The Korean Journal of Medicine

  • 제87권2호
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  • Pages.193-199
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  • 2014
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  • 1738-9364(pISSN)
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  • 2289-0769(eISSN)
대한내과학회 (The Korean Association of Internal Medicine)
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이상성 오른쪽 빗장밑동맥이 있는 흉부대동맥류의 스텐트 이식편 치료

Hybrid Treatment of an Aortic Arch Aneurysm with an Aberrant Right Subclavian Artery

  • 최종현 (부산대학교 의학전문대학원 부산대학교병원 순환기내과) ;
  • 장혜윤 (부산대학교 의학전문대학원 부산대학교병원 순환기내과) ;
  • 전무송 (부산대학교 의학전문대학원 부산대학교병원 순환기내과) ;
  • 이혜원 (부산대학교 의학전문대학원 부산대학교병원 순환기내과) ;
  • 박진섭 (부산대학교 의학전문대학원 부산대학교병원 순환기내과) ;
  • 김상필 (부산대학교 의학전문대학원 부산대학교병원 흉부외과) ;
  • 이한철 (부산대학교 의학전문대학원 부산대학교병원 순환기내과)
  • Choi, Jong Hyun (Division of Cardiology, Department of Internal Medicine, Pusan National University Hospital, Pusan National University School of Medicine) ;
  • Jang, Hye Yoon (Division of Cardiology, Department of Internal Medicine, Pusan National University Hospital, Pusan National University School of Medicine) ;
  • Jeon, Moo Song (Division of Cardiology, Department of Internal Medicine, Pusan National University Hospital, Pusan National University School of Medicine) ;
  • Lee, Hye-Won (Division of Cardiology, Department of Internal Medicine, Pusan National University Hospital, Pusan National University School of Medicine) ;
  • Park, Jin Sup (Division of Cardiology, Department of Internal Medicine, Pusan National University Hospital, Pusan National University School of Medicine) ;
  • Kim, Sang-pil (Department of Thoracic and Cardiovascular Surgery, Pusan National University Hospital, Pusan National University School of Medicine) ;
  • Lee, Han Cheol (Division of Cardiology, Department of Internal Medicine, Pusan National University Hospital, Pusan National University School of Medicine)
  • 투고 : 2013.05.31
  • 심사 : 2013.09.05
  • 발행 : 2014.08.01
⟨ 이전 논문 다음 논문 ⟩

초록

흉부대동맥류는 크기가 클수록 파열로 인한 사망의 가능성이 높아지는 위험한 질환이다. 이러한 경우 수술적 치료를 통한 대동맥류의 제거가 필요하나 위험인자가 많은 고위험군 환자에 있어서는 수술에 따른 부작용이 매우 높은 편이다. 따라서 최근에 이러한 환자에서는 흉부 대동맥 혈관 내 스텐트이식편 삽입술이 수술을 대체하여 널리 시행되고 있다. 이에 저자들은 고령 및 다발성 골수종으로 수술 고위험군인 대동맥궁 대동맥류 환자에서 왼쪽 온목동맥에서 왼쪽 빗장밑동맥우회로술과 흉부 대동맥 혈관 내 스텐트이식편 삽입술을 함께 시행하였으며 이상성 오른쪽 빗장밑동맥이 있음에도 불구하고 특별한 합병증 없이 양쪽 팔의 혈류가 원활한 좋은 결과를 경험하였기에 문헌고찰과 함께 1예를 보고하는 바이다.

Aberrant right subclavian artery (ARSA) is a rare congenital anomaly but is the most common of the congenital vascular anomalies of the aortic arch. We report the case of a 68-year-old female undergoing chemotherapy for multiple myeloma who had a large thoracic aortic aneurysm (7.4 cm) with ARSA. She was treated with a hybrid procedure that combined a left common carotid-to-subclavian artery bypass with a "thoracic endovascular aortic repair (TEVAR)" because of the risk associated with a thoracotomy. A stent graft was deployed in the proximal part of the descending aorta to cover the thoracic aortic aneurysm after a left common carotid-to-subclavian bypass was made to restore blood flow in the left arm. There was no endoleak on digital subtraction angiography. Hybrid therapy can be performed successfully for the treatment of thoracic aortic aneurysm with ARSA.

키워드

참고문헌

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