Weyrich G, Beck A
Department of Diagnostic Radiology, University Hospital of Freiburg, FRG.
Radiat Med. 1990 Nov-Dec;8(6):215-8.
Traumatic iliac arteriovenous fistulas (AVFs) are extremely rare, with only two cases reported in literature involving the internal iliac artery and the external iliac vein. We report the case of a 23-year-old man who sustained a gunshot injury to the left lower quadrant of his abdomen and subsequently developed unilateral leg edema of "elephantiasic proportions." Intra-arterial digital subtraction angiography six years later was essential for diagnosis and comprehension of the pathomechanism. The angiographic examination showed an internal iliac false aneurysm, as well as a high-flow arteriovenous communication between the left internal iliac artery and external iliac vein complicated by thrombotic occlusion of the left common iliac vein. The initial vascular injury and the surgical management of simple ligation were thought to be responsible for the iliac AVF and the subsequent thrombosis of the common iliac vein. On the one hand, the thrombotic occlusion of proximal vein led to a sharp increase of mean pressure in the proximal and distal arteries and in the distal vein, resulting in chronic venous insufficiency with incompetent varicose veins. On the other hand, the restriction of venous outflow produced extreme peripheral edema and large superficial veins serving as collaterals to bypass the fistula. Vascular surgery could repair the lesion by closing and bypassing the AVF.
创伤性髂动静脉瘘（AVF）极为罕见，文献中仅报道过两例涉及髂内动脉和髂外静脉的病例。我们报告了一名23岁男性的病例，他腹部左下腹遭受枪伤，随后出现了“象皮肿样”的单侧腿部水肿。六年后的动脉内数字减影血管造影对于诊断和理解发病机制至关重要。血管造影检查显示髂内假性动脉瘤，以及左髂内动脉与髂外静脉之间的高流量动静脉交通，并伴有左髂总静脉血栓形成。最初的血管损伤以及单纯结扎的手术处理被认为是导致髂动静脉瘘和随后髂总静脉血栓形成的原因。一方面，近端静脉的血栓形成导致近端和远端动脉以及远端静脉的平均压力急剧升高，从而导致慢性静脉功能不全伴静脉曲张功能不全。另一方面，静脉流出受限导致极度外周水肿和作为绕过瘘管的侧支的大浅静脉。血管手术可以通过闭合和绕过动静脉瘘来修复病变。
