Salo J A, Verkkala K, Ketonen P, Perhoniemi V, Harjola P T
J Cardiovasc Surg (Torino). 1987 Mar-Apr;28(2):180-3.
The diagnostic features and operative results of six patients with spontaneous aorto-caval fistula associated with abdominal aortic aneurysm were analyzed. Abdominal pain, pulsatile abdominal mass and haematuria were constant preoperative findings in all patients. Radiological signs of congestive heart failure of various degrees were present in five, abdominal bruit in four and preoperative renal failure in three patients. As preoperative diagnostic examinations i.v. pyelography was done in two patients and ultrasound scanning and angiography of the abdominal aorta in a further two patients. In one ultrasound scanning a dilated inferior vena cava and hepatic veins were seen as an indirect sign of ACF, while in both angiograms the ACF was seen. In these two cases the diagnosis of ACF was made preoperatively, while in four other cases the diagnosis was made during the operation. Three patients survived the operation and were still alive after eight months, four years and six years respectively. Postoperative complications developed in two patients: postoperative ileus in one and deep venous thrombosis and pneumonia in another. Because of its rarity aorto-caval fistula is difficult to diagnose. The presence of haematuria in a patient suffering from abdominal aortic aneurysm should strongly suggest the diagnosis of an aorto-caval fistula.
分析了6例与腹主动脉瘤相关的自发性主动脉腔静脉瘘患者的诊断特征和手术结果。腹痛、搏动性腹部肿块和血尿是所有患者术前的常见表现。5例患者有不同程度充血性心力衰竭的影像学表现，4例有腹部杂音，3例术前有肾衰竭。作为术前诊断检查，2例患者进行了静脉肾盂造影，另外2例患者进行了腹部主动脉超声扫描和血管造影。1例超声扫描显示下腔静脉和肝静脉扩张，作为ACF的间接征象，而在2例血管造影中均可见ACF。这2例患者术前诊断为ACF，另外4例患者在手术中诊断。3例患者术后存活，分别在8个月、4年和6年后仍存活。2例患者出现术后并发症：1例发生术后肠梗阻，另1例发生深静脉血栓形成和肺炎。由于主动脉腔静脉瘘罕见，难以诊断。腹主动脉瘤患者出现血尿应强烈提示主动脉腔静脉瘘的诊断。
