アヅマ　タカシ   Adzuma Takashi   東　隆    所属   医学部 医学科（附属足立医療センター）    職種   准教授
言語種別	日本語
発表タイトル	第三世代開窓型弓部ステントグラフトの治療成績
会議名	第47回日本心臓血管外科学会学術総会
主催者	日本心臓血管外科学会
学会区分	全国規模の学会
発表形式	口頭
講演区分	シンポジウム・ワークショップ パネル（公募）
発表者・共同発表者	◎東隆, 横井良彦, 山崎健二
発表年月日	2017/02/27
開催地 （都市, 国名）	東京都
概要	*シンポジウム2／弓部瘤のステントグラフト治療成績 BackgroundIn most cases of arch aneurysm, precurved fenestrated stent grafts work well for sealing around neck vessels. Smaller fenestrations seal better. Branches are more feasible for sealing in cases with insufficient landing zones.PatientsWe performed 93 thoracic endovascular aortic arch repairs with oneoff custom-designed endografts with choice of fenestration or branch depending on the case.MethodsWe used the precurved fenestrated Najuta endograft. The custom-made fenestrations are about the same size as the orifices of neck vessels and can be modified as ring ports for branches as needed. The ring port was made of a long platinum coil sutured cylindrically around the fenestration. For branches, we used the Aorfix AAA Stent Graft Plug-in Leg, which has a ring stent structure and connects well with the ring port.Results 1Of 93 cases treated since October 2014 with a hybrid-design endograft, 87 received a fenestrated endograft without branches; 10 received fenestration and branches, including 7 cases with single, 2 cases with double, and 1 case with triple branches. The proximal landing zone was zone 0 in almost all cases.Results 2The technical success rate was 100%. Postoperative computed tomography confirmed type I endoleaks from fenestrations in 5 cases but no endoleak from branches. Mild cerebral infarction occurred in 3 cases (1 in a branch case).ConclusionA fenestrated endograft with branches avoids extra anatomical bypass andachieves complete anatomical repair in arch aneurysms. The technique foran additional branch is simple. However, this procedure has moderatepotential risk of a cerebrovascular accident.