Cinara I S, Davidovic L B, Kostic D M, Cvetkovic S D, Jakovljevic N S, Koncar I B
Institute for Cardiovascular Diseases of the Serbian Clinical Centre, Belgrade, Serbia and Montenegro.
Acta Chir Belg. 2005 Nov-Dec;105(6):616-20. doi: 10.1080/00015458.2005.11679788.
The operative treatment of 26 aorto-caval fistulas during the last 18 years is reviewed (24 male and two female patients; average of 65.3 year). Out of 1698 cases presenting an abdominal aortic aneurysm, 406 presented with rupture, and 26 had aorto caval fistula. In 24 cases (92.3%) it concerned an atherosclerotic aneurysm. One aneurysm with aorto-caval fistula was secondary to abdominal blunt trauma (3.8%), and one due to iatrogenic injury (3.8%). The time interval between first clinical signs of aorto-caval fistula and diagnosis, ranged from 6 hours to 2 years (average 57,3 days). Clinical presentation included congestive heart failure infive patients (11.5%), extreme leg edema in 13 (50.0%), hematuria in 2 (7.0%), renal insufficiency 2 (7.0%), and scrotal edema in six patients. Diagnosis was made by means of color duplex scan in eight patients (30.7%), CT in seven patients (27%), NMR in three patients (11.5%), and angiography in seven patients (27%). Most reliable physical sign was an abdominal bruit,present in 20 patients (77%). In ten patients (38.4%) correct diagnosis was not made prior to surgery. The operative treatment consisted of transaortic suture of the vena cava (25 pts-96.0%), and aneurysm repair. Five operative deaths occurred (19,2%), and for all of them it concerned a misdiagnosis. Cause of death was myocardial infarction (one patient-3.8%), massive bleeding (one patient-3.8%), MOF (two patients-7, 0%), and colon gangrene (one patient-3.8%). Follow-up period varied from six months to 18 years (mean 4 years and two months). Long term results showed a 96% patency rate. No postoperative lower extremity venous insufficiency nor pelvic venous hypertension was observed post-operatively.
回顾过去18年中26例主-腔静脉瘘的手术治疗情况（24例男性患者和2例女性患者；平均年龄65.3岁）。在1698例腹主动脉瘤患者中，406例出现破裂，其中26例发生主-腔静脉瘘。24例（92.3%）与动脉粥样硬化性动脉瘤有关。1例主-腔静脉瘘的动脉瘤继发于腹部钝性创伤（3.8%），1例由于医源性损伤（3.8%）。主-腔静脉瘘的首发临床症状至诊断的时间间隔为6小时至2年（平均57.3天）。临床表现包括5例患者（11.5%）出现充血性心力衰竭，13例（50.0%）出现极度下肢水肿，2例（7.0%）出现血尿，2例（7.0%）出现肾功能不全，6例患者出现阴囊水肿。8例患者（30.7%）通过彩色双功超声扫描确诊，7例患者（27%）通过CT确诊，3例患者（11.5%）通过核磁共振确诊，7例患者（27%）通过血管造影确诊。最可靠的体征是腹部杂音，20例患者（77%）出现该体征。10例患者（38.4%）在手术前未做出正确诊断。手术治疗包括经主动脉缝合腔静脉（25例-96.0%）和修复动脉瘤。发生了5例手术死亡（19.2%），所有死亡均与误诊有关。死亡原因是心肌梗死（1例患者-3.8%）、大出血（1例患者-3.8%）、多器官功能衰竭（2例患者-7.0%）和结肠坏疽（1例患者-3.8%）。随访期从6个月至18年不等（平均4年零2个月）。长期结果显示通畅率为96%。术后未观察到下肢静脉功能不全或盆腔静脉高压。
