2-debranched TEVARを施行した患者さんの再手術は極めて困難です。
多重のステントグラフトはトリミングするだけでも苦労します。
さらに、ネックレス状に胸骨前面に留置された左右腋窩動脈バイパスは開胸を制限し、手術の難易度を高めるだけでなく、将来の治療選択肢を奪ってしまいます。
外来で患者さんが「この胸骨前の出っ張りは？」と、人工血管の盛り上がりを指差して聞かれると、十分な説明（再手術制限や動脈瘤再拡大リスクなど）があったのか疑問に思います。高リスクで開胸不可の患者ならともかく、若い方にこの手術は避けるべきだと強く感じます。
Reoperation after 2-debranched TEVAR is extremely challenging. Overlapping and trimming multiple stent graft layers is a real struggle. Plus, the bilateral axillary artery bypasses—placed like a necklace across the front of the sternum—limit sternotomy. This doesn’t just raise surgical difficulty; it robs future treatment options. In clinic, patients point to the bulge from the artificial graft and ask, “What’s this lump in front of my chest bone?” It makes me question: Were they fully explained about reoperation limits and aneurysm re-expansion risks? For high-risk patients where opening the chest is impossible, okay. But for younger ones? I strongly believe we should avoid this surgery. Prioritize options that preserve choices. Thoughts?
