Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
Clinic for Vascular and Endovascular Surgery, University Clinical Center of Serbia, Belgrade, Serbia.
Int Angiol. 2024 Aug;43(4):394-403. doi: 10.23736/S0392-9590.24.05221-0. Epub 2024 Sep 9.
The purpose of this paper is to examine and assess the outcomes following open repair in 39 patients who experienced aorto-caval fistula (ACF) resulting from the spontaneous rupture of an abdominal aortic aneurysm (AAA).
We reviewed the clinical records of all patients surgically treated with open repair for ACF at the Clinic for Vascular and Endovascular Surgery of the Serbian Clinical Center in Belgrade, Serbia, from January 2012 to February 2023. All of the patients in this series were consecutive and had aorto-caval fistula from AAA. No patients were excluded from the procedure due to the life-threatening nature of the state. A follow-up assessment was performed during the follow-up examination or by telephone interview with the patient or a family member.
All patients were male, with mean age 67.4±8.3 years (range: 52-83 years). The 30-day mortality rate in our cohort was 35.9%, with three (7.7%) intraoperative deaths, and 11 deaths in the postoperative period (28.2%). A total of 25 patients out of 39 (64.1%) in the original cohort have survived the surgery and the postoperative period and were followed-up for a total of 67.1 person-years. The mean follow-up was 3.7±2.2 years (range 0.25-8.4 years). Two patients (8.0%) died during the follow-up, 16 patients (64.0%) survived, and seven (28.0%) were lost to follow-up. The long-term mortality rate in the cohort that survived the postoperative period was 3.0/100 person-years.
ACF caused by spontaneous AAA rupture into the inferior caval vein or iliac veins is a relatively rare, life-threatening condition which requires prompt treatment. An exact preoperative diagnosis is essential for perioperative strategy. As the comparison of our results with the results from contemporary literature indicates, wherever possible endovascular repair should be considered since it results might be superior to open repair.
本文旨在检查和评估 39 例因腹主动脉瘤（AAA）自发性破裂导致腔静脉或髂静脉腔静脉瘘（ACF）而行开放修复患者的结局。
我们回顾了塞尔维亚贝尔格莱德临床中心血管和血管外科学诊所 2012 年 1 月至 2023 年 2 月期间接受开放修复治疗 ACF 的所有患者的临床记录。本系列中的所有患者均为 AAA 所致 ACF 的连续患者。由于病情危及生命，没有患者因该手术而被排除在外。在随访检查期间或通过电话采访患者或其家属进行随访评估。
所有患者均为男性，平均年龄 67.4±8.3 岁（范围：52-83 岁）。我们队列的 30 天死亡率为 35.9%，其中 3 例（7.7%）术中死亡，11 例（28.2%）术后死亡。39 例患者中有 25 例（64.1%）在原始队列中存活手术和术后，并随访了 67.1 人年。平均随访时间为 3.7±2.2 年（范围 0.25-8.4 年）。2 例（8.0%）患者在随访期间死亡，16 例（64.0%）患者存活，7 例（28.0%）患者失访。存活术后患者的长期死亡率为 3.0/100 人年。
自发性 AAA 破裂进入下腔静脉或髂静脉引起的 ACF 是一种相对罕见的、危及生命的疾病，需要及时治疗。准确的术前诊断对于围手术期策略至关重要。正如我们的结果与当代文献的结果比较所示，只要可能，应考虑血管内修复，因为其结果可能优于开放修复。
