Ingoldby C J, Case W G, Primrose J N
Department of Surgery, St James's University Hospital, Leeds.
Ann R Coll Surg Engl. 1990 Sep;72(5):335-8; discussion 338-9.
Six cases of acute aortocaval fistula are reported, which illustrate the difficulties of diagnosis and management in a rare life-threatening condition. Five cases arose from spontaneous rupture of aortic aneurysms and one from trauma. In four cases the diagnosis was made before surgery. Useful diagnostic features included inappropriate jugular venous distension in five patients, lower abdominal and trunk cyanosis in three patients and a palpable thrill in three patients. Preoperative diagnosis permitted attempts to control venous haemorrhage in three cases, one by balloons through the aortic sac and two by transvenous positioning of balloon catheters in the vena cava before aortic opening. The use of transvenous balloon catheters was found to be helpful in reducing haemorrhage. Four patients left hospital alive. Preoperative recognition of the signs of an acute aortocaval rupture and preliminary balloon tamponade appear to be valuable in the management of acute aortocaval fistulas.
本文报告了6例急性主动脉腔静脉瘘病例，这些病例说明了这种罕见的危及生命状况在诊断和治疗上的困难。5例由主动脉瘤自发性破裂引起，1例由外伤引起。4例在手术前确诊。有用的诊断特征包括5例患者出现不适当的颈静脉扩张，3例患者出现下腹部和躯干发绀，3例患者可触及震颤。术前诊断使3例患者得以尝试控制静脉出血，1例通过经主动脉囊置入球囊，2例在打开主动脉前经静脉将球囊导管置入腔静脉。发现使用经静脉球囊导管有助于减少出血。4例患者出院时存活。术前识别急性主动脉腔静脉破裂的体征并进行初步球囊压迫，在急性主动脉腔静脉瘘的治疗中似乎很有价值。
