高拍出性心不全をともなう外傷性浅大腿動静脈瘻に対してステントグラフト内挿術を施行した1例  [in Japanese] Endovascular Repair for Traumatic Superficial Femoral Arteriovenous Fistula with High-output Heart Failure: Report of a Case  [in Japanese]

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Author(s)

    • 露木 肇 Tsuyuki Hajime
    • 浜松医科大学第二外科・血管外科 Division of Vascular Surgery, Second Department of Surgery, Hamamatsu University School of Medicine
    • 海野 直樹 Unno Naoki
    • 浜松医科大学第二外科・血管外科|浜松医療センター血管外科 Division of Vascular Surgery, Second Department of Surgery, Hamamatsu University School of Medicine|Division of Vascular Surgery, Hamamatsu Medical Center
    • 竹内 裕也 Takeuchi Hiroya
    • 浜松医科大学第二外科・血管外科 Division of Vascular Surgery, Second Department of Surgery, Hamamatsu University School of Medicine
    • 犬塚 和徳 Inuzuka Kazunori
    • 浜松医科大学第二外科・血管外科 Division of Vascular Surgery, Second Department of Surgery, Hamamatsu University School of Medicine
    • 佐野 真規 Sano Masaki
    • 浜松医科大学第二外科・血管外科 Division of Vascular Surgery, Second Department of Surgery, Hamamatsu University School of Medicine
    • 斉藤 貴明 Saito Takaaki
    • 浜松医科大学第二外科・血管外科 Division of Vascular Surgery, Second Department of Surgery, Hamamatsu University School of Medicine
    • 片橋 一人 Katahashi Kazuto
    • 浜松医科大学第二外科・血管外科 Division of Vascular Surgery, Second Department of Surgery, Hamamatsu University School of Medicine
    • 矢田 達朗 Yata Tatsuro
    • 浜松医科大学第二外科・血管外科 Division of Vascular Surgery, Second Department of Surgery, Hamamatsu University School of Medicine
    • 嘉山 貴文 Kayama Takafumi
    • 浜松医科大学第二外科・血管外科 Division of Vascular Surgery, Second Department of Surgery, Hamamatsu University School of Medicine
    • 山中 裕太 Yamanaka Yuta
    • 浜松医科大学第二外科・血管外科|浜松医療センター血管外科 Division of Vascular Surgery, Second Department of Surgery, Hamamatsu University School of Medicine|Division of Vascular Surgery, Hamamatsu Medical Center

Abstract

<p>症例は30歳代の男性.数年前にナイフによる左大腿部の刺傷歴があった.呼吸困難と左下肢腫脹を主訴に当科を受診した.胸部単純X線検査で心胸郭比72%,血液生化学検査でNT-proBNP 1005 pg/mLと上昇していた.造影CTおよび下肢血管造影では大腿中央部の浅大腿動脈–静脈の間で瘻孔が形成しており,左下肢静脈は早期に造影され,著しく拡張していた.外傷性浅大腿動静脈瘻(AVF)による高拍出性心不全と診断し,動脈側へのステントグラフト内挿術を行う方針とした.左鼠径部から順行性にアプローチし,造影で瘻孔部を確認したのち,同部を閉鎖するようにステントグラフト(GORE Excluder, PLC181000J, W. L. Gore & Associates, Inc, U.S.A)を留置した.最終造影で静脈が描出されなくなったことを確認して手術を終了した.術後7日目で下肢周径の左右差はなくなり,胸部症状も消失した.退院後の経過も良好である.四肢AVFに対するステントグラフト治療は低侵襲で有効な治療選択肢と思われた.</p>

<p>A 30-year-old man with a complaint of dyspnea and swelling of his left lower limb was referred to our hospital. He had a few years' history of stab injury to his left thigh. A chest radiography revealed severe cardiomegaly with 72% cardiothoracic ratio, and the amino-terminal pro-brain natriuretic peptide (NT-proBNP) level was elevated at 1,005 pg/mL. Contrast-enhanced computed tomography and angiography revealed a dilated left iliofemoral artery and vein, and superficial femoral arteriovenous fistula (AVF). We performed an endovascular repair of the traumatic AVF using a stent graft (GORE Excluder, PLC181000J, W. L. Gore & Associates, Inc, USA), which was deployed in the superficial femoral artery. After the surgery, his symptoms improved immediately and significantly. Endovascular repair with a stent graft is an excellent alternative treatment for traumatic AVF of the extremities.</p>

Journal

  • The Japanese Journal of Phlebology

    The Japanese Journal of Phlebology 30(1), 15-18, 2019

    Japanese Society of Phlebology

Codes

  • NII Article ID (NAID)
    130007603278
  • Text Lang
    JPN
  • ISSN
    0915-7395
  • Data Source
    J-STAGE 
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