SURGICAL TREATMENT OF THE THORACOABDOMINAL AORTIC ANEURYSM WITH DYSPHAGIA

概要

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Because the esophagus has a mobile structure surrounded by loose areolar tissue of the posterior mediastinum, its displacement rarely produces dysphagia.In a case of thoracoabdominal aortic aneurysm in a 57-year-old male who was admitted to our hospital with the chief complaint of dysphagia, Crawford's graft inclusion technique was carried out with the aid of partial cardiopulmonary bypass. The aneurysm was fusiform in nature and in Group IV according to Crawford's classification. Exposure of the aneurysm was made through a left thoraco-retroperitoneal abdominal approach (spiral opening method). The patient had reconstruction of visceral branches, namely, celiac artery, superior mesenteric artery, and both renal arteries. The patient underwent reattachment of a few pairs of aortic segmental arteries between the levels of the ninth thoracic and second lumbar arteries to the graft, and the procedure was performed based on the intraoperative spinal cord evoked potential.The postoperative course was uncomplicated, and dysphagia disappeared without paraplegia.This case to be described here, to our knowledge, is a rare example of obstruction of the distal esophagus due to a thoracoabdominal aortic aneurysm.
日本臨床外科学会の論文