Houdek K, Moláček J, Třeška V
Rozhl Chir. 2020 Spring;99(5):236-238. doi: 10.33699/PIS.2019.98.5.236-238.
Aorto-caval fistula can be associated with abdominal aortic aneurysm. The fistula can manifest with nonspecific symptoms. The rupture of abdominal aortic aneurysm is one of the leading symptoms. The symptoms and the necessity of treatment are related to these acute conditions. This article describes the case of a 78 years old man with a huge abdominal aortic aneurysm and aorto-caval fistula that was presented with a sudden onset of abdominal pain, dyspnoea, hypotension and cardiac insufficiency with an acute cor pulmonale. Urgent surgery was performed - aneurysm resection with transaortic suture of the fistula and aortic replacement using a Dacron graft. Resuscitation and defibrillation were needed during the surgery due to fibrillation cardiac arrest, which were successful. The post-operative period was complicated with a persisting consciousness disorder of the patient and persisting myocardial ischaemia, resulting in the patients death 3 weeks after the surgery. The aim of this report is to point out the severity of this condition, the various treatment options of this uncommon disease with an uncertain prognosis, and also the importance of a multidisciplinary approach, essential in the entire treatment process as well as in the primary diagnosis.
主动脉腔静脉瘘可与腹主动脉瘤相关。该瘘可表现为非特异性症状。腹主动脉瘤破裂是主要症状之一。症状及治疗的必要性与这些急症相关。本文描述了一名78岁男性病例，其患有巨大腹主动脉瘤和主动脉腔静脉瘘，表现为突发腹痛、呼吸困难、低血压及急性肺心病伴心功能不全。进行了急诊手术——动脉瘤切除、经主动脉缝合瘘口并使用涤纶补片置换主动脉。手术期间因房颤心脏骤停需要进行复苏和除颤，且获得成功。术后患者出现持续意识障碍和持续心肌缺血，导致患者在术后3周死亡。本报告的目的是指出这种疾病的严重性、这种预后不确定的罕见疾病的各种治疗选择，以及多学科方法的重要性，这在整个治疗过程以及初步诊断中都至关重要。
