Imagami Toru, Sakamoto Masaki, Kani Hisanori, Tadakoshi Masao
Department of Surgery, Nagoya Tokushukai General Hospital, Kasugai City, Japan.
Department of Surgery, Nagoya Tokushukai General Hospital, Kasugai City, Japan.
Int J Surg Case Rep. 2020;77:580-583. doi: 10.1016/j.ijscr.2020.11.087. Epub 2020 Nov 19.
Various collateral pathways maintain blood flow to the lower extremities in patients with Leriche syndrome. The occurrence of true aneurysms in the lumbar artery-a component of an extensive collateral circulation network in patients with Leriche syndrome-is extremely rare.
A 73-year-old man with Leriche syndrome was diagnosed with lumbar artery aneurysm complicated by a duodenal fistula. The patient underwent endovascular repair, surgical duodenal fistula closure, and debridement of the aneurysm wall until coil exposure.
With the same mechanism, patients with aortic occlusive disease may develop an aneurysm and arterio-enteric fistula in the collateral circulation. Combination of treatments may be important for hemostasis, control of infection, and maintaining adequate distal perfusion.
Endovascular embolization can control bleeding as well as serve as a landmark for the debridement of contaminated aneurysm. Surgical fistula closure and aneurysm-wall debridement are useful for control of local infection.
在勒里什综合征患者中，多种侧支循环途径维持下肢血流。勒里什综合征患者广泛侧支循环网络的组成部分——腰动脉真性动脉瘤的发生极为罕见。
一名73岁的勒里什综合征男性患者被诊断为腰动脉瘤并发十二指肠瘘。患者接受了血管内修复、十二指肠瘘手术闭合以及动脉瘤壁清创直至线圈暴露。
基于相同机制，主动脉闭塞性疾病患者的侧支循环中可能出现动脉瘤和动脉肠瘘。联合治疗对于止血、控制感染以及维持足够的远端灌注可能很重要。
血管内栓塞可控制出血，并可作为污染性动脉瘤清创的标志。手术闭合瘘管和清创动脉瘤壁有助于控制局部感染。
