Marcelletti C, Astolfi D, Pinto F D, Eusanio G D, Ferrini L, Salvolini U
J Cardiovasc Surg (Torino). 1977 Mar-Apr;18(2):137-40.
A fistula located between the abdominal aorta and the inferior vena cava is an unusual acquired condition which necessitates prompt diagnosis and, in most instances, emergency surgical repair. The signs and symptoms are related to the size of the shunt. The classical findings are those of a continuous abdominal bruit, edema and venous pooling of the legs, wide pulse pressure, and sudden progressive high-output cardiac failure. Aortography is the definitive diagnostic procedure. However it is impractical in those situations presenting an asymptomatic fistula and contraindicated in presence of signs of progressive renal failure, where emergency surgical treatment is required. In these instances aorta-caval fistula can be correctly diagnosed by means of radionuclide aortography. The fistula can usually be repaired from within the aneurysm after endoarterectomy. Then the aortic graft replacement is completed. In rare cases the pathology at operation is such that this type of repair cannot be performed and an unexpected replacement of the inferior vena cava may be required. The purpose of this paper is to present the description of a patient in whom the diagnosis of aorta-caval fistula was confirmed by means of an isotope angiogram, followed by a successful surgical graft replacement of the abdominal aorta and a dacron tubular graft replacement of the inferior vena cava.
腹主动脉与下腔静脉之间的瘘是一种罕见的后天性疾病，需要及时诊断，在大多数情况下还需要进行急诊手术修复。其体征和症状与分流的大小有关。典型表现为持续性腹部杂音、下肢水肿和静脉淤血、脉压增宽以及突发性进行性高输出量心力衰竭。主动脉造影是确诊的诊断方法。然而，对于无症状瘘的情况，主动脉造影并不实用；对于存在进行性肾衰竭体征且需要急诊手术治疗的患者，主动脉造影则属禁忌。在这些情况下，放射性核素主动脉造影可正确诊断主动脉 - 腔静脉瘘。通常在动脉内膜切除术后，可从动脉瘤内部修复瘘。然后完成主动脉移植物置换。在极少数情况下，手术中的病理情况使得无法进行此类修复，可能需要意外地置换下腔静脉。本文的目的是介绍一名患者，通过同位素血管造影确诊为主动脉 - 腔静脉瘘，随后成功进行了腹主动脉手术移植物置换和下腔静脉涤纶管状移植物置换。
