the purpose of surgical and endovascular treatment for profunda femoris artery aneurysm (PFAA) associated with abdominal... |
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| SubjectTerms | abdominal aortic aneurysm endovascular surgery hybrid surgery profunda femoris artery aneurysm ステントグラフト ハイブリッド治療 大腿深動脈瘤 腹部大動脈瘤 |
| Title | 腹部大動脈瘤・大腿深動脈瘤に対してステントグラフト内挿術と大腿深動脈血行再建術を同時施行した1例 |
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