A case of acute subdural hematoma after cerebrospinal fluid drainage in patient with thoracic endovascular aortic repair

症例は77歳, 女性. 脳梗塞の既往あり, 胸部大動脈瘤 (70mm) を指摘され当院受診した. 手術ハイリスクのためステントグラフト内挿術 (thoracic endovascular aortic repair ; TEVAR) を施行した. 術前評価にてAdamkiewicz動脈がTEVARに伴い閉塞することが明らかであり, スパイナルドレナージ (cerebrospinal fluid drainage ; CSFD) を挿入したうえで, TEVARを施行した. 外腸骨動脈の石灰化および狭窄のため大腿動脈からのTEVAR用シース挿入困難であり, 後腹膜アプローチにて総腸骨動脈からシース...

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Published inShinzo Vol. 45; no. 4; pp. 465 - 470
Main Authors Tazaki, Junichi, Miyamoto, Susumu, Imai, Masao, Sakata, Ryuzo, Shioi, Tetsuo, Kimura, Takeshi, Higashitani, Nobuya, Horikawa, Kyohei, Abekura, Yu, Marui, Akira, Funaki, Takeshi, Goto, Toru
Format Journal Article
LanguageJapanese
Published Japan Heart Foundation 2013
公益財団法人 日本心臓財団
Subjects
TEVAR
スパイナルドレナージ
急性硬膜下血腫
胸部大動脈瘤
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ISSN0586-4488
2186-3016
DOI10.11281/shinzo.45.465

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Abstract 症例は77歳, 女性. 脳梗塞の既往あり, 胸部大動脈瘤 (70mm) を指摘され当院受診した. 手術ハイリスクのためステントグラフト内挿術 (thoracic endovascular aortic repair ; TEVAR) を施行した. 術前評価にてAdamkiewicz動脈がTEVARに伴い閉塞することが明らかであり, スパイナルドレナージ (cerebrospinal fluid drainage ; CSFD) を挿入したうえで, TEVARを施行した. 外腸骨動脈の石灰化および狭窄のため大腿動脈からのTEVAR用シース挿入困難であり, 後腹膜アプローチにて総腸骨動脈からシースを挿入し, TAGステントグラフトを留置した. シース抜去時に血管壁を損傷したため, 術中から輸血を要し, 外科的に修復して閉腹した. 術後, 播種性血管内凝固症候群 (disseminated intravascular coagulation syndrome ; DIC) となり輸血を要したが, 翌日に意識混濁と右共同偏視を認め, CTで右急性硬膜下血腫を認めたため, 緊急開頭血腫除去術を施行した. 開頭術後は頭部再出血および出血による神経学的後遺症は認めず, 輸血治療によりDICは改善した. TEVAR施行後にendoleakは認めず, 術後47日目に転院となった.  TEVARによる重篤な合併症の1つに対麻痺があるが, その予防目的にCSFDは有用な手段である. 急性硬膜下血腫はCSFDの予後にかかわる重大な合併症であるが, TEVARにおけるCSFD後の急性硬膜下血腫の頻度は報告されていない. 今回われわれは, 早期発見と他科との連携により後遺症を残さず救命に成功した症例を経験したので報告する.
AbstractList 症例は77歳, 女性. 脳梗塞の既往あり, 胸部大動脈瘤 (70mm) を指摘され当院受診した. 手術ハイリスクのためステントグラフト内挿術 (thoracic endovascular aortic repair ; TEVAR) を施行した. 術前評価にてAdamkiewicz動脈がTEVARに伴い閉塞することが明らかであり, スパイナルドレナージ (cerebrospinal fluid drainage ; CSFD) を挿入したうえで, TEVARを施行した. 外腸骨動脈の石灰化および狭窄のため大腿動脈からのTEVAR用シース挿入困難であり, 後腹膜アプローチにて総腸骨動脈からシースを挿入し, TAGステントグラフトを留置した. シース抜去時に血管壁を損傷したため, 術中から輸血を要し, 外科的に修復して閉腹した. 術後, 播種性血管内凝固症候群 (disseminated intravascular coagulation syndrome ; DIC) となり輸血を要したが, 翌日に意識混濁と右共同偏視を認め, CTで右急性硬膜下血腫を認めたため, 緊急開頭血腫除去術を施行した. 開頭術後は頭部再出血および出血による神経学的後遺症は認めず, 輸血治療によりDICは改善した. TEVAR施行後にendoleakは認めず, 術後47日目に転院となった.  TEVARによる重篤な合併症の1つに対麻痺があるが, その予防目的にCSFDは有用な手段である. 急性硬膜下血腫はCSFDの予後にかかわる重大な合併症であるが, TEVARにおけるCSFD後の急性硬膜下血腫の頻度は報告されていない. 今回われわれは, 早期発見と他科との連携により後遺症を残さず救命に成功した症例を経験したので報告する.
Author Imai, Masao
Goto, Toru
Tazaki, Junichi
Abekura, Yu
Funaki, Takeshi
Horikawa, Kyohei
Kimura, Takeshi
Marui, Akira
Shioi, Tetsuo
Higashitani, Nobuya
Sakata, Ryuzo
Miyamoto, Susumu
Author_FL 東谷 暢也
田崎 淳一
今井 逸雄
堀川 恭平
後藤 徹
安部倉 友
丸井 晃
塩井 哲雄
舟木 健史
宮本 享
坂田 隆造
木村 剛
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  fullname: 今井 逸雄
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  fullname: 丸井 晃
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  fullname: Goto, Toru
  organization: Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
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DocumentTitleAlternate スパイナルドレナージ併用の胸部ステントグラフト内挿術後に急性硬膜下血腫を生じた1例
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References 2) Hiratzka LF, Bakris GL, Beckman JA, et al : 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with Thoracic Aortic Disease : a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. Circulation 2010 ; 121 : e266-369
3) Coselli JS, Lemaire SA, Koksoy C, et al : Cerebrospinal fluid drainage reduces paraplegia after thoracoabdominal aortic aneurysm repair : results of a randomized clinical trial. J Vasc Surg 2002 ; 35 : 631-639
5) Estrera AL, Miller CC 3rd, Huynh TT, et al : Preoperative and operative predictors of delayed neurologic deficit following repair of thoracoabdominal aortic aneurysm. J Thoracic Cardiovasc Surg 2003 : 126 : 1288-1294
1) Feezor RJ, Lee WA : Strategies for detection and prevention of spinal cord ischemia during TEVAR. Semin Vasc Surg 2009 ; 22 : 187-192
6) Wynn MM, Mell MW, Tefera G, et al : Complications of spinal fluid drainage in thoracoabdominal aortic aneurysm repair : a report of 486 patients treated from 1987 to 2008. J Vasc Surg 2009 ; 49 : 29-34
4) Dardik A, Perler BA, Roseborough GS, et al : Subdural hematoma after thoracoabdominal aortic aneurysm repair : an underreported complication of spinal fluid drainage ? J Vasc Surg 2002 ; 36 : 47-50
7) Murakami H, Yoshida K, Hino Y, et al : Complications of cerebrospinal fluid drainage in thoracoabdominal aortic aneurysm repair. J Vasc Surg 2004 ; 39 : 243-245
References_xml – reference: 3) Coselli JS, Lemaire SA, Koksoy C, et al : Cerebrospinal fluid drainage reduces paraplegia after thoracoabdominal aortic aneurysm repair : results of a randomized clinical trial. J Vasc Surg 2002 ; 35 : 631-639
– reference: 1) Feezor RJ, Lee WA : Strategies for detection and prevention of spinal cord ischemia during TEVAR. Semin Vasc Surg 2009 ; 22 : 187-192
– reference: 4) Dardik A, Perler BA, Roseborough GS, et al : Subdural hematoma after thoracoabdominal aortic aneurysm repair : an underreported complication of spinal fluid drainage ? J Vasc Surg 2002 ; 36 : 47-50
– reference: 5) Estrera AL, Miller CC 3rd, Huynh TT, et al : Preoperative and operative predictors of delayed neurologic deficit following repair of thoracoabdominal aortic aneurysm. J Thoracic Cardiovasc Surg 2003 : 126 : 1288-1294
– reference: 7) Murakami H, Yoshida K, Hino Y, et al : Complications of cerebrospinal fluid drainage in thoracoabdominal aortic aneurysm repair. J Vasc Surg 2004 ; 39 : 243-245
– reference: 2) Hiratzka LF, Bakris GL, Beckman JA, et al : 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with Thoracic Aortic Disease : a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. Circulation 2010 ; 121 : e266-369
– reference: 6) Wynn MM, Mell MW, Tefera G, et al : Complications of spinal fluid drainage in thoracoabdominal aortic aneurysm repair : a report of 486 patients treated from 1987 to 2008. J Vasc Surg 2009 ; 49 : 29-34
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Snippet 症例は77歳, 女性. 脳梗塞の既往あり, 胸部大動脈瘤 (70mm) を指摘され当院受診した. 手術ハイリスクのためステントグラフト内挿術 (thoracic endovascular aortic repair ; TEVAR) を施行した....
SourceID nii
jstage
SourceType Publisher
StartPage 465
SubjectTerms TEVAR
スパイナルドレナージ
急性硬膜下血腫
胸部大動脈瘤
Title A case of acute subdural hematoma after cerebrospinal fluid drainage in patient with thoracic endovascular aortic repair
URI https://www.jstage.jst.go.jp/article/shinzo/45/4/45_465/_article/-char/en
https://cir.nii.ac.jp/crid/1390001204048536960
Volume 45
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