弓部（遠位弓部）大動脈瘤に対する胸部ステントグラフト内挿術

Thoracic endovascular aortic repair（ TEVAR） combined of neck branch reconstruction（ debranching TEVAR：dTEVAR） is applied to aortic arch aneurysm for minimally invasive reduction and improvement of treatment results. We report the initial and long-term results of dTEVAR for the treatment of aortic arch aneurysm. TEVAR for zone 0-2 area was applied in 49 cases （Zone 0：1：2；8：5：36 cases）. Total dTEVAR was applied in zone 1 cases and 2 dTEVAR was performed in zone 2 cases. One dTEVAR or TEVAR with simple coverage of left subclavian artery was applied in zone 2 cases. Operative mortality within 30 days was 0％ and there was 1 case in hospital death due to coronary arterial rupture after percutaneous coronary intervention. Perioperative morbidity included 1 case（2.0％） spinal cord ischemia, 4（ 8.2％）arm claudication. In long-term follow-up, 5 cases died during the observation period （stroke in 1 case, heart failure in 1, neoplasma in 2, unknown in 1）, but not in aortic rupture. Secondary type1 endoleak occurred in 2 cases（4.1％）. Graft occlusion for neck branch reconstruction was complicated with 3 cases（6.1％）, however no complications related to the graft occlusion. Our strategy of TEVAR provided durable results in patients treated for aortic arch aneurysm, with few adverse events.