Salo J A, Verkkala K A, Ala-Kulju K V, Heikkinen L O, Luosto R V
Department of Thoracic and Cardiovascular Surgery, Helsinki University Central Hospital, Finland.
J Vasc Surg. 1990 Jul;12(1):41-4.
During a period of 13 years 11 patients were operated on because of a spontaneous aortocaval fistula caused by a ruptured abdominal aortic aneurysm. The classic diagnostic signs of an aortocaval fistula (pulsatile abdominal mass with bruit and high output heart failure) were present in approximately half of the patients, whereas hematuria was a constant finding in all patients. Six patients had macrohematuria, and five had microhematuria. Seven patients (64% survived, and four had postoperative complications: 1 ileus, 2 postoperative pneumonias, 2 deep venous thrombosis, 1 postoperative hemorrhage. The mean operative blood loss was 7 L. After operation the average follow-up time was 4 years. In four patients who died the perioperative (within 30 days) causes of death were renal failure, a bleeding duodenal carcinoma, myocardial infarction, and operative bleeding. It is concluded that hematuria is a more frequent finding than earlier assumed among patients whose abdominal aortic aneurysm has ruptured into the vena cava. The presence of hematuria in a patient suffering from an abdominal aortic aneurysm is an indication for aortography to rule out an aortocaval fistula.
在13年的时间里，有11例患者因腹主动脉瘤破裂导致的自发性主动脉腔静脉瘘接受了手术。大约一半的患者出现了主动脉腔静脉瘘的典型诊断体征（搏动性腹部肿块伴杂音和高输出量心力衰竭），而血尿是所有患者的常见表现。6例患者出现肉眼血尿，5例患者出现镜下血尿。7例患者（64%）存活，4例患者出现术后并发症：1例肠梗阻、2例术后肺炎、2例深静脉血栓形成、1例术后出血。平均手术失血量为7升。术后平均随访时间为4年。4例死亡患者围手术期（30天内）的死亡原因分别为肾衰竭、十二指肠癌出血、心肌梗死和手术出血。结论是，在腹主动脉瘤破裂进入腔静脉的患者中，血尿的发生率比之前认为的更高。腹主动脉瘤患者出现血尿提示应进行主动脉造影以排除主动脉腔静脉瘘。
