Brunkwall J, Länne T, Bergentz S E
Department of Vascular and Renal Diseases, Lund University, Malmö University Hospital, Sweden.
Eur J Vasc Endovasc Surg. 1999 Mar;17(3):191-6. doi: 10.1053/ejvs.1998.0688.
To study renal function in patients with aortocaval fistula, before and after surgery.
Retrospective study.
During the last 22 years nine male patients (median age 67, age range 50-72) with spontaneous aortocaval fistula in combination with AAA were operated upon. This constitutes 4% of the patients with ruptured AAA and 1.5% of all patients with AAA.
A preoperative diagnosis of aortocaval fistula was established in three of the nine cases. The medium duration of symptoms prior to surgery was 5 days (range 4 h-14 days). The fistula was combined with an extravasating ruptured AAA in only three patients. Seven of the patients had acute renal insufficiency, with creatinine levels of in median 292 mumol (IQR 218-342). Creatinine declined to 172 mumol/l (IQR 170-313) on the fifth postoperative day in uncomplicated cases and to 86 mumol at discharge. One patient died due to multi-organ failure, whereas the other left hospital well and alive with normal renal function.
Acute preoperative renal insufficiency due to an aortocaval fistula in patients with AAA is often due to venous congestion, and is normalised after successful surgery.
研究主腔静脉瘘患者手术前后的肾功能。
回顾性研究。
在过去22年中，对9例男性患者（中位年龄67岁，年龄范围50 - 72岁）进行了自发性主腔静脉瘘合并腹主动脉瘤的手术。这占破裂腹主动脉瘤患者的4%，占所有腹主动脉瘤患者的1.5%。
9例患者中有3例术前确诊为主腔静脉瘘。术前症状的中位持续时间为5天（范围4小时 - 14天）。仅3例患者的瘘合并有外渗性破裂腹主动脉瘤。7例患者出现急性肾功能不全，肌酐水平中位值为292μmol（四分位间距218 - 342）。在无并发症的情况下，术后第5天肌酐降至172μmol/l（四分位间距170 - 313），出院时降至86μmol。1例患者死于多器官功能衰竭，而另1例患者出院时情况良好，肾功能正常。
腹主动脉瘤患者因主腔静脉瘘导致的术前急性肾功能不全通常是由于静脉淤血，成功手术后可恢复正常。
