Beierlein Wolfram, Walker Tobias, Aebert Hermann
Klinik für Thorax-, Herz- und Gefässchirurgie, Universitätsklinikum Tübingen.
Med Klin (Munich). 2002 Jun 15;97(6):357-60. doi: 10.1007/s00063-002-1165-5.
A 75-year-old patient was hospitalized for angina pectoris and tachycardia. Neither ECG nor laboratory examinations were diagnostic for myocardial infarction. Because of an abdominal thrill and a history of an aortic aneurysm a thoracic and abdominal CT scan was performed. It revealed a rupture of the infrarenal aortic aneurysm into the inferior vena cava. In an emergency operation the aortocaval fistula was closed and the infrarenal aorta including both Aa. iliacae was replaced by a prosthesis. The patient recovered rapidly and was discharged home on the 11th postoperative day.
Aortocaval fistulas are rare complications of abdominal aortic aneurysms. Due to altered hemodynamics they may become manifest by symptoms usually typical for other diseases. Computed tomography appears to be the most rapid and safe diagnostic measure. Particularly in patients with unstable hemodynamics, surgical transaneurysmatic closure of the fistula together with a prosthetic replacement of the diseased vessel is the therapy of choice.
一名75岁患者因心绞痛和心动过速住院。心电图和实验室检查均未诊断出心肌梗死。由于腹部有震颤且有主动脉瘤病史，遂进行了胸部和腹部CT扫描。结果显示肾下腹主动脉瘤破裂入下腔静脉。在急诊手术中，关闭了主动脉腔静脉瘘，并用假体替换了包括双侧髂动脉在内的肾下腹主动脉。患者恢复迅速，术后第11天出院。
主动脉腔静脉瘘是腹主动脉瘤的罕见并发症。由于血流动力学改变，它们可能表现出通常为其他疾病所特有的症状。计算机断层扫描似乎是最快速、安全的诊断方法。特别是对于血流动力学不稳定的患者，经动脉瘤手术闭合瘘管并同时用假体置换病变血管是首选的治疗方法。
